gender reassignment surgery in pakistan

28,000 people have applied for ‘gender reassignment surgery’ in the last 3 years in Pakistan

According to reports, the Ministry of Interior has recently received numerous applications from people seeking gender reassignment surgery . The Ministry has submitted the details of applications received to the Senate for approval.

As per details, 28,723 individuals have applied for gender reassignment surgery during the incumbent government’s rule.

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Speaking to a media outlet, the interior ministry spokesperson shared why people request a sex change surgery. He said:

Citizens apply for gender reassignment due to medical reasons.

Summary of Data from 2018 to 2021

According to data provided by trusted sources, several men and women have sought approval for gender reassignment surgery from 2018 to 2021. A total of 16,530 men applied for gender reassignment (from men to women), while 12,154 women sought gender reassignment (from women to men). It should be noted that nine men applied for gender reassignment (from men to transgender), 21 transgender people requested gender reassignment (from transgender to men), and nine transgender people wanted gender reassignment (from transgender to women).

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Phalloplasty

Phalloplasty  / FTM Bottom Surgery in Bangkok, Thailand

          Female to male gender affirmation surgery changes the appearance of female genitals to that of a male's. This has a profound and confirming effect on trans men as they are able to have the body that they were meant to have: Can urinate standing up and can achieve erections with many procedures, will no longer have a vagina, and if a hysterectomy is performed, will also no longer menstruate.

           There are two main methods for creating a new penis. These include changing the clitoris into a penis or using a skin flap from the patient's forearm or thigh to create a penis. A person will typically have taken male hormones for at least a year before undergoing either type of surgery. During the procedure, the surgeon also removes the vagina in a vaginectomy, and a hysterectomy is often performed at the same time.

           Phalloplasty is a surgical procedure in which a penis is created. During the procedure, surgeons take one or more "flaps" of skin and other tissues from a donor site on the body, such as the arms, thighs, or abdomen, and use them to form a penis and urethra.

Phalloplasty in Female-to-Male Gender Confirmation Surgery

 A good Candidate for phalloplasty should have qualities as follow:

1. The patient must be at least 20 years of age. Consent from parents or legal guardians is required to complete the surgery for minors under 20 years old. 2. The patient must have continuously taken male hormone for at least one year. 3. The patient must have lived a life as a man for at least one year. 4. The patient must have undergone a psychiatric evaluation and been declared mentally stable and fit by a psychiatrist. 5. The patient must be physically fit. 6. The patient must have undergone mastectomy and total hysterectomy-oophorectomy for at least six months prior to phalloplasty.

Since 1997 Dr Kamol has performed over 10,000 procedures on transgender patients and over 5,000 sex reassignment surgeries (SRS). Recognized and respected throughout the medical community as one of the most experienced surgeons working in gender reassignment surgery in the world Dr. Kamol currently performs more than 500 male-to-female sex reassignment surgeries each year. He is the chief plastic surgeon at Kamol Cosmetic Hospital in Bangkok, Thailand where he leads the team in male-to-female and female-to-male sex transitions and face feminization. 

See more Dr. Kamol Profile

Benefits of Phalloplasty include:

• Patients are more likely to be able to sexually penetrate their partners.
• The phallus is significantly larger than those created through metoidioplasty although sensation is significantly lower.
• People feel that this surgery creates more natural-looking genitalia.

Phalloplasty Techniques

Kamol Cosmetic Hospital offers the options for phalloplasty as the follows:

1. Anterolateral thigh pedicle flap (ALT-Phalloplasty)

This is the primary option for phalloplasty in Kamol Hospital.

Due to the individual desire variation, we offer the surgical options for ALT-phalloplasty as follows;

• Full phalloplasty with urethral lengthening: the process starts with prefabricating the urethra The surgery is a two-stage technique with the urethral prefabrication and total vaginectomy for at least 6 months before ALT-flap phalloplasty. The skin with its pedicle containing nerves and vessels from the front and outer part of the thigh is used to reconstruct the new penis. The urethra and sensory nerves are anastomosed at once.
• Phalloplasty with metoidioplasty: in case of metoidioplasty was done earlier, the new ALT-phalloplasty can be done on top of the micropenis. The sensory nerves are shared with the micropenis and the ALT penis. The patient can be standing to urinate through the micropenis at the base of the ALT penis. With this technique, the patient does not take a chance on urethral issues such as urethral stricture or urethral fistula.
• Phalloplasty without the urethral lengthening: this is the most simple phalloplasty without urination concerns. The surgical scar is at the bottom of the penis and the patient urinates through the original urethra
• This is a non-vessel anastomosis technique, thus the risks of vascular thrombosis are very low

Donor skin preparation and the options for the ALT phalloplasty;

•  The patient should have hair removal at the front and side of the thighs to avoid the hair growing at the shaft of the new penis.
• The thigh skin thickness must be thin to avoid an oversize penis. Skin fold at the mid-front thigh must be less than 1.5 cm. In case of the thick thigh skin, the patient needs to lose weight, exercise, or have liposuction before surgery.
• The donor site at the thigh is covered with a split-thickness skin graft from the adjacent area.
• In case of avoiding the skin graft, the patient may have the pre-expanded ALT-phalloplasty with the tissue expansion technique. In this technique, the patient needs to stay 1-2 months for the thigh skin expansion before the flap surgery.
• The vaginectomy, hysterectomy, and oophorectomy must be done at least 6 months before the penile reconstruction.
• van der Sluis WB., Ronkes BL., Steensma TD., Al-Tamimi M., van Moorselaar., Bouman BM., Pigot Garry LS.  Comparison of surgical outcomes and urinary functioning after phalloplasty with versus without urethral lengthening in transgender men. Int J Trans health. https://doi.org/10.1080/26895269.2022.2110548
• Colebunders SD., Stillaert F., Monstrey S. Pre-expanded Anterolateral Thigh Perforator Flap for Phalloplasty. Clin Plast Surg. 44(1):129-141. https://doi.org/10.1016/j.cps.2016.08.004

Advantages of ALT Phalloplasty:

• Good skin color match
• Larger girth than RFF Phalloplasty
• Some natural rigidity
• Less obvious donor site, concealable with clothing
• Decreased surgical time with Pedicled ALT
• Good sensation
• Good potential for urethroplasty

Disadvantages of ALT Phalloplasty:

• More difficult in patients with thicker skin and more subcutaneous thigh fat
• In some patients, girth can be excessive
• Less predictable perforator layout adds complexity
• Sensation is reportedly less than RFF Phalloplasty

Picture 1: ALT-Pedicle Flap

Picture 2:ALT phalloplasty creation

How to prepare ALT donor site?

1. Mark site at the non dominant Thigh 15x18 cm as shown in the video clip.

2. Hair Removal at this area, 

3. Check the quality of skin, make sure the skin pinch should be less than 1.5-1.8 cm. In case of over thickness, the patient can do liposuction then wait for 6 months to one year to make skin softer. We can create phalloplasty. If the patients need to do urethral prefabrication, they can do it a few months after liposuction .  If the patient does not need urethral with phalloplasty, after preparing donor site, they can do phalloplasty. After 1-2 years after phalloplasty, they can do implant. 

Picture 3:How to prepare ALT donor site

ALT Phalloplasty Without Urethral Integration:

Phalloplasty, also known as male genital reconstruction surgery, is a surgical procedure that aims to reconstruct or construct a functional and aesthetically pleasing penis for individuals who were born with ambiguous genitalia, have suffered from traumatic injuries, or have undergone gender reassignment surgery.

“The standard phalloplasty procedure typically involves the creation of a neophallus (artificial penis) and the integration of a urethra, allowing for urinary function. However, some individuals may choose to undergo a variation of this procedure known as "ALT Phalloplasty Without Urethral Integration." 

What is ALT Phalloplasty Without Urethral Integration?

ALT Phalloplasty Without Urethral Integration is a type of phalloplasty procedure that involves the creation of a neophallus without the integration of a urethra. This means that the individual will not have the ability to urinate through the neophallus and will instead need to use alternative methods such as a urinary catheter or stoma bag. This type of phalloplasty is typically recommended for individuals who have medical conditions that make it difficult to connect the urethra to the neophallus or for those who are not interested in undergoing urethral integration.

How is ALT Phalloplasty Without Urethral Integration performed?

The ALT Phalloplasty Without Urethral Integration procedure typically involves the following steps:

Anesthesia: Before the procedure, the patient is given general anesthesia to ensure that they are completely unconscious and pain-free during the surgery.

Donor Site Selection: The surgeon will select a donor site for the tissue that will be used to construct the neophallus. This can be taken from the patient's own body (autograft) or from a donated source (allograft).

Tissue Harvesting: The selected tissue is then harvested and prepared for use in the construction of the neophallus.

Neophallus Creation: The surgeon will then use the harvested tissue to construct the neophallus, taking care to shape it in a manner that resembles a natural penis.

Closure: After the neophallus has been constructed, the incisions are closed and the patient is moved to the recovery room.

Benefits of ALT Phalloplasty Without Urethral Integration

There are several benefits to undergoing ALT Phalloplasty Without Urethral Integration, including:

Improved Aesthetic Appearance: The neophallus constructed during this procedure can be shaped to resemble a natural penis, improving the individual's overall appearance and increasing their confidence.

Lower Risk of Complications: By avoiding the integration of the urethra, there is a lower risk of complications such as urethral strictures or fistulas.

Shorter Recovery Time: The absence of urethral integration typically means a shorter recovery time, allowing the patient to return to normal activities more quickly.

ALT Phalloplasty Without Urethral Integration is a variation of the standard phalloplasty procedure that involves the creation of a neophallus without the integration of a urethra. This procedure is recommended for individuals with medical conditions that make it difficult to connect the urethra to the neophallus or for those who are not interested in undergoing urethral integration.

2. Alternate options of phalloplasty in Kamol hospital

       2.1   Radial forearm free flap (RFF): The skin at the front side of the forearm is used to reconstruct the new penis under the microsurgery technique.

Radial forearm free flap (RFF) technique:

We provide two techniques, as follows;

A. Two-stage technique: The two-stage radial forearm free flap technique involves urethral prefabrication prior to themain step (phalloplasty) for six months. This is suitable for those who have small size of forearm.

B. One-stage technique: The one-stage radial forearm free flap involves reconstruction of the neo penis and neo urethra in one stage under microsurgery technique.

Advantages of RFF:

• The skin in this area tends to be thinner.

Disadvantages of RFF:

• Donor site can be difficult to conceal.
• Partial skin graft loss
• Decreased sensitivity,
• Possible motion issues with the hand

Picture 2: Radial Forearm Free Flap

Picture 3: Radial Forearm Free Flap

       2.2   Fibula Free Flap (FFF):

The skin, nerves, and some parts of the fibula bone are used as the neophallus (penis) under the microsurgery technique.

Fibula free flap (FFF) technique:

The skin, a piece fibula bone, and nerves are used for the neo penis in one stage under microsurgery technique. The neo urethra is being pre-laminated in situ for six months prior to the main step of neo penis reconstruction.

Advantages of FFF:

• Length of the flap's blood supply
• Less prominent scarring;
• Natural rigidity for penetration with the use of the  fibula bone

Disadvantages of FFF:

• Rigid appearance of the phallus.
• Potential bone resorption
• Potential curving and fracture of autologous bone transplants

Picture 4: Fibula Free Flap

       2.3   Musculocutaneous Latissimus Dorsi (MLD) flap:

The skin island containing nerves and vessels is moved to the genital area to reconstruct the neo penis under the microsurgery technique.

Musculocutaneous Latissimus Dorsi (MLD) free flap technique:

The skin paddle contained nerves and vessels is moved from the area behind the arm to the genital area under the microsurgery technique to reconstruct the neo in the first stage. The neo urethra is constructed the second stage

Advantages of MLD:

●      Less conspicuous donor site.

●      Relatively hairless donor site

●      Good aesthetic outcomes.

●      Possibilities for penetrative sex.

Disadvantages of MLD:

●      Poor sensitivity of the phallus

●     Phallus can be large requiring additional debulking procedures

Picture 5: Musculocutaneous Latissimus Gorsi (MLD)

Urethral reconstruction of phalloplasty

Comparison of different phalloplasty techniques, preparation of phalloplasty.

           After a phalloplasty procedure, it is important for the patient to follow their surgeon's postoperative care instructions carefully in order to minimize the risk of complications and optimize the healing process. This may include taking medications as prescribed, keeping the incision site clean and dry, and avoiding strenuous activities. In some cases, physical therapy may be recommended to help improve the function of the newly constructed penis.

Risk and Complication

           1. Infection: As with any surgery, there is a risk of infection following a phalloplasty procedure. This can be serious and may require additional treatment, such as antibiotics.

           2. Bleeding: There is also a risk of bleeding during or after the surgery. In some cases, this may require a return to the operating room to control the bleeding.

           3. Scarring: Scarring is a common complication of phalloplasty. The extent of scarring will depend on the specific technique used and the patient's individual healing process.

           4. Problems with skin flaps: The skin flaps used to construct the penis during a phalloplasty procedure may not heal properly or may not have a satisfactory appearance. In some cases, additional surgery may be needed to correct these issues.

           5. Nerve and blood vessel damage: There is a risk of damage to the nerves and blood vessels in the area during a phalloplasty procedure. This can result in decreased sensitivity or impaired blood flow to the newly constructed penis.

           6. Failure to achieve desired results: It is important for patients to have realistic expectations about the outcome of a phalloplasty procedure. In some cases, the results may not be as expected, and additional surgery may be needed to achieve the desired outcome.

Getting to Know for Phalloplasty Surgery:

How to prepare for phalloplasty donor site

Preparing for phalloplasty donor site surgery is an important step in ensuring a successful procedure and a smooth recovery.

How to detransition from MTF to Male?

Detransitioning is the process of reversing a gender transition. In the case of MtF detransitioning, individuals who have undergone

Comparision between ALT and MLD phalloplasty

There are several techniques available for phalloplasty, including Anterolateral Thigh (ALT) Phalloplasty and Musculocutaneous Latissimus Dorsi (MLT) Flap Phalloplasty.

ALT Phalloplasty Reviews

Video: Testimonials of Phalloplasty

Why Kamol Cosmetic Hospital is popular for Phalloplasty?

              Kamol Hospital is a popular choice for phalloplasty surgery due to several reasons, including its expertise and experience, state-of-the-art facilities, comprehensive pre- and post-operative care, patient-centered approach, and reputation for excellence in gender affirmation surgeries

Expertise and Experience:

One of the key reasons why Kamol Hospital is popular for phalloplasty surgery is the expertise and experience of its surgical team. The hospital has a team of highly skilled and experienced surgeons who specialise in gender affirmation surgeries, including phalloplasty. They have performed numerous successful surgeries, and their expertise in this field is widely recognized.

State-of-the-art Facilities:

Another factor that makes Kamol Hospital popular for phalloplasty surgery is its state-of-the-art facilities. The hospital is equipped with modern and advanced surgical equipment and facilities that ensure the highest level of safety and quality of care for patients. The hospital also has advanced imaging technology to aid in surgical planning and patient education

Comprehensive Pre- and Post-operative Care:

Kamol Hospital provides comprehensive pre- and post-operative care to ensure that patients receive the best possible outcome and experience. Before surgery, patients undergo a thorough medical evaluation and counselling to ensure they are physically and mentally prepared for the surgery. After surgery, patients receive follow-up care, including counseling and support services, to aid in their recovery.

Patient-Centered Approach:

Kamol Hospital takes a patient-centered approach to care, meaning that they work closely with patients to understand their individual needs and preferences, and tailor the treatment plan accordingly. The hospital's staff is highly trained to provide compassionate care, and they prioritise patient comfort and satisfaction throughout the treatment process.

Reputation:

Kamol Hospital has built a reputation for excellence in gender affirmation surgeries, including phalloplasty. Many patients who have undergone surgery at Kamol Hospital have shared positive feedback and experiences, which has contributed to its popularity. The hospital's commitment to patient-centered care, state-of-the-art facilities, and experienced surgical team have earned it a reputation as a top choice for phalloplasty surgery.

Why Thailand is a plastic surgery destination?

               Thailand is a top destination for plastic and cosmetic surgery, as it is the high quality and specialist skills of the surgeons, they provide first-class hospital treatments, and the affordable cost all add up to a satisfying all-around package. There is also the added temptation to recover post-procedure in luxury hotels or recovery service apartments

Female to Male Surgery

• Top Surgery / Mastectomy 15 -->
• Facial Masculinization / FMS 15 -->
• FTM Hysterectomy 15 -->
• Metoidioplasty 15 -->
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• Pakistani woman seeks...

Pakistani woman seeks court approval for sex change to earn a living

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A 22 year old Pakistani woman has petitioned the Peshawar High Court for permission to have sex reassignment surgery so that she can work publicly and support her family.

Kainat Murad told The BMJ , “I want to work and earn a livelihood for my family. I have no brothers or sisters, and my parents, who cannot work, need my support.” She said that it was difficult to venture out in public and work as a woman in Pakistan’s male dominated society.

Her lawyer, Saifullah Muhib Kakakhel told The BMJ that his client had gender dysphoria and that she suffered from depression, anxiety, and insomnia. “Her father has been suffering from paralysis for over a decade, and she is unable to earn a livelihood as a woman,” he said.

Kakakhel said that violation of women’s rights was common in Pakistan and prevented the free movement of women. “It isn’t easy for a female to go freely from home to workplace,” he said.

In a written application to the high court, Murad said that she had been living as a boy or man since childhood, played sports with boys, and wore men’s clothes. She said that women were not safe at their workplace and were sexually harassed, humiliated, and exploited. It was her constitutional right to live the life of her choice and change her sex, she said.

According to Kakakhel, Murad was extremely poor and could not afford to pay for sex reassignment surgery. She has asked the court for her surgery to be carried out in a state run hospital free of cost.

Murad claimed that she was advised by doctors to approach the high court for permission to undergo the sex reassignment surgery to prevent legal complications.

Khalid Masud, director of the Lady Reading Hospital in Peshawar, told The BMJ that the hospital was ready to carry out the surgery if the court sanctioned it.

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Home Lahore First successful transgender operation at LGH

First successful transgender operation at LGH

For the first time in the history of Lahore General Hospital, Amara, a matriculation the student was made a boy after undergoing a unique operation.

Under the supervision of the Head of the Department Plastic Surgery Dr. Roomana Ikhlaq along with assistant professors Dr. Muhammad Nasrullah Dr. Muhammad Imran completed this gender reassignment procedure after performing a complicated but successful surgery of four hours, after which the parents changed her name to Ammar. The patient was discharged from the hospital after recovery.

Principal Ameer Uddin Medical College Prof. Dr. Sardar Muhammad Al-Freed Zafar while congratulating the doctors on the first successful transgender operation through plastic surgery at LGH said that it is practical proof of their professionalism and competence which is highly admirable and commendable.

Prof. Al-freed Zafar further said that the doctors and surgeons of PGMI/LGH are not less qualified and competent than the doctors of any world-class hospital and the General Hospital is equipped with all the latest medical equipment and facilities as well to provide the best surgery facilities to all the patients.

Talking to media in this regard, Dr. Roomana Akhlaq said that Amara underwent a complete medical examination on arrival at the hospital and after various diagnostic tests in the light of which it was decided to perform the operation which was successful.

Leading Gynecologist Prof. Al-freed Zafar while answering the questions of the media said that gender reassignment is not possible in Pakistan as a fashion.

Only when the boy or girl shows signs of the opposite sex, hormonal changes and other such issues in early childhood, then the doctors check up on the patient and determine whether the sex change of the said boy or girl is necessary and due.

He said that such gender reassignment operations are being carried out in Pakistan as per requirement but not as a fashion like other countries.

The family of Ammar thanked the doctors, nurses, and paramedics for taking better care of their patient and expressed their happiness over their daughter’s change of gender.

They told that right from childhood she was showing different signs like why and by the time she reached puberty, his face had begun to grow like a man’s, and a hormonal check-up was done, which was performed by doctors at the General Hospital, who undertook this complex operation.

After the sex change, Ammar said in his talk that he is thankful to Allah Almighty and the addition of a boy in our family is a reward from nature on which everyone is happy.

He said that after this successful operation his world has changed as girls at school used to make fun of boy’s voices while my hobby was riding motorcycles, playing cricket and other sports on which people were surprised. Now I have become a boy for which I am very happy.

These moments are nothing short of a miracle for me. Ammar’s mother said that such operations cost millions of rupees in the private sector but the administration and doctors of the LGH have provided the best medical facilities free of cost. Ammar expressed that he will fulfill the responsibility of his family.

On his recovery, Ammar marked victory and thanked the doctors, nurses and paramedics who treated him very well. Dr. Abdul Aziz, Dr. Saima Fatima, Mehwish Saeed, Navera Sharif, Humera Boota and other medical staff were present on this occasion.

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Gender reassignment surgery remains successful in Lahore

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LAHORE: A teen with indeterminate sex underwent successful gender-change surgery in Lahore to become a male, ARY News reported on Friday.

13-year-old Kinza, named Abdullah after the procedure, was operated by a specialist surgeon Dr Afzal Shaikh in Pakistan’s first-ever dedicated centre for treatment of indeterminate sex.

Kinza was provided free-of-cost treatment at the centre built in Aghaz Trust Hospital in Punjab’s provincial capital.

Talking about the case, Dr Shaikh said Kinza was diagnosed with indeterminate sex eight months ago.

“Abdullah will be kept under observation at the centre for some time,” Shaikh said.

Earlier in March 2018, a girl had approached the Islamabad High Court (IHC) and sought its permission to undergo sex-change surgery.

The girl, through her lawyer, submitted before a bench that she had been experiencing physical changes in her body and she was advised to undergo a gender reassignment surgery.

The petitioner had also prayed to direct the National Database and Registration Authority (Nadra) record and other government departments to change her gender in her identity documents.

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Deconstructing Transgender Identities in Pakistan, India, and Iran in Colonial and Post-colonial Context

• Thematic Section
• Published: 24 January 2020
• Volume 63 , pages 31–37, ( 2020 )

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• Mahso Gichki 1  

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This article examines rights-based mobilization amongst the transgender community in Pakistan, India, and Iran. It tackles the dominant discourse of Human Rights, which has always found its geographic epistemic in the Global North. Thus, it argues that understanding the rights of transgender people in a non - Western world requires tracing the etymological history of such rights language, which is embedded within a greater vernacular knowledge of rights influenced by its colonial past.

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Interrogating the Gaze of Normativity: A Study of Transgender Women in West Bengal

Transgender in a Global Frame

Traditional Genders, Modern Sexualities: Struggles over Sexual and Gender Nonconformity in Postcolonial India

Khawaja Saras (superintendents of the house) who were slave-nobles who worked in elite houses of Indian rules (Hinchy 2019 ). They used to serve as guards, administrators and even as military commanders and collected revenues from lands. They were considered as ‘eunuchs’ during the British era. Today, some transgender communities refer to themselves as Khawaja Saras as a politer term.

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Gichki, M. Deconstructing Transgender Identities in Pakistan, India, and Iran in Colonial and Post-colonial Context. Development 63 , 31–37 (2020). https://doi.org/10.1057/s41301-020-00243-3

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Today's Paper | March 15, 2024

Ji seeks formation of medical board to recommend gender change instead of 'self-perceived identity'.

The Jamaat-i-Islami (JI) on Monday presented a bill in the Senate seeking an amendment in the Transgender Persons (Protection of Rights) Act, 2018, for the creation of a medical board that would recommend whether a person's gender should change, instead of them seeking a reassignment on the basis of their personal identity.

The law , in its current state, reads: "A person recognised as transgender ... shall have [the] right to get himself or herself registered as per self-perceived gender identity with all government departments including, but not limited to, Nadra (National Database and Registration Authority)."

Opposing this provision, the amendment bill presented by Senator Mushtaq Ahmad calls for the formation of a gender reassigment board to suggest to Nadra whether a person's gender should be reassigned.

It recommends the formation of such boards at the district level after the approval of the prime minister and provincial chief ministers, with each board comprising a professor doctor, a psychologist, a male general surgeon, a female general surgeon, and a chief medical officer.

The proposed law seeks a prohibition of gender reassignment surgeries or any other treatment to change genital features on the basis of "any psychological disorder or gender dysphoria". It also states that the law in its present form could lead to the "legalisation of homosexual marriages".

Read: Being transgender — facts, myths and rights

Arguing that the current law violates the dignity of Muslim women, it further states that deeming gender identity a personal matter is contrary to the teachings of Islam.

As Senator Ahmad presented the bill in the upper house, he too contended that under the current law, a person could get themselves registered as a man or a woman not on the basis of their biology but their "personal thoughts".

Quoting interior ministry data that stated that around 28,000 cases of gender change were processed over the past three years, he said Nadra had been changing people's genders following a mere request by them.

This form of the law, he argued, was against the Holy Quran and Sunnah.

Opposing the bill, Human Rights Minister Shireen Mazari said the proposed amendment was aimed at "victimising" transgender persons as the current law gave them the right to identity.

"Till date, not a single complaint has been received regarding the misuse of this [existing] law," she added.

JI and Jamiat Ulema-i-Islam-Fazl senators protested Mazari's remarks, following which Senate Chairman Sadiq Sanjrani sent the bill to the relevant standing committee for discussion.

Gender reassigment cases over 3 years

During last week's Senate session , Senator Ahmad had sought information about the total number of applications received for issuance of gender change certificates by Nadra from July 2018 to June 2021, with original and intended gender-wise breakup of the applicants.

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When is it permissible to do a sex-change operation from male to female or vice versa?

Publication : 04-12-2014

Views : 145315

Praise be to Allah.

Firstly: 

It is not possible for anyone, no matter who he is, to change the creation of Allah, may He be exalted, from male to female or vice versa. Whoever Allah, may He be exalted, has created as a male can never become a female who menstruates and gives birth! 

Yes, the doctors may tamper with him to satisfy his perversion so that he will think that he has become a woman, but he will never be truly female and will live in a state of anxiety and worry, which may lead him to commit suicide. 

Secondly: 

What a person may feel in his mind and heart, that he is of a gender other than what he appears to be to us does not give him an excuse to change his gender; rather it comes under the heading of following the Shaytaan in changing the creation of Allah – outwardly but not truly – and those feelings do not make it permissible for him to undergo surgery or take medicines and hormones to change his outward appearance. Rather he must be content with the decree of Allah, may He be exalted, and treat his case on the basis of faith and obedience to Allah. It is not permissible for him to make himself appear outwardly to be of a gender other than his real gender with which Allah created him, otherwise he will be committing a major sin; if this person is really female then she will be masculinised and if he is really male then he will be effeminate. 

Please see also the answers to questions no. 21277 and 34553  

The surgery that is permissible in such cases is if a person was originally created male or female, but his genital organs are hidden. In that case it is permissible to do surgery in order to make those organs appear, and to give him or her medicine or hormones to strengthen the characteristics with which Allah originally created him or her. 

But in the case of one who was created with both female and male genitalia – this is what is called ambiguous intersex – it is not permissible to be hasty in removing one and making the other more apparent. Rather we should wait until it is known what Allah, may He be exalted, will decree for this individual, which may become apparent after some time has passed. 

For a more detailed discussion on intersex please see the answer to question no. 114670  

There follows a detailed fatwa from the scholars of the Standing Committee for Issuing Fatwas, who were asked about a case similar to what is mentioned in the question. They replied: 

Firstly: Allah, may He be exalted, says (interpretation of the meaning): “To Allah belongs the kingdom of the heavens and the earth. He creates what He wills. He bestows female (offspring) upon whom He wills, and bestows male (offspring) upon whom He wills. Or He bestows both males and females, and He renders barren whom He wills. Verily, He is the All-Knower and is Able to do all things” [ash-Shoora 42:49].  So the Muslim must accept and be content with whatever Allah creates and decrees. 

In your case, if you are as you mentioned, that you are certain of your masculinity and that you can play the male role efficiently, even if you have not actually engaged in any sexual activity with any person, then you must preserve your masculinity and accept that which Allah has granted to you of virtue and a favourable situation. . 

Secondly: once your masculinity is proven and established, then having surgery to turn into a female – as you think – is changing the creation of Allah, and is an expression of discontent on your part with what Allah has chosen for you, even if we assume that the surgery is going to be successful and lead to what you want of becoming female. But there is no way that it can be successful, for both males and females have their own, distinct faculties and physical makeup, the development and characteristics of which are decreed only by Allah, may He be exalted, and are not just the penis of the male or the vaginal opening of the female. Rather the man has a complete, integrated system comprising the testicles and other organs, each of which has a special function and characteristics, and produces specific secretions and so on. Likewise the woman has a uterus and other connected parts that work in harmony with it, and each part has its own function and characteristics, and produces specific secretions and so on. Among all of them there are connections and harmony over which none of His creation have any power of estimation, creation, control, management or preservation. Rather all of that is under the control of Allah, the All-Knowing, Most Wise, Most High, Almighty, Most Kind and All-Aware. 

Therefore the surgery that you want to do is a kind of tampering and striving for something in which there is no benefit. In fact it may be dangerous; if it does not lead to death, then at the very least it will lead to taking away that which Allah has given you without you attaining what you want, and you will still be affected by what you have mentioned of psychological problems that you want to get rid of by means of this surgery that is bound to fail. 

Thirdly: if your masculinity is not established, and you only think that you are a man because of what you see in your body of outward masculine appearance, in contrast to what you feel in yourself of having feminine characteristics and an inclination towards males and being sexually attracted to them, then you should examine your situation and not go ahead with the surgery that you have mentioned. You should consult experienced specialist doctors. If they determine that you are male in outward appearance but are in fact female, then you may submit yourself to their treatment, so that they can bring out your femininity by doing surgery. But that will not in fact be a sex change from male to female, because this will not be up to them; rather it will be bringing out your true nature and removing what is in your body, and what you feel deep inside you of confusion and ambiguity. But if nothing is clear to the experts, then do not take the risk of undergoing this surgery; be content with the decree of Allah and be patient with what has befallen you, seeking to please your Lord and protecting yourself against the possible consequences of doing an operation without guidance and insight concerning your condition. Turn to Allah and beseech Him to relieve you of what you are facing, and to heal you from your psychological problems, for control of all things is in His hand, may He be glorified, and He is able to do all things. End quote. 

Shaykh ‘Abd al-‘Azeez ibn Baaz, Shaykh ‘Abd ar-Razzaaq ‘Afeefi, Shaykh ‘Abdullah ibn Qa‘ood, Shaykh ‘Abdullah ibn Ghadyaan 

Fataawa al-Lajnah ad-Daa’imah (25/45-49) 

And Allah knows best.

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• Gender Reassignment Surgery Cost (MTF & FTM)

Explore the rising demand for gender reassignment surgery worldwide. Learn about the various procedures and their detailed costs in this comprehensive article.

• Transgender Surgery

By Priyanka Dutta Deb

6th June '22

Gender reassignment surgery cost varies depending on the type of transition. 

• For male to female (MTF) transition, the cost ranges from $2438 to $6095 and  
• For female to male (FTM) transition, the cost falls between $4876 and $9752 .

When considering the cost of gender reassignment surgery, it's important to note that these figures encompass the surgical expenses alone. Additional costs, such as:

• pre-operative consultations
• post-operative care
• hospitalization may also be involved

For a precise cost estimate that aligns with your specific needs, it is highly recommended that you consult reliable healthcare providers or clinics.

Begin with clarity. Contact us for detailed cost insights now.

There are two broad types of gender reassignment surgery : top surgery and bottom surgery. The top surgery is performed for both people assigned female at birth (AFAB) and assigned male at birth (AMAB). 

• Male to female or non-binary (MTF/N): This procedure entails using saline or silicone implants to boost chest size and form for a more feminine or female appearance. Male-to-female top surgery is done under general anesthesia.
• Female to male or non-binary (FTM/N):  During FTM top surgery, breast tissue is removed and the chest is shaped to give the patient a flat, masculine, or male appearance. Following this, a nipple graft is planted to give a complete look .

Before we discuss each service's cost, let's take a quick look at overall transgender surgery costs in different countries.

You must be curious to know the gender change surgery cost of different surgical procedures. Let's read.

What is the Cost of Male-to-Female Top Surgery?

Breast augmentation or augmentation mammoplasty is another name for MTF and MTN top surgery. 

The MTF/N top surgery or breast augmentation surgery cost in India is around USD 1290 to USD 1940 . The surgeon's expertise and experience are two of the most critical aspects that affect the cost.

For the duration of the surgery, you will be put under general anesthesia. Your surgeon may choose different breast augmentation methods depending on your desired chest size, implant kind, and incision site. The average time for MTF and MTN top surgery is 1 to 2 hours .

The insertion cost and the implant cost are the two components of the surgery cost.

Navigating your options?  Contact us today for more information on cost!

What is the cost of female-to-male top surgery?

An FTM or FTN top surgery procedure takes from   1.5 to 4 hours . Various treatments are performed to get a more flat, masculine, or male-looking chest. Double incision, periareolar, and keyhole are the most popular procedures used by surgeons. 

The FTM top surgery cost ranges around USD 3870 .

Now that we have already discussed top surgery costs, let's take a look at how much mtf bottom surgery costs.

AFAB and AMAB people can undergo bottom surgery as part of their gender confirmation process. Bottom surgery involves transforming or reconstructing the bottom or genitalia. This involves Vaginoplasty, penile transplant , phalloplasty, and metoidioplasty.

What is the cost of male-to-female bottom surgery?

Vaginoplasty surgery is the major procedure performed in bottom surgery . There are three main options under Vaginoplasty. Penile inversion, non-penile inversion Vaginoplasty, and recto-sigmoid or colon graft.

The clitoris is moulded from the head/tip of the penis in all three surgical approaches. The Vaginoplasty cost is around USD 3870 to USD 4520.

Now, let's look at female to male bottom surgery cost.

What is the Cost of Female-to-Male Bottom Surgery?

This procedure involves the removal of the female organs in the lower region and reassigning them to male sexual parts. It includes removing the uterus, vaginal remodeling, labia reconstruction, metoidioplasty, and phalloplasty.

The whole procedure may cost somewhere around USD 5160 to USD 10,335 . 

To get a clearer picture of gender reassignment surgery cost, connect with us now .

What is the Cost of Facial Feminization Surgery?

Facial feminization surgery is a technique that involves changing your facial characteristics to make them appear more feminine. FFS is concerned with bone structure and nose shape. FFS is distinct for each person and can affect any part of the face or neck.

The facial feminization surgery cost is USD 1350 . 

What is Hormonal Replacement Cost?

Hormonal replacement therapy is for both MTF/N and FTM/N transitioning.

MTF/N: The hormones for a male-to-female transition enhance the alignment of your gender identity. It helps induce physical changes in your body produced by female hormones during puberty (gender congruence). Male secondary sex traits can be avoided if feminizing hormone therapy like progesterone is initiated before male puberty. The hormonal replacement therapy cost for MTF/N is USD 12/month.

FTM/N: You'll be administered the male hormone testosterone during masculinizing hormone therapy. It suppresses your menstrual cycles and lowers oestrogen synthesis in your ovaries.  The hormonal replacement therapy cost FTM/N is USD 7/month.

To make a more informed decision, talk to us today.

Factors affecting the cost of gender reassignment surgery:

• Hospital charges:  It depends on the type of hospital you choose. Moreover, the cost also depends on whether you are admitted to a general ward or a private room.
• Psychiatrist : If you need a psychiatrist to deal with your physical changes, your cost will impact you. A psychiatrist is recommended to understand better the complex procedures and adjustments you will need before and after your surgery.
• Clinical Experts and Surgeons : You will discuss the specifics of your gender change surgery with your doctor. It includes an assessment of your medical health status, discussing your long-term gender confirmation goals, and evaluating which procedures may be most appropriate to assist you in your journey. You can ask for specific details such as risks, benefits, and what to expect from the surgery.
• Medical Insurance:  Your medical insurance will play an essential role in the procedure, saving you a lot of money.
• Accommodation Charges:  The accommodation charges are included for international patients.
• Medication charges : These charges include all the medication you will receive before and after the procedure ends.
• Pre- and Post-treatment charges:  The pre-treatment charges include doctor consultation fees, diagnosis charges, etc. The post-treatment charges may include medicine costs, doctor's revisit charges, etc.

Your health is too important to ignore –  schedule your appointment now.

Do Insurance Companies Cover Gender Reassignment Surgery?

Yes, insurance companies that cover gender reassignment surgery! There is no legal prohibition for that. Not all employers provide insurance coverage to unmarried or live-in partners of straight employees. But, several organizations nowadays provide medical insurance to their employees' same-sex partners, including coverage for gender-reassignment surgery.

Some independent companies have made it a goal to try and incorporate this coverage into their medical insurance for employees.  

Note: This article is on the cost of gender reassignment surgery, and data about it is only for your informational purposes and is subject to change.  

1. Side effects of gender reassignment surgery

• Infections.
• Side effects of anesthesia.
• Difficulty in urinating.
• Severe complications in intestines.
• Leakage of urine through openings.
• Closure of vaginal opening.

2. Who typically undergoes gender reassignment surgery?

Gender reassignment surgery is typically undergone by individuals who experience gender dysphoria, a condition where an individual's gender identity does not match their assigned sex at birth. It is usually recommended as a last resort after other treatments such as therapy, hormone therapy, and social transition have been tried.

3. What are the types of gender reassignment surgery?

The two main types of gender reassignment surgery are "top surgery," which refers to surgeries that alter the chest and breast area, and "bottom surgery," which refers to surgeries that alter the genital area. Top surgery may involve a mastectomy, breast augmentation, or breast reduction. Bottom surgery may involve genital reconstruction, orchiectomy, metoidioplasty, or phalloplasty. 4. Do the costs vary for different types of gender affirmation procedures? Yes, the cost can vary based on the specific surgeries involved, such as chest or breast augmentation, facial feminization, or genital reconstruction. References: 

https://my.clevelandclinic.org/

Dr. Josef Hadeed Plastic Surgery | Beverly Hills & Los Angeles (josefhadeedmd.com)

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Transgender surgery – Knowledge gap among physicians impacti... : Current Urology (lww.com)

https://jamanetwork.com/journals/jamasurgery/fullarticle/2779429  

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Female to Male (FTM) Surgery Cost in 2023

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Discover resilience and well-being with practical insights on gender dysphoria in adults. Your guide to a balanced and authentic life.

FTM Post Op, What You Can Expect Post FTM Surgery For Transgender?

Are you considering transitioning from female to male? Gender reassignment surgery, also known as FTM surgery, can be a decisive step in living authentically and achieving the body you have always wanted. This transformative procedure involves a range of surgical options, including the top Surgery, chest reconstruction, hysterectomy, and phalloplasty, each tailored to the individual's unique needs and goals.

Post Op MTF, What You Can Expect Post MTF Surgery For Transgender?

Explore the latest statistics on post-operation male-to-female (MTF) surgery worldwide. Learn about the trends in gender reassignment procedures and the impact they have on the transgender community. Discover the advances in medical technology that have made these surgeries safer and more accessible than ever before.

Question and Answers

After sex change body Ex vometing

Female | 20

In case you are experiencing vomiting after a sex change surgery, please consider medical attention. This could be a symptom of the complication, like an infection or medication intolerance. It is advisable to see a gender reassignment surgeon or a doctor who has dealt with transgender patients in the past. Do not delay seeking medical care.  

Answered on 21st Feb '24

Dr. Vinod Vij

In ftm hrt, would the physical effects be noticeable? I have family that are very conservative and am just wondering whether they will be able to notice.

Indeed, the physical results of FTM HRT are visible but may differ depending on an individual. It is possible also to identify some physical changes such as a deepening voice, facial and body hair growths, and redistribution of the fatty mass. It is best to consult with a gender-affirming healthcare provider who specializes in trans healthcare

Answered on 29th Jan '24

Can a transgender male have a period?

Men who are transgenders assigned female at birth still possess uterus, and consequently continue to menstruate as normal. Hormone therapy commonly used in the gender transition brings about a significant decrease or cessation of menstrual bleeding. In order to get personalized advice regarding the management of menstrual health for those going through gender transition, a specialist in transgender medicine or endocrinology needs to be consulted.

Answered on 18th Jan '24

Female to male fmga operation cheyinchukuna valaki pillalu putte is there a possibility

FMGA surgery DOES NOT allow for biological pregnancy.. 

Answered on 13th Dec '23

Hi mai m2f crossdresser ho mai self m2f hormons treatment karna chahti hu khya app mujje guide kar sakte hai ki meri body or breast female jaisi karne ke liye kis name ki hormones tablet pills le sakti ho

For feminization before hormonal therapy few tests has to be done, the eligibility and other health conditions need to check and based on that proper treatment plan can be prescribed.

Answered on 12th Dec '23

Transgender Surgery Hospitals In Other Cities

Top related speciality doctors in other cities.

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• v.116(15); 2019 Apr

Quality of Life Following Male-To-Female Sex Reassignment Surgery

Géraldine weinforth.

1 Department of Plastic Surgery and Hand Surgery, Universitätsspital Zürich

Richard Fakin

Pietro giovanoli, david garcia nuñez.

2 Department of Plastic, Reconstructive & Aesthetic Surgery and Hand Surgery, Center for Gender Variance, Universitätsspital Basel

Associated Data

Additional points regarding the study method

We conducted a systematic key word guided literature search of four databases (PubMed, EMBASE, Web of Science, PsycINFO) in March 2017 in order to identify the current medical literature relating to our research question. Among the search terms we used were “transsexualism”, “reassignment surgery”, and “quality of life” ( etable 1 ). The article search was adapted to the technical requirements (for example, the option of using MeSH terms) of each database and undertaken by GW and DGN independently, supported by the recommendations summarized in the PRISMA statement ( 16 ).

Inclusion criteria

We included only articles that focused on the topic of the quality of life of trans women who had had sex reassignment surgery, independently of the studies’ population sizes and publication dates. GW, RF, and DGN operationalized the search terms by using an iterative process following the PICO method ( e1 ) ( etable 1 ) and a search string was created with these ( eTabelle 2 ) . The search for publications intentionally identified only studies reported in English or German.

Exclusion criteria

Studies that did not exclusively focus on trans persons (for example, LGBT [= lesbian, gay, bisexual, and transgender] studies) or that did not evaluate quality of life by using a standardized questionnaire were not considered. Furthermore, this review did not include review articles, published dissertations, nor congress presentations/commentaries. Studies of trans persons who were under age were excluded too.

Screening process

During the study selection process we excluded according to the mentioned criteria those studies that were not able to contribute to answering our research question ( figure ). Furthermore, we searched the reference lists of all selected articles in order to be able to include further studies that were not found in the databases. This yielded four additional studies that met the inclusion criteria. In a parallel and independent process, DGN checked the results of this search. In cases where discrepancies were found, a solution pertaining to the inclusion of the relevant study was found by consensus.

Study analysis

After the study selection process we viewed full-text articles and collated important key study data ( table 1 ). According to the definitions in the PICO scheme ( e1 ) we collated all relevant parameters from the individual studies in further full-text reviews. The first author extracted the data, and DGN checked these in a second, independent process. All included articles are non-randomized studies of evidence level III ( e2 ). Some studies ( 17 – 21 ) reported on the quality of life of trans women as well as trans men. In these cases we ensured that the data evaluation for trans women was done separately or the ratio M–F/F–M was in favor of trans women. Where information was lacking or lack of clarity existed in individual studies, we contacted the authors. Table 2 shows the quality characteristics of the included studies.

The prevalence of persons who are born with primary and secondary male sexual characteristics but feel that they are female (trans women) is ca. 5.48 per 100 000 males in Germany. In this article, we provide a detailed overview of the currently available data on quality of life after male-to-female sex reassignment surgery.

This review is based on publications retrieved by a systematic literature search that was carried out in the PubMed, EMBASE, Web of Science, and PsycINFO databases in March 2017.

The 13 articles (11 quantitative and 2 mixed quantitative/qualitative studies) that were found to be suitable for inclusion in this review contained information on 1101 study participants. The number of trans women in each study ranged from 3 to 247. Their mean age was 39.9 years (range: 18–76). Seven different questionnaires were used to assess postoperative quality of life. The findings of the studies permit the conclusion that sex reassignment surgery beneficially affects emotional well-being, sexuality, and quality of life in general. In other categories (e.g., “freedom from pain”, “fitness”, and “energy”), some of the studies revealed worsening after the operation. All of the studies were judged to be at moderate to high risk of bias. The drop-out rates, insofar as they were given, ranged from 12% to 77% (median: 56%).

Current studies indicate that quality of life improves after sex reassignment surgery. The available studies are heterogeneous in design. In the future, prospective studies with standardized methods of assessing quality of life and with longer follow-up times would be desirable.

The term “gender incongruence” (GI) describes the situation in which a person does not identify with the gender they were assigned at birth on the basis of physical sexual characteristics and that they consequently experience “a marked and persistent incongruence between. .. experienced gender and the assigned sex” ( 1 ). The term trans women describes persons with congenital primary and secondary male sexual characteristics (assigned male at birth) who feel/identify as women. Trans men are persons who feel/identify as men but who have primary and secondary female sexual characteristics (assigned female at birth). Persons who fully identify with the sex/gender they were assigned at birth are known as cis women and cis men.

A data analysis from 2000 showed a prevalence in Germany of 4.26 trans persons/100 000 population (5.48 trans women/100 000 of the male population and 3.12 trans men/100 000 of the female population) ( 2 ). We are not aware of any more recent data for Germany.

If persons with gender incongruence develop clinically relevant biopsychosocial suffering, they have gender dysphoria (GD), according to the DSM-5 classification ( 3 ). For many trans persons, physical transition is the best option for alleviating the symptoms of gender dysphoria ( 4 ). Sex/gender reassignment hormone treatment as well as surgery have a central role in this setting ( 5 ). The latter comprise surgical procedures involving the genitals (sex reassignment surgery) ( box ), the breasts, and the face and vocal cords, as well as hair epilation ( 6 ).

Principle of male-to-female sex reassignment surgery

• Bilateral orchiectomy
• Preparation of the glans (head) of the penis with the complete neurovascular bundle
• Preparation of the urethra
• Subtotal resection of the cavernous bodies (corpora cavernosa) and the corpus spongiosum of the penis
• Preparation of the neovaginal space in the perineal area between rectum and urethra/bladder
• Penile inversion vaginoplasty (pedicle flap from the skin of the penal shaft: gold standard)
• If required, use of free split-thickness skin grafts
• In selected cases, this is the primary indication—for example, in trans women with penoscrotal hypoplasia or at the patient’s wish (for better natural secretion).
• This procedure can also be used as a secondary intervention in patients after unsatisfactory penile inversion vaginoplasty.
• Construction of a neo-clitoris from the glans (head) of the penis
• Construction of a urethral neo-meatus after urethral shortening as required
• Construction of labia from the remaining scrotal skin, possibly also labia minora

A US study showed that from 2000 to 2011, the rate of surgical sex reassignment measures among trans persons rose from 72% to 83.9% ( 7 ). These data move the question of the effectiveness of such operations increasingly into the focus of clinical attention and awareness ( 8 – 11 ).

In the context of evidence-based medicine, the consensus is now that the success of medical procedures should not be studied merely in terms of objective results (survival and complication rates, measurements of functionality, etc), but that patients’ personal wellbeing should be included in assessing the success of any procedure ( 12 , 13 ). Review articles to date have shown that sex reassignment hormone treatment has a positive effect on the quality of life of trans persons ( 14 , 15 ). By contrast, an overall assessment of quality of life after sex reassignment surgery is so far lacking. In this article we will attempt to provide a review of current studies, and on this basis we will investigate the question of quality of life after sex reassignment surgery.

For the review to be as representative as possible, this article deals with trans women only, whose incidence is notably higher than that of trans men (0.41 male to female/100 000 total male population in Germany and 0.26 female to male/100 000 total female population in Germany) ( 2 ).

We conducted as systematic literature search in PubMed, EMBASE, Web of Science, and PsycINFO in March 2017. GW and DGN independently undertook the article search on the basis of the recommendations summarized in the PRISMA statement ( 16 ). Details of the methods are described in the eMethods section.

We included only articles on the subject of the quality of life of trans women after sex reassignment surgery. GW, RF, and DGN operationalized ( etable 1 ) the search terms in an iterative process according to the PICO method ( e1 ) and set out a search string ( etable 2 ).

* Key words used in accordance with the PI(C)O method

* Catch phrases and key words used in the literature search

Among others, we excluded studies that did not focus exclusively on trans persons or that didn’t collect data on quality of life by using a standardized questionnaire. We also excluded studies in underage trans people.

The Figure shows the study selection process.

Flow chart illustrating the study selection process

All included articles are non-randomized studies with an evidence level of III ( e2 ). In the case of studies that reported on the quality of life of trans women as well as trans men ( 17 – 21 ) we ensured that the data for trans women were evaluated separately or that the ratio of M–F/F–M favored trans women. Table 1 shows further key study data; Table 2 shows the quality characteristics of the studies.

* 1 Numbers of study participants after removal of dropouts ( table 2 ); exception: Lindqvist et al. ( 23 ), see Table 2

* 2 M–F, male-to-female; F–M, female to male, sex reassignment surgery

* 1 M–F male to female; F–M female to male, reassignment surgery

* 2 Prospective study design

* 3 Of originally 190 participants, n = 160 (84.21%) completed the questionnaire preoperatively and n = 47 (24.73%) postoperatively

* 4 Out of a total of 190 study participants, n = 146 (76.84%) completed the questionnaire preoperatively, n = 108 (56.84%) 1 year postoperatively, n = 64 (33.68%) 3 years postoperatively, and n = 43 (22,63%) 5 years postoperatively. Most of the 190 participants completed the questionnaire at least at two follow-up points.

The studies made use of the following instruments:

• 6 studies used the Short Form 36 Health Survey (SF-36) ( 18 , 20 , 22 – 25 );
• 2 studies used the World Health Organization’s Quality of Life 100 questionnaire (WHOQOL-100) ( 17 , 26 );
• 2 studies used the Subjective Happiness Scale (SHS) in combination with the Satisfaction with Life Scale (SWLS) and the Cantrils Ladder of Life Scale (CLLS) ( 27 , 28 );
• 2 studies used the FLZ questionnaire ( Fragebogen zur Lebenszufriedenheit ) ( 21 , 29 ); and
• 1 study used the King’s Health Questionnaire (KHQ) ( 19 ).

None of the questionnaires constitutes an investigative tool that is specifically tailored to trans persons. Table 3 shows the result scales. Table 2 shows the confounding variables and, as far as it is possible to assess this, the risk of bias.

*For the studies referenced in parentheses, it was not possible to calculate effect sizes

Quality of life

The SF-36 and WHOQOL-100 are validated, reliable and disease–non-specific instruments for measuring health-related quality of life ( 30 , 31 ). They can be used to gain information on the individual health status and allow for observing disease-related stresses over time. The questionnaires collect data on numerous aspects of daily life, which in their totality reflect quality of life. They are used internationally and therefore make cross-cultural studies an option ( 32 ).

Studies that used the SF-36 to answer the question of postoperative quality of life ( 18 , 20 , 22 – 25 ) observed after sex reassignment surgery an improvement in “social functioning”, “physical” and “emotional role functioning”, “general health perceptions”, “vitality”, and “mental health” (p = 0.025 to p >0.05). In two of these studies ( 22 , 24 ), “mental health” in trans women after sex reassignment surgery did not differ significantly from the standard sample. This explains the formally non-significant result. Ainsworth and Spiegel ( 22 ) showed that trans women without surgical intervention when compared indirectly with cis women from the SF-36 standard sample reported significantly poorer “mental health” (39.5 vs 48.9; p <0.05). Lindqvist et al. ( 23 ) and Weyers et al. ( 24 ) found an improvement in “self-perceived health” in the first postoperative year (p <0.05 and p <0.009), which deteriorated later but did not fall as low as its original score (p <0.0001). Furthermore, the studies concluded that “physical pain” increased postoperatively and “physical functioning” decreased; the postoperative follow-up periods varied between 3 months ( 18 ) and 5 years ( 23 ). According to Lindqvist et al. ( 23 ), “physical pain” in trans women five years postoperatively was comparable to that in the standard population (72.5 vs 72.7; SD 26.5).

Studies that used the WHOQOL-100 came up with the following results: Cardoso da Silva et al. ( 26 ) observed postoperatively an increase in “sexual activity” (p = 0.000) compared with the preoperative evaluation (prospective study design). Furthermore they found a postoperative improvement in the “psychological domain” (p = 0.041) and “social relationships” (p = 0.007), but a deterioration in “physical health” (p = 0.002) and “independence” (p = 0.031). Accordingly, deteriorations were seen in the areas of “energy” and “fatigue”, “sleep”, “negative feelings”, “mobility”, and “activities of daily living” (p <0.05). Castellano et al. ( 17 ) found after sex reassignment surgery for the group of trans women compared with the group of cis women no significant differences relating to “sexual activity” (65.85 vs 66.28; p >0.05), “body image” (64.64 vs 65.47; p >0.05), and the “quality of life score” (67.87 vs 69.49; p >0.05).

Quality of life and urinary incontinence

The King’s Health Questionnaire (KHQ) is a validated questionnaire for evaluating the impact of urinary incontinence on quality of life ( 33 ), a topic of central importance for trans persons ( 34 ). This questionnaire interrogates the quality of life domains always in association with urinary incontinence as the main problem. Kuhn et al. ( 19 ) showed that “general health” in trans persons was experienced as poorer to a relevant extent (Cohen’s d = 4.126; p = 0.019), and “physical” (d = -7.972; p <0.0001) and “personal limitations” (d = -7.016; p <0.001) were experienced to a greater extent. In contrast to this, trans persons felt less limited in terms of “role limitation” (d = 3.311; p = 0.046). For “emotions”, “sleep”, “incontinence”, and “symptom severity”, the differences to the control group did not reach significance. The control group consisted of cis women who had undergone abdominopelvic surgery. The evaluation of the visual analogue scale (VAS) showed a lower (d = 14.136; p <0.0001) degree of general life satisfaction in the group of trans persons.

Life satisfaction

The SHS ( 35 ), SWLS ( 36 ), and CLLS ( 37 ) are validated and internationally used visual analogue scales to evaluate life satisfaction. The SHS evaluates individual happiness and associated physical, mental, and social wellbeing ( 35 ). The SWLS was used as a short-form scale in the cited studies (also known as L-1) and included only the question on general life satisfaction ( 36 ). The CLLS evaluates emotional wellbeing associated with life satisfaction as well as subjective health ( 37 ).

Studies that used the SHS, SWLS, and CLLS ( 27 , 28 ) to evaluate postoperative life satisfaction reported a high degree of “subjective happiness” (5.6; SD 1.4 and 5.9; SD 0.6), of “satisfaction with life“ (27.7; SD 5.8 and 27.1; SD 2.1) and “subjective wellbeing” (8.0 [range: 4–10] and 7.9; SD 0.7) in trans women after intestinal vaginoplasty. The studies cited earlier differ with regard to the following items: Bouman et al. ( 27 ) studied a population of young trans women (mean age: 19.1 years) with penoscrotal hypoplasia after primary laparoscopic intestinal vaginoplasty. The study participants had received puberty blockers during their transition therapy, which resulted in penoscrotal hypoplasia and made penile inversion vaginoplasty ( box ) impossible. Van der Sluis et al. ( 28 ) studied an older population (mean age: 58 years) of trans women after secondary intestinal vaginoplasty—that is, patients who required secondary intestinal reconstruction owing to vaginal stenosis or insufficient vaginal length after penile inversion vaginoplasty. The postoperative follow-up period varied between 1–7.5 years ( 27 ) and 17.2–34.3 years ( 28 ). In spite of the different patient populations, these studies found that sex reassignment surgery had a positive effect on life satisfaction.

The FLZ is a validated multidimensional questionnaire for evaluating individual general life satisfaction ( 38 ). It is used in life quality and rehabilitation research and enables the recording of changes if administered repeatedly. It is available in a German language version only; for this reason, its results apply only to German speaking populations.

Studies that used the FLZ questionnaire ( 21 , 29 ) found that the postoperative life satisfaction of trans women in terms of “health” does not differ from that of the general population. Additionally, Papadopoulos et al. ( 29 ) found no differences for “friends”, “hobbies”, “income”, “work”, and “relationship.” A subanalysis of the module “health” found postoperatively in both studies a relevant decrease in “fitness” (d = 0.521; p <0.001) and “energy” (d = 0.494; p <0.003). Zimmerman et al. ( 21 ) additionally found a significant decrease in “ability to relax/equilibrium” (p = 0.002), “fearlessness/absence of anxiety” (p = 0.015), and “absence of discomfort/pain” (p = 0.037). Both studies ( 21 , 29 ) were retrospective surveys that were undertaken once only in a time period between 6 months and 58 months postoperatively. Papadopoulos et al. ( 29 ) included only subjects into the study who did not require any further corrective surgery after sex reassignment surgery or who had already undergone a second procedure for the purpose of minor corrections.

Two prospective studies documented postoperatively a notable improvement in quality of life ( 23 , 26 ). Four studies found that the life quality of trans women after sex reassignment surgery was no different from that of cis women ( 17 , 20 , 22 , 24 ). Sex reassignment surgery has also been shown to have a positive effect on life satisfaction ( 27 , 28 )—the exception was urinary incontinence, in which case life satisfaction dropped ( 19 ). Lindqvist et al. ( 23 ) and Weyers et al. ( 24 ) observed an improvement in self-perceived health in the first postoperative year, which then drops, albeit not all the way down to its original level. This is consistent with the honeymoon phase described by De Cuypere et al. ( 39 ), which has been described as a euphoric period in the first year after surgery. Several studies ( 18 , 20 – 25 ) showed that physical pain increased after surgery and physical functioning deteriorated. This is easily explained by the surgery itself, however; the postoperative follow-up periods in these studies varied between 3 months ( 18 ) and 5 years ( 23 ).

Altogether the study results imply that sex reassignment surgery has an overall positive effect on partial aspects, such as mental health, sexuality, life satisfaction, and quality of life.

These results were confirmed by Barone et al. ( 40 ) and Murad et al. ( 15 ) in their review articles, which were published in 2017 and 2010, respectively. Barone et al. ( 40 ) in a systematic review evaluated patient reported results after sex reassignment surgery; among others, regarding life satisfaction. Murad et al. ( 15 ) in a meta-analysis focused on quality of life and psychosocial health after hormone therapy (main aspect) and sex reassignment surgery. In sum, both studies found improvements in quality of life and life satisfaction after sex reassignment surgery, and an improvement at the psychosocial level. Hess et al. ( 11 ) concluded that the study participants benefited from sex reassignment surgery—they too found high rates of satisfaction postoperatively in Germany.

As sex reassignment surgery often constitutes the final step of sex reassignment measures, hormone therapy as well as accompanying psychotherapy may have had a confounding effect. Not all studies adjusted for confounding factors. A lack of randomization and control or the use of a matched control group ( 17 , 19 ) in the studies also introduced methodological bias ( table 2 ). Furthermore, the high dropout rates of 12% ( 17 ) to 77% ( 23 ) (median: 56%), which are mainly due to non-respondents, should be assessed critically. In our experience, however, the patient population of trans women is often reticent and is not interested in study participation because of personal reasons (“to not be reminded of that time”). Other authors have shared this observation ( 18 , 24 ), which may also explain the occasionally high dropout rates. There is also the possibility that dissatisfied patients were among the dropouts. Owing to socioeconomic and clinical conditions, the studies from Croatia ( 18 ) and China ( 25 ) need to be evaluated separately. On the one hand, the authors of both studies draw attention to the public’s lack of awareness and understanding (and the associated psychological stress for trans women) in these countries, and, on the other hand, statutory sickness funds did not cover the costs of all treatments, which were therefore accessible to only few patients. This explains the notably lower participant numbers of 3 ( 18 ) and 4 ( 25 ) male-to-female transitions after sex reassignment surgery. None of the included studies reported potential suicide rates.

The strength of this review lies in the fact that we included only studies that used standardized questionnaires. Tests (such as the SF-36 or WHOQOL-100) represent validated and reliable measuring instruments, for some of which reference standard populations exist, and they enable international and intercultural comparison. Furthermore, standardized questionnaires have the advantage of a high degree of objectivity in terms of conducting, evaluating, and interpreting studies.

The available study data show that sex reassignment surgery has a positive effect on partial aspects—such as mental health/wellbeing, sexuality, and life satisfaction—as well as on quality of life overall.

It should be noted that the studies are almost exclusively retrospective analyses of mostly uncontrolled and small cohorts, for which no valid or specific measuring instruments are available to date. Because of the high dropout and non-response rates, the current data should be interpreted with caution.

In spite of the essentially positive results, the data are not satisfactory at this point in time. Due to the studies’ limited follow-up times, no conclusions can be drawn as yet about the long term consequences of such procedures. Furthermore, many studies did not use standardized questionnaires and/or scores, which makes comparisons between individual studies difficult.

Key messages

• Trans persons suffer from the tension between their biologically characterized body and their experienced sex/gender.
• Undergoing medical and/or social transition seems for many trans persons the best possible solution for alleviating their gender dysphoria symptoms.
• Results from studies imply that sex reassignment surgery on the one hand has positive effects in terms of partial aspects of quality of life, such as mental health, sexuality, and life satisfaction, and, on the other hand, on quality of life overall.
• Because of the studies’ high dropout rates (12–77%; median 56%), the results should be interpreted with caution.
• The studies did not include information on potential suicide rates.

Supplementary Material

Acknowledgments.

Translated from the original German by Birte Twisselmann, PhD.

Conflict of interest statement

The authors declare that no conflict of interest exists.

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Female to Male Gender Reassignment Surgery (FTM GRS)

Female-to-male gender reassignment surgery (FTM GRS) is a complex and irreversible genital surgery for female transsexual who is diagnosed with gender identity disorder and has a strong desire to live as male. The procedure is to remove all female genital organs including the uterus, ovaries, and vagina with the construction of male genitalia composed of the penis and scrotum.  

The patient who is fit for this surgery must strictly follow the standard of care set by the World Professional Association of Transgender Healthcare (WPATH) or equivalent criteria; Express desire or live in another gender role (Female gender) long enough, under hormonal replacement therapy, evaluated and approved by a psychiatrist or other qualified professional gender therapist.  

Apart from genital surgery, the patient would seek other procedures to allow them to live as males smoothly such as breast amputation, facial surgery, body surgery, etc.  

Interested in having this procedure?

Useful Information

Ensure you consider all aspects of a procedure. You can speak to your surgeon about these areas of the surgery in more detail during a consultation.

The surgery is very complicated and only a handful of surgeons are able to perform this procedure. It is a multi-staged procedure, the first stage is the removal of the uterus, ovary, and vagina. The duration of the procedure is 2-3 hours. The second and later stages are penis and scrotum reconstruction which is at least 6 months later. There are several techniques for penile reconstruction depending on the type of tissue such as skin/fat of the forearm, skin/fat of the thigh, or adjacent tissue around the clitoris. This second stage of surgical time is between 3-5 hours. A penile prosthesis can be incorporated simultaneously or at a later stage. The scrotal prosthesis is also implanted later.  

The procedure is done under general anesthesia and might be combined with spinal anesthesia for faster recovery by reducing the usage of anesthetic gas.  

Inpatient/Outpatient

The patient will be hospitalized as an in-patient for between 5-7 days for each stage depending on the technique and surgeon. The patient will have a urinary catheter at all times in the hospital.  

Additional Information

What are the risks.

The most frequent complication of FTM GRS is bleeding, wound infection, skin flap or graft necrosis, urinary stenosis and fistula, unsightly scar, etc. The revision procedure is scar revision, hair transplant, or tattooing to camouflage unsightly scars.   

What is the recovery process?

During hospitalization, the patient must be restricted in bed continuously or intermittently for several days between 3-5 days. After release from the hospital, the patients return to their normal lives but not having to do physical exercise during the first 2 months after surgery. The patient will have a urinary catheter continuously for several weeks to avoid a urinary fistula. If the patient has a penile prosthesis, it would need at least 6 months before sexual intimacy.  

What are the results?

With good surgical technique, the result is very satisfying with an improved quality of life. The patient is able to live in a male role completely and happily either on their own or with their female or male partners.  

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Congress must support parents who protect their children from irreversible gender procedures

Editor's note: The following guest column was submitted by Republican U.S. Sen. John Kennedy to the Louisiana USA Today Network.

Those who advocate for minors to be able to change genders believe powerful medications and surgery are the only way to help gender dysphoric children. Most parents in Louisiana, however, believe that irreversible medical procedures could harm these children in the future if they change their minds about changing their sex.

Some adult activists pressure parents, doctors, lawmakers and children themselves to allow minors to permanently change their bodies to match whatever gender they may think they prefer. If a young boy thinks he is a girl, these activists think the boy’s gender preference should be automatically "affirmed" by giving the kid puberty blockers, cross-sex hormones and sex-reassignment surgeries.

These pediatric gender procedures can maim and sterilize children. Puberty blockers include the same drugs that the government uses to chemically castrate sex offenders, and they can permanently diminish a child’s bone density.

Yet some activists want to and do give these drugs to second graders. Cross-sex hormones can destroy a child's fertility, but these activists believe 13-year-olds are mature enough to decide to take them.

Sex-reassignment surgeries slice off healthy organs and skin tissue to construct genitals that may never regain sensation, and gender activists advocate allowing 15-year-olds to go under the knife at their own discretion.

Such demands are even more disturbing when you realize that roughly 85% of children who say they experience gender dysphoria will outgrow it by the time they finish adolescence. It is impossible, however, to fully undo the effects of cross-sex hormones or heal the scars of mastectomies or genital surgeries. So why do some people insist that parents usher kids into gender-changing surgeries and inject them with sterilizing drugs?

Despite the gender activists’ claims, these medical procedures may not improve outcomes for children who have or think they have gender dysphoria. A study published in the American Journal of Psychiatry found no significant reduction in mental health issues or suicide-related hospitalizations among adults who underwent hormone treatments.

There’s also "no advantage of surgery" as it relates to certain mental health improvements or hospitalizations for suicide attempts. Still, activists market these draconian procedures to parents as "life-saving" treatments.

Many children who think they were assigned the wrong sex at birth struggle with serious mental health issues. Children who identify as transgender are up to 13 times more likely to have ADHD, depression, or anxiety than non-transgender children. Roughly 35% of the children who received treatment at one major European clinic had moderate or severe autism. Pushing these children to medically transition is reckless.

Everywhere parents look (and in many places they don’t), gender activists are encouraging kids to question their gender. Some public school classrooms include books with graphic depictions of explicit sexual material. Some libraries host "drag queen story hour" for little kids. Disney elevates transgender characters. TikTok algorithms force-feed minors an endless stream of transgender how-to guides.

This in-your-face transgender rhetoric appears to be influencing an unprecedented number of children. Nationwide, the population of children who claim to be transgender roughly doubled between 2017 and 2020. Louisiana children aged 13 to 17 years old are three times more likely to identify as transgender than adults between the ages of 25 and 64 years old.

It’s tough to be a kid, and there are many reasons children might question who they are and who they want to be. School is challenging, bullies are mean, and puberty is awkward for most boys and girls.

We shouldn’t, however, allow children to go through irreversible physical changes to address what, statistically, is likely a temporary season of confusion or anxiety. The Louisiana Legislature was wise to pass a bipartisan bill, H.B. 648, which outlawed these irreversible treatments on Louisiana’s children until they are of the majority age.

Parents need protection from gender activists, too. In some states, parents can lose custody of their children for refusing to affirm the child’s stated gender preference. Other states allow minors to access puberty blockers or cross-sex hormones without parental consent. Parents shouldn’t be punished for choosing to protect their children from extremists.

That’s why I’m cosponsoring the Families’ Rights and Responsibilities Act , a bill that would help parents fight back if they are attacked for opposing the transgender agenda. Supporting parents who want to protect their children and help them make the right decision if they are gender confused is the safest, strongest way to lift up our kids and foster healthy families.

There are too many stories of minors who end up regretting taking puberty blockers and cross-sex hormones or undergoing sex-change surgery, and I fear that many more stories are going to come to light. I’m going to do all I can to allow kids to be kids until they are old enough to decide for themselves.

• वेब स्टोरीज

• Bhaskar khaas
• Sex Change | UP Transgender Sex Reassignment Surgery Story

ब्लैकबोर्ड- 22 साल लड़के के शरीर में रही: अब लड़की बनी, मां-भाई को सच्चाई नहीं पता; साड़ी पहनकर घर जा नहीं सकती

‘बनारस। बाबा विश्वनाथ की नगरी। जहां दुनियाभर से लोग आस्था और मोक्ष के लिए आते हैं और यहां की गलियों की रौनक में खो जाते हैं। बनारस की इन्हीं गलियों में धमाचौकड़ी मचाते मैं बड़ी हुई।

मैं शरीर से लड़का थी। ऑपरेशन कर अब मैंने लड़की का शरीर पा लिया है। फिर भी गली-मोहल्ले के लोग मुझे लड़के के तौर पर ही जानते हैं। जाहिर-सी बात है कि मेरी परवरिश एक लड़के की तरह हुई है। आपसे बात करने के बाद मैं अपने घर जाऊंगी। उससे पहले मुझे अपने एक दोस्त के घर जाना होगा। ये साड़ी- ब्लाउज और आईलाइनर सब उसी के घर उतार दूंगी। वहां मैंने जींस-टीशर्ट रखा है, जिसे पहनकर ही अपने घर जाऊंगी।

मेरे डोरबेल बजाने पर मेरी मां अपने बेटे के लिए दरवाजा

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