Gender affirming surgery, also called gender confirmation surgery or sex reassignment surgery, is an important part of transition for some people. At the Washington University Transgender Center at St. Louis Children’s Hospital, we offer gender affirming surgery to youth 18 years and older. 
We know choosing surgery is a big decision, and we’re committed to a shared decision-making process. We work with each patient to determine whether gender affirming surgery meets their needs and preferences. We also discuss what types of surgery are right for them. Our surgical options offer a lot of flexibility.

Transmasculine (or Female to Male) Surgery

We offer a variety of surgical options for young transgender men and others assigned female at birth whose bodies don’t line up with their gender identity. Our team will go over all of these options with you:

  • Phalloplasty (a type of bottom surgery): Creation of a penis using tissue from other parts of the body. 
  • Metoidioplasty (a type of bottom surgery): Creation of a penis from the clitoris after hormone therapy has enlarged the clitoris.
  • Chest masculinization (top surgery): Removal of excess chest tissue and reconstruction of a more masculine chest contour.
  • Hysterectomy and oophorectomy: Removal of the uterus and ovaries. 
  • Vaginectomy: Removal of the vagina and closure of the vaginal opening.
  • Facial masculinization: A variety of cosmetic procedures to make the face look more male, including forehead lengthening, cheek augmentation and jaw recontouring. 

Transfeminine (or Male to Female) Surgery 

We offer a variety of surgical options for young transgender women and others assigned male at birth whose bodies don’t line up with their gender identity. Our team will go over all of these options with you:

  • Vaginoplasty (bottom surgery): Removal of the penis and testicles, followed by creation of a vagina, clitoris and labia from penile tissue. 
  • Breast augmentation: Insertion of breast implants. 
  • Body contouring: Creation of curves by adding fatty tissue to the hips and buttocks
  • Facial feminization: A variety of treatments including laser hair removal; reduction of the Adam’s apple; brow lift; and reshaping of the nose, cheeks or jaw. 

What to Expect Before Gender Affirming Surgery

  • During an initial evaluation at the Transgender Center, we discuss each patient’s medical and gender history, and all the options available to them. 
  • For patients who see surgery as part of their transition, we’ll help to set up an appointment with a surgeon. The surgeon will discuss short-term and long-term goals, and go over the risks, benefits and expected results of the procedure(s) you have chosen. 
  • Before surgery, your insurance company may require six months or more of hormone therapy and letters of support from two mental health providers. Some insurance plans require patients to be at least 18 before having gender affirming surgery.
  • We encourage patients to talk about fertility preservation with our team. To preserve their fertility, many of our patients choose to freeze their eggs or bank their sperm before having gender affirmation hormones or surgery. We work to create a plan that works for each person. 

What to Expect After Gender Affirming Surgery 

  • Recovery time varies depending on the procedure. Your surgeon will provide post-surgical instructions and schedule a follow-up visit. 
  • As with most surgeries, there will be scars. However, your surgeon will do whatever is possible to minimize scars. 
  • Our team will work with you to develop a long-term health plan.
  • After recovering from gender affirming surgery, some patients want to change their legal name. If this is something you want, we’ll be happy to share resources that can help with this process.

Is Gender Affirming Surgery the Right Choice?  

There’s no right or wrong answer to this question. Some people see gender affirming surgery as part of their gender journey; some don’t. Either way, making a decision does require careful preparation, research and comprehensive mental health support. 

Why Choose St. Louis Children’s Hospital for Gender Affirming Surgery

Care for the whole person: We’re committed to developing a plan tailored to each patient’s needs and goals. We don’t just examine the body — we consider social concerns, family dynamics and overall health. 

Internationally recognized standards: With each surgical procedure, we follow the World Professional Association of Transgender Health guidelines.
A wealth of resources: For patients who want to change their name or gender markers after surgery, we can offer resources to help with that process. We can also point you toward a variety of support groups and other local resources that can connect you to the LGBTQ+ community in St. Louis and beyond.