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Who can receive a surgical consult at the Center for Gender Surgery?

We see patients who have been referred by an outside behavioral health or primary care provider who has documented their diagnosis of gender dysphoria and the appropriateness of surgical treatment. When calling for an appointment, please let our team know if you are only seeking information about surgery rather than a full consult. If so, we will schedule you to talk with a team member who will explain the whole process, but you will not undergo a full assessment until you decide that surgery is something you wish to pursue.

What happens during the initial consultation for gender surgery?

During your initial consultation, you will first be seen by the team’s social worker and physician’s assistant (PA). In this assessment, you will review a number of factors, including your medical, behavioral health, and substance use history. You will also be asked for a brief overview of your gender history and the social worker will assess you for factors that could affect your ability to have surgery safely. This includes making certain that you have enough support in place to handle post-surgical care and that, if you’re working, you have a plan for paying your rent while you are out after surgery. The purpose of the social work assessment is to determine your readiness for surgery, not to delve deeply into your mental health. After you are seen by the social worker and PA, they will review your history with the surgeon. Then the PA, the surgeon, or both will go over the procedure with you in depth. This is both so that you can understand the risks of the procedure and so that you can express what you hope to accomplish through gender-affirming surgery. It’s important for the team to know that your goals are realistic, and for you to know what surgery can accomplish. Our nurse will also discuss with you the day-to-day details of recovery and then help you make a to-do list to get ready to move forward. If you are seeking top surgery (chest reconstruction or breast augmentation), we will perform a physical exam and take pictures at your initial consult. If you are seeking genital surgery, there is no physical exam until a later date.

What happens after the initial consultation for gender surgery?

Following a consultation, our team will meet to decide whether you are ready to move forward with surgery. If the answer is yes, the team will begin to work on obtaining prior authorization from your insurance. Once this is obtained, you will move forward with any necessary hair removal, which can take up to six months. A second scenario is that the team may determine that you will be a good candidate in the future, but that you are not ready for us to submit for authorization or to schedule surgery. This may be because you need more time in therapy or on hormones to qualify for surgery. It may also be because you need better, or additional, letters from your outside providers. Once this "homework" is complete, you may return for a second consultation. A final scenario is that we determine that you are not a candidate for surgery. This may be because you are too early in your gender journey. It could also be for health reasons, such as having too high a BMI or a history of smoking. In this case, you may be referred to GeMS, which provides physical and psychological assessment, care and support to young people with gender dysphoria. You may return at a later time to meet with the Center staff again for reevaluation and assessment.