Sex Reassignment Surgery

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Sex Reassignment Surgery. Nick Dolding / Getty Images

Sex reassignment surgery (SRS), also known as gender reassignment surgery (GRS), is a means of transitioning to a different gender through surgical alteration of the body. This transition is also known as transsexualism.

Men who are transitioning to female are known as male-to-female transsexual, MTF, transsexual female, and trans female.

Women who are transitioning to male are known as female-to-male transsexual, FTM, transsexual male, and trans male.

Rapid advances in the knowledge of sex hormones and plastic surgery following World War II allowed the advancement of medical and surgical solutions for transsexualism.

What is the difference between “transgender” and “transsexual”?

“Transgender” refers to individuals who identify with a gender identity that differs from that usually associated with their sex at birth. The gender assigned is usually based on the appearance of the external genitalia. Transgender people may or may not have undergone sex reassignment surgery. Transgenderism has been recorded since ancient times.

“Transsexual” refers to individuals who have undergone surgery to change the appearance of their birth genitalia to that opposite of their biological sex.

Why would a person undergo sex reassignment surgery?

Many transgender people claim to be uncomfortable with their biological sex and its associated gender role. The American Psychiatric Association (APA) has identified this as gender identity disorder (GID).

GID may cause duress and impairment on social and personal levels.

For these individuals, gender role changing, hormone therapy, and sex reassignment surgery permit their outside appearance to match what they feel internally.

What is gender identity disorder (GID)?

There are two essential criteria for GID:

  • A desire to escape biological/assigned gender: Demonstrated as a consistent aversion to his or her sex and its associated gender role​
  • A desire to be a member of the other sex: Demonstrated as a consistent identification with the other gender

What does “transitioning” to another gender involve?

“Transitioning" to another gender may involve:

  • Dressing and living as a different gender in order to adopt an identity associated with the opposite biological sex, without surgery
  • Taking sex hormones and/or surgically removing or modifying genitals and reproductive organs in order to adopt an identity associated with the opposite biological sex

What steps must be taken before a person has sex reassignment surgery?

  • A mental health evaluation is required before the use of hormones and before undergoing elective sex reassignment surgery
  • A diagnosis of gender identity disorder (GID) must be made
  • The individual must take on the role of the desired sex in everyday activities, both socially and professionally (known as “real-life experience” or “real-life test”)

What is the purpose of mental health evaluation before sex reassignment surgery?

There are three main objectives of a mental health evaluation:

  • To assess the individual’s mental state with regard to gender identity and make a diagnosis of GID
  • To rule out psychiatric abnormalities that would influence an individual’s mental state, such as psychosis, intersex state, endocrine disorders, perversions, or addiction
  • To evaluate the individual’s readiness for hormone therapy and sex reassignment surgery

What is hormone therapy and why is it important for transitioning?

For transgender individuals desiring sex reassignment surgery, hormone therapy (HT), also called hormone replacement therapy (HRT), involves taking estrogen (for a href="">male-to-female transition) or testosterone (for female-to-male transition) before, during, and after the surgical transition to another gender.

The purpose of hormone therapy is to change the physical appearance into that of the desired gender.

What is the effect of testosterone on females?

Changes to the body include:

  • Wasting away of the uterus and ovaries, resulting in inability to have children
  • Baldness or localized hair loss, especially at temples and crown of head
  • Beard and mustache growth
  • Deepening of the voice
  • Enlargement of the clitoris
  • Increased growth of body hair
  • Development of acne, similar to male puberty
  • Increased muscle mass and strength
  • Increase in number of red blood cells
  • Redistribution of fat from breasts, hips, and thighs to abdominal area

Behavioral changes include:

  • Aggression
  • Increased sex drive

What is the effect of estrogen on males?

Changes to the body include:

  • Breast development
  • Loss of erection
  • Shrinkage of testicles
  • Decreased acne
  • Decreased facial and body hair
  • Decreased muscle mass and strength
  • Softer and smoother skin
  • Slowing of balding
  • Redistribution of fat from abdomen to hips, thighs, and buttocks

Behavioral changes include:

  • Decreased sex drive

How long before the effects of hormone therapy are noticed?

The feminizing effects of estrogen and the masculinizing effects of testosterone may appear after the first couple of doses although it may be several years before a person is satisfactorily transitioned. This is especially true of breast development.

How long does the sex reassignment surgery process take?

Surgery is delayed until at least one year after the start of hormone therapy and at least two years after the first mental health evaluation.

What surgeries are involved in transitioning from a male to a female?

Sex change surgery involves top surgery and bottom surgery.

Top surgery includes:

  • Creation of female hairline
  • Male pattern hair removal
  • Reduction of Adam’s apple
  • Voice change surgery

Bottom surgery includes:

  • Removal of the penis and scrotum
  • Creation of a vagina and labia​

What surgeries are involved in transitioning from a female to a male?

As with male to female transitions, sex change surgery involves top surgery and bottom surgery.

Top surgery includes:

Bottom surgery includes:

  • Removal of the uterus and ovaries
  • Creation of a penis and scrotum

How much does sex reassignment surgery cost?

SRS can be prohibitively expensive to most transgendered individuals. Overall costs of counseling, hormones, electrolysis, and operations typically range from $30,000 to $80,000.


American Psychiatric Association. Transgender Individuals and Gender Identity. Accessed May 6, 2011.

Intersex Society of North America.

Kyomen HH, Nobel KW, Wei JY. The use of estrogen to decrease aggressive physical behavior in elderly men with dementia. Journal of the American Geriatrics Society, Vol 39(11), Nov 1991, 1110-1112.

Transgender Health.

Transgender Procedures.

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