Gender affirming surgery consultation
For patients who have completed their specialist gender assessment and wish to pursue surgical interventions, including genital, chest, breast or facial feminisation surgeries, we provide a consultation to explore individual expectations and the potential short, medium and long term costs, benefits and outcomes of these interventions. We also take account of patients' broader circumstances as discussed in their initial assessment, e.g. social situation, physical health and psychological wellbeing, and experience of transition.
Following this consultation we provide an opinion regarding suitability and readiness for surgery. This opinion makes reference to the eligibility criteria for surgery as described in national and international guidelines. If appropriate, a referral can be made to a specialist surgeon providing gender affirming surgeries*. In the case of genital surgery, the patient is required to organise a further consultation with another gender specialist to obtain a second opinion**. Once a second positive opinion has been recieved a referral to a specialist genital surgeon can be made.
Eligibility criteria for all surgeries
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Persistent, well-documented gender dysphoria
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Capacity to make a fully informed decision and to consent for treatment
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Age of majority in given country (18 and over UK)
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If significant medical or mental health concerns are present, they must be reasonably well controlled
Current guidelines state that hormone therapy is not a prerequisite for chest surgery and that one specialist opinion is required before a referral can be made.
*In some circumstances a chest surgeon may request two specialist opinions, e.g. where there may be significant mental health issues or a non-binary gender identity.Patients need to check with their chosen surgeon and, if necessary, arrange a further opinion.
Additional eligibility criteria for genital surgery
For hysterectomy and/or salpingo-oophorectomy:
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12 months’ continuous endocrine treatment as appropriate to the patient’s goals (unless not clinically indicated for the patient or the patient is otherwise unable to take hormones)
For vaginectomy, urethroplasty, phalloplasty, metoidioplasty, testicular prosthesis and/or scrotoplasty, penectomy, orchidectomy, vaginoplasty, clitoroplasty and/or labiaplasty:
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12 months’ continuous endocrine treatment as appropriate to the patient’s goals (unless not clinically indicated for the patient or the patient is otherwise unable to take hormones)
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At least 12 months’ living continuously in a gender role that is congruent with the gender identity
**Current guidelines state that two specialist opinions are required before a referral for genital surgery can be made. Some surgeons require that one opinion comes from a 'medically qualified' clinician. Patients need to check with their chosen surgeon and if necessary, ensure that their second opinion is sought from a medical practitioner.
Location
At this current time, most consultations are conducted online via secure video link. Appointments can also be made in person at our Exeter base, if necessary.
Appointment duration
For patients who wish to be referred for (non-genital) surgery immediately following specialist gender assessment, the consultation is usually included in the assessment.
For existing GISW patients returning at a later date for consultation: 1 hour.
For patients of other services requesting a first or second opinion: 1.5 hours.
Pricing & payment
Included in the cost of the specialist gender assessment for patients seeking (non-genital) surgery immediately following assessment: £600.
For existing GISW patients returning at a later date for consultation: £200.
For patients of other services requesting a first or second opinion: £300.
Payment is made at the point of booking using a secure online booking and payment system.
Clinical documents & referrals
A summary of the consultation and an opinion regarding eligibility for surgery is produced and included in the assessment report or written separately if not part of the assessment. Patients are asked to confirm that the content of the report represents an accurate reflection of the consultation before it is finalised. A copy is sent to the patient, their GP and if eligibility criteria are met then a referral to a gender specialist surgeon is made.
The World Professional Association for Transgender Health’s Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (2012, Version 7) states the following criteria must be met before a referral for surgery can be made: