Gender-Affirming Surgery

At Swedish, we have a select group of providers who specialize in gender-affirming surgeries for transgender and gender-diverse patients. For other transgender health needs, including assistance navigating the health care options available to you, visit our Transgender Health section. 

Learn more about preparing for surgery and the several types of surgery we offer below.

Preparing for Surgery

Washington State Medicaid

Private insurance

  • For patients with private insurance, please call your insurance plan to verify surgical requirements or reach out to the Swedish Transgender Health Navigator for verification support. 

Mental health letters

Gender-Affirming Hysterectomy

Hysterectomy is the surgical removal of the uterus and usually the cervix as well. It can be done vaginally (no abdominal incisions), laparoscopically or robotically with tiny abdominal incisions. It is generally an outpatient surgery with no overnight stay.

Our hysterectomy team

Preparation for hysterectomy

No specific preoperative preparation is required outside of meeting with your surgeon who may order an ultrasound if you have not had one, as well as some baseline blood work. A pap smear may be necessary if you have not had one within the past three to five years. 

Considerations and risks

Benefits of hysterectomy can include gender affirmation, relief from pelvic pain or vaginal bleeding and removal of the cervix, which typically ensures you won't need any more pap smears.  Ovaries can be removed at the same time as hysterectomy, or they can be kept intact. This decision involves a discussion of the risks and benefits of the loss of hormones from the ovaries. Keeping the ovaries also allows for future egg harvesting if you desire a biological child. 

Risks of the surgery are low but can include bleeding, infection, pain and damage to surrounding organs. After a hysterectomy it is not possible to get pregnant. If you are interested in discussing fertility preservation options, we can refer you to a fertility specialist. 

For those that may want to have genetic children after removal of ovaries at the time of hysterectomy, it is possible to freeze eggs or embryos prior to surgery. This involves consultation with a fertility specialist and subsequent hormonal stimulation of the ovaries, with a minor surgical procedure to remove eggs from the body. We work frequently with Pacific Northwest Fertility, home of the Center for LGBTQ+ Fertility, with providers that are experienced working with gender diverse patients.  

Recovery

Typical recovery to get back to a desk job is a couple of weeks. Longer restrictions including nothing in the vagina and no heavy lifting for eight to 12 weeks.

Aftercare from surgery 

Once you go home it is safe to eat but listen to your body and eat what feels comfortable, starting with smaller portions. You can shower the day after your surgery, allowing water to run over any incisions. Pain is generally controlled with Tylenol and Ibuprofen, with narcotic medications for breakthrough pain. While on pain medications drinking plenty of water and using a stool softener is key. Incisions heal in the first few days. Talk with your surgeon about the dressings that should be used and when you can remove them as it may vary by surgeon. If there is heavy bleeding, fevers, redness or chills you should contact your doctor's office immediately. Walking is allowed as soon as you are able, stairs are safe to climb. Talk with your surgeon about post operation lifting restrictions as they may vary by surgeon.

Gender-Affirming Oophorectomy

Oophorectomy is surgical removal of one or both ovaries. It can be done laparoscopically with tiny incisions as an outpatient surgery with no overnight stay. It can be performed in conjunction with a hysterectomy or can be done separately. Surgical removal of both ovaries removes the hormones they make, which include estrogen, progesterone and testosterone. Typically, the recommendation is to leave normal appearing ovaries in place, even in gender affirming surgery, as they can be a backup source of hormone. Leaving ovaries in place can also allow for use of the eggs at a later time for fertility. Ultimately, however, it is up to the patient.

Our oophorectomy team 

Preparation for oophorectomy

No specific preoperative preparation is required outside of meeting with your surgeon who may order an ultrasound if you have not had one, as well as some baseline blood work. 

Considerations and risks 

Benefits of oophorectomy can include reduction of the female hormone estrogen for gender affirmation and if the ovaries are abnormal, may also provide pain relief. Risks are low but can include bleeding, infection, pain and damage to surrounding organs. High volume surgeons have better outcomes, so consider seeking out a high-volume minimally invasive gynecologic surgeon. After an oophorectomy you will not have any more eggs, so if you are interested in discussing fertility preservation options, we can refer you to a fertility specialist.

For those who may want to have genetic children after removal of ovaries at the time of oophorectomy, it is possible to freeze eggs or embryos prior to surgery. This involves consultation with a fertility specialist and subsequent hormonal stimulation of the ovaries, with a minor surgical procedure to remove eggs from the body. We work frequently with Pacific Northwest Fertility, home of the Center for LGBTQ+ Fertility, with providers that are experienced in working with gender diverse patients.  

Recovery

You can generally return to a desk type job in two to three weeks. We ask that you refrain from lifting for six to eight weeks.

Aftercare from surgery

Once you go home it is safe to eat but listen to your body and eat what feels comfortable, starting with smaller portions. You can shower the day after your surgery, allowing water to run over any incisions. Pain is generally controlled with Tylenol and Ibuprofen, with narcotic medications for breakthrough pain. While on pain medications drinking plenty of water and using a stool softener is key. Incisions heal over the first few days. Talk with your surgeon about dressings that should be used and when you can remove them as they may be removed by surgeon. If there is heavy bleeding, fevers, redness or chills you should contact your doctor's office immediately. Walking is allowed as soon as you are able, stairs are safe to climb. Talk with your surgeon about post operation lifting restrictions as they may vary by surgeon. 

Gender-Affirming Rhinoplasty

Rhinoplasty is plastic surgery to change the outer shape of the nose. The surgery is done in an operating room as an outpatient procedure and does not typically require an overnight stay.

Our rhinoplasty team

Preparation

No specific preoperative preparation is required other than meeting with the surgeon. Depending on your past medical history, you may need to have a primary care provider clearance visit.

Considerations and risks

The benefits of rhinoplasty surgery include gender affirmation as well as potential improvement in nasal breathing. The risks of surgery include bleeding, infection, reaction to the anesthesia, injury to surrounding structures, poor healing, thickened scar, asymmetry, scar bands and septal perforation.

Recovery

The pain is typically managed well with either an opioid pain reliever or acetaminophen l after surgery. Most people are able to return to work after about one week. It is common to have skin bruising for the first one to two weeks. You can also place an ice pack on the surgery site for 20 minutes at a time to help with pain and swelling.

Aftercare from surgery 

For the first week after surgery you will have a tape dressing on your nose which you will need to keep dry. You will perform incision-line cleaning two to three times a day until your first postoperative visit, which is about one week after surgery. The nose is not typically packed with gauze after surgery. There will be dissolvable sutures that come out on their own over the first few weeks after surgery.

Gender-Affirming Tracheal Shave

Tracheal shave surgery is the surgical trimming of the Adam’s apple or laryngeal prominence. The surgery involves a horizontal skin incision which is made in the central area of the neck. 

Our tracheal surgery team

Preparation

No specific preoperative preparation is required other than meeting with the surgeon. Depending on your past medical history, you may need to have a primary care provider clearance visit.

Considerations and risks

The benefits of tracheal shave surgery include gender affirmation. The risks of surgery include bleeding, infection, reaction to the anesthesia, injury to surrounding structures, injury to the vocal cords, voice change, poor healing, thickened scar, asymmetry, persistent laryngeal prominence and airway swelling.

Recovery

The pain is typically managed well with acetaminophen after surgery. Most people are able to return to work after four to seven days. It is common to have skin bruising for the first one to two weeks. You can also place an ice pack on the surgery site for 20 minutes at a time to help with pain and swelling.

Aftercare from surgery  

For the first few days after surgery you will have a gauze dressing over your neck surgery site. You will also have skin stitches removed about one to two weeks post-surgery at your first postoperative visit. Once you remove your dressing, you’ll perform incision-line cleaning two to three times per day until that first postoperative visit (one to two weeks after surgery). You can get your stitches wet with soap and water 48 hours post-surgery.