Understanding Gender Incongruence, Gender Dysphoria, and Gender Identity Disorder

Gender Incongruence is characterized by a persistent mismatch between a person’s assigned sex at birth and the gender they identify with. Often referred to as Gender Dysphoria or Gender Identity Disorder (GID), it is an experience of discomfort or distress caused by this incongruence.

As per the World Health Organization’s declaration in May 2019, Gender Incongruence is no longer classified as a psychiatric illness but as a condition requiring medical intervention and support.

The Diagnosis of Gender Dysphoria

To begin transitioning, an individual must first receive a diagnosis of Gender Dysphoria from a specialized psychiatrist with expertise in transgender care. The diagnosis is the first step on the gender transition journey, which may involve both psychological counseling and medical support for certain periods.

Hormonal Therapy: A Key Step in Gender Transition

Hormonal therapy, also known as Hormone Replacement Therapy (HRT), plays a vital role in transitioning. For Transwomen (Male to Female transition), the process typically includes:

• Estrogen therapy

• Progesterone

• Testosterone blockers (T-blockers)

For Transmen (Female to Male transition), Testosterone (T) therapy is used to encourage male physical characteristics.

Hormonal therapy is guided by an endocrinologist and marks the beginning of the Medical Transition process.

Sex Reassignment Surgery (SRS): Surgical Transition Process

Once an individual has undergone a certain period of hormonal therapy, Sex Reassignment Surgery (SRS), also known as Gender Affirmation Surgery, is performed. These procedures are essential to bring an individual’s physical characteristics in line with their gender identity.

Sex reassignment surgeries include a range of procedures, including facial and body modifications, chest surgery, and genital affirmation surgeries, depending on the type of transition (Male to Female or Female to Male).

SRS is carried out following WPATH (World Professional Association for Transgender Health) guidelines, though these may vary from individual to individual.

Male to Female Surgical Transition Procedures

Here are common procedures involved in Male to Female (MtF) transition:

Facial Feminization Surgery (FFS):

• Forehead reconstruction (type 1, type 2, type 3, and Type K)

• Nose feminization (feminizing rhinoplasty)

• Malar augmentation (cheek feminization)

• Lip augmentation, lip lift

• V-line surgery (V shaping)

• Tracheal shave (Adam’s Apple correction)

Voice Feminization Surgery:

• Surgical procedures designed to adjust vocal cords for a more feminine pitch.

Breast Augmentation (Chest Feminization):

• Breast implants or fat grafting/transfer to enhance the breast size and shape.

Genital Affirmation Surgery:

• Vulvaplasty

• Penile inversion vaginoplasty

• Peri-sanctuary peritoneal vaginoplasty (PPV)

• Sigma lead SRS

• Sigmoid colon vaginoplasty

• Corrective SRS

• Orchiectomy (removal of testes)

Body Feminization/Contouring:

• 360° liposuction

• Butt augmentation/implants

• Brazilian Butt Lift (BBL)

• Rib removal (creating an hourglass figure)

Female to Male Surgical Transition Procedures

Common procedures for Female to Male (FtM) transition include:

Chest Masculinization Surgery (Top Surgery):

• Keyhole surgery or double incision top surgery

• Nipple grafting for a more masculine chest appearance

Female to Male Genital Surgery (Bottom Surgery):

• Mini MG SRS:

  • Laparoscopic hysterectomy and oophorectomy (removal of uterus and ovaries)

  • Vaginectomy (removal of the vagina)

  • Urethral extension/elongation and urethra masculinization

• Metoidioplasty:

  • Surgical procedure to create a phallus using the existing clitoral tissue.

• Scrotoplasty and testicular implants:

  • Creation of a scrotum with artificial testicles for a more masculine appearance.

• Phalloplasty:

  • Abdominal flap, radial artery forearm flap, MLD flap, or ALT flap to create a neophallus.

  • Penile implants for functionality.

Face Masculinization Surgery (FMS):

• Beard and mustache hair transplants

• Facial implants to create a more masculine facial structure