The Premier Transgender Surgery Institute, New Delhi, India

Gender Incongruence/ Gender Dysphoria/Gender Identity Disorder:

Gender Incongruence is defined as marked/persistence incongruence between one’s assigned sex at birth (biological sex) and the experienced or felt/perceived gender. Gender Incongruence is also known as Gender Identity Disorder (GID) or Gender Dysphoria.

As per WHO Declaration (May, 2019), Gender Incongruence is no more a Psychiatric Illness.

The treatment is popularly known as Transition or Transformation (Male to Female transition and Female to Male transition).

The first step in the path of treatment /transitioning journey of a transsexual /transgender (both MtF or FtM) is to get the diagnosis of Gender Incongruence/Gender Dysphoria. This is established by an experienced psychiatrist who specially deals in the field of Transgenderism. Depending on the situation, psychological counselling may be advised for a certain period.

Once the diagnosis of Gender Dysphoria is established, Hormonal Therapy is instituted in accordance to Endocrinologist. This is also known as Medical Transition. Hormone therapy in transgenders (Transmen and Transwomen) is popularly known as HRT. Hormonal Replacement Therapy in Female to Male transgenders is also known as T (Testosterone) Therapy. Oestrogen, progesterone and testosterone blockers (T- blockers) are the mainstay for male to female medical transition.

After a certain period of hormonal treatment, sex reassignment surgeries (procedures) are carried out also known as Surgical Transition. The usual practice followed is as per WPATH standards/guidelines, though the guidelines are quite flexible and vary individual to individual.

Sex reassignment surgery (abbreviation SRS, also known as Gender affirmation surgery or Sex change operation) is conglomerate term used for all the surgical procedures which are carried out to alter a person’s physical appearance and function to resemble to that of opposite sex. Other terms used for Sex reassignment procedure are Gender reassignment surgery, Gender Correction Surgery, Gender Confirmation Surgery.

Various Male to Female surgical transition procedures are –

• Facial Feminization Surgery (FFS) which include-
  1. Forehead reconstruction (type 1, type 2 and type 3 and Type K)
  2. Nose feminization (feminizing rhinoplasty)
  3. Malar augmentation (cheek feminization)
  4. Lip augmentation, lip lift
  5. V line surgery , V shaping
  6. Tracheal shave (Adam’s Apple correction)
• Voice feminization surgery
• Breast augmentation (Chest Feminization), Breast Implants or Fat grafting/transfer for breast enhancement
• Genital Affirmation Surgery – (Cosmetic SRS- 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 (Hour Glass Figure)

Various Female to Male surgical transition procedures are—

• Chest masculinization also known as Top surgery (Key hole and double incision top surgery, Nipple Graft)
• Female to male Genital Surgery (Bottom surgery)–
  Mini MG SRS-
  • Laparoscopic Hysterectomy and oophorectomy (uterus/womb and ovaries removal)
  • Vaginectomy (vagina removal)
  • Urethral extension/elongation and Urethra masculinization
  • Metoidioplasty
  • Scrotoplasty, Testicular Implants
  Phalloplasty (abdominal flap, radial artery forearm flap, MLD flap ALT flap) Penile implants
• Face masculinization Surgery (FMS)–
  • Beard and Moustache hair transplant
  • Facial Implants