Interested in Having Gender-Affirming Surgery? Keep These Four Pieces of Advice in Mind

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When it comes to transitioning, there is no one or "right" way to undergo your process. For some, being their most authentic self may come solely through changing their pronoun or receiving hormone therapy or having a form of gender-affirming surgery -- or a combination of all three.

In no way are procedures such as chest masculinization, breast augmentation, vaginoplasty or phalloplasty required to transition. However, for those of you who feel that surgery is a necessity to live your truth, there's a lot you need to know -- not just about what the surgeries entail, but also their numerous nuances. sat down with several transgender individuals and experts to get the scoop on four important factors you need to know, now.

Make Sure You Do Your Research!

Andy Marra
Andy Marra
Audrey Gater

Whatever form of surgery you are planning to have, not only do you need to know what the surgery entails but also who is the most-qualified surgeon in your area.

Andy Marra, a trans gender woman from New York City who recently had genital surgery, stresses that doing this work will help ensure the quality of care that you deserve.

"Yes, trans health care needs to be better, and we need more surgeons who are culturally competent, but in 2017, there are many more health care professionals and surgeons who provide trans care than ever before. So, you do not have to just go with the first surgeon you find or the cheapest," she says.

In addition, make sure you scrutinize surgeons' before-and-after pictures and talk to others in the community about their experiences -- not just about physical outcomes but also their surgeon's culturally competency and sensitivity. In addition, become familiar with the World Professional Association for Transgender Health (WPATH) to understand a range of issues, including eligibility, insurance coverage, how many referrals you need depending on where you live, etc.

Remember: Surgery can be scary and overwhelming, and it's crucial that you go into it armed with the facts.

Work on Your Health Prior to Surgery

You cannot underestimate the seriousness of these procedures.

They can be major reconstructive surgeries that require a lot of healing and can result in complications and certain infections. This is why you need to be in optimal health beforehand, says Zil Goldstein, NP, the program director for the Center for Transgender Medicine and Surgery at Mount Sinai in New York City.

"We are not going to perform surgeries on people who are unhealthy," she says.

With any surgery, you have to be medically cleared first, and that requires having a certain body-mass index (some require no higher than a 33) and a physical to ensure that any chronic diseases you have -- such as diabetes or high blood pressure -- are in check.

"[If you want surgery,] having extra body fat can put [added] pressure on parts of the body that need to heal, and we've found that can prevent you from healing adequately," she said.

This emphasis on healing and health in relation to gender-affirming surgery rings especially true for those trans folks living with HIV, whose immune systems are already vulnerable.

Goldstein emphasizes: "Your viral load must be undetectable. If you're not taking your meds or you are but your meds are not effective, that it going to stand in the way of your healing and usher in infections and other potentially serious complications."

She also adds that one should quit smoking prior.

"This is for everyone, particularly for getting [bottom surgeries]. There are so many delicate blood vessels that we need to stay alive and stay flowing, and smoking can close those vessels and cause blood clots."

Factor in Aftercare and the Need for a Strong Support System

Tiq Milan
Tiq Milan

As we stated above, many of these surgeries are pretty major and can require time off work, being incapacitated for weeks to a few months and aftercare that can include dilation of the genitals and draining tubes from various parts of your body.

Tiq Milan, a trans man who lives in Brooklyn, stresses how crucial it is to understand the self-care that's required afterward.

"After my top surgery, I was sent home with long tubes coming out of my chest, and I had to measure how much liquid was draining every day. Then, I had to follow up weekly to show the amount that was draining. It's part of the process, and you have to take it seriously."

Marra also hopes that others take into account how necessary it is to have a strong support system afterwards in order to thrive and heal.

"I was bedridden the first month, so I relied heavily on my fiancé, my mother and a small group of close friends for everything from cooking meals, helping me get to the bathroom, running errands and keeping my morale high."

She adds, "I was lucky to have this strong support system, because you cannot do this alone."

Please Set Realistic Expectations

Jenna Rapues, M.P.H.
Jenna Rapues, M.P.H.
Selfie by Jenna Rapues

While numerous studies have shown that undergoing gender-affirming surgery can improve one's quality of life and mental health, Jenna Rapues, M.P.H., the interim director of the Center for Excellence for Transgender Health in San Francisco, says she's encountered clients with unrealistic expectations about how surgery will change their lives.

"I have so many trans female clients who have told me, 'Once I get my surgery, I'll be a normal woman, and all of my problems will be solved.' The surgery is one piece of transitioning, but it doesn't necessarily address or solve the other issues in our life. That is always going to be an ongoing process, and we are constantly evolving."

In addition, Rapues emphasizes the need to have realistic post-surgery expectations about what your body will look like afterward.

"If you get a [vaginoplasty], there is a chance that it won't always mirror or function [sexually] in the same way that a biological vagina does."

But Milan, who has phantom nerve pain and scars from his top surgery, points out that it's crucial to love yourself regardless.

"I love my chest, and getting it done was another step toward me becoming my most authentic self."