Gender-Affirming Surgery

What Does Gender-Affirming Treatment Mean?

The term gender-affirming treatment describes all medical measures used to align a person's physical sex characteristics with their gender identity. It replaces older terms now considered stigmatising, such as "sex change". Transition is not a single, uniform process but an individual path that, depending on personal wishes and medical indication, can consist of various building blocks – from psychosocial support through hormone therapy to surgical procedures.

Internationally, diagnostics and treatment recommendations are based on the Standards of Care issued by WPATH (World Professional Association for Transgender Health), which are regularly updated and currently exist in their 8th version (SOC 8, 2022). In Germany, specialised centres also follow the guidelines of the German Society for Sex Research as well as the recommendations of the German Society of Urology.

Hormone Therapy

Hormone therapy is often the first medical step of transition and can already bring about far-reaching physical changes. In transmasculine individuals (female to male), testosterone is typically used, which among other effects promotes beard growth, deepens the voice, increases muscle mass and changes fat distribution. In transfeminine individuals (male to female), oestrogens are used, often combined with anti-androgens; typical effects include breast development, a change in body contour and softer skin.

Hormone therapy is carried out under endocrinological supervision and requires regular laboratory monitoring, since long-term effects on bone density, metabolism and cardiovascular health must be taken into account.

Surgical Procedures

Surgical measures within gender-affirming treatment are diverse and are guided by individual wishes and the clinical picture. In transmasculine individuals, mastectomy (breast removal with male chest contouring) as well as genital procedures such as metoidioplasty or phalloplasty are common. In transfeminine individuals, breast augmentation, genital surgery to create a neovagina (vaginoplasty), and aesthetic- reconstructive procedures such as facial feminisation surgery are among the frequently performed procedures.

Genital procedures are complex, require specialised experience, and involve an intensive aftercare phase. They are usually performed only after a stable course of hormone therapy and following thorough diagnostics and assessment of indication.

Further Measures

In addition to hormonal and surgical measures, non-medical aspects of transition play an important role: voice training to adapt the speaking voice, hair removal (for example laser or electrolysis treatment of the face or body), and the legal adjustment of first name and gender entry – in Germany possible since the Self-Determination Act (SBGG) came into force in November 2024, through a declaration at the registry office.

Psychosocial Support

Psychotherapeutic and psychosocial support is not a formal hurdle but an integral part of transition. It serves to clarify individual wishes, prepare for medical measures, and support social transition. According to current research – including a systematic review in the British Medical Journal (Hembree et al. and Dhejne et al.) – psychological distress among trans and non-binary individuals is significantly elevated before transition; well- supported measures lead in the majority of cases to a marked improvement in quality of life and a reduction in comorbidities such as depression and anxiety disorders.

A Note on UGRS

Gender-affirming procedures are not part of the core surgical scope of our practice. We provide information on this topic as part of our glossary and refer patients seeking specialised counselling and treatment to dedicated centres for transgender health.