What Happens During Transgender Transformation and Surgery?

Transgender transformation or transsexual bottom surgery is a medical procedure or procedures that change the appearance and/or function of a transgender person’s existing genital features to match the genitals of their identified gender. This means removing a penis/vagina and replacing it with the genital of the opposite sex.

What is Transgender and What is Gender Reassignment Surgery?

Transgender is the term used to describe people who’s gender identity is different from the gender assigned at birth. In simpler terms, it is used to describe people who believe they were born with the “wrong” genitals. Some transgender people choose to live with their assigned genitals, however, others choose to have top and/or bottom surgery for their body to match their gender.

The surgery male to female is a serious and lengthy op that can have several complications and some transgender people choose only to have “top surgery”. Top surgery is the removal or addition of “feminine” breasts. Some people wish to avoid transgender surgery altogether and choose to continue living with their assigned genitals whilst using other methods such as hormone replacement therapy.

How Does Transgender Surgery Work and What are the Risks?

Transgender surgery has several different names;

  • Sex change
  • Gender reassignment surgery
  • Transgender transformation sequence
  • Transgender surgery male to female
  • Transgender surgery female to male
  • Top surgery is usually completed in a separate operation to bottom surgery, which is often a much longer surgery.

    Transgender Bottom Surgery Female to Male

    FTM bottom surgery has transgender transformation sequences and can be completed in two different ways to create a neopenis; a “Metoidioplasty” (the easier of the two processes) and a “Phalloplasty”:


  • Sepa/rate clitoris from surrounding tissue (HRT therapy helps to elongate the cliterus making this process easier).
  • Clitorus repositioned to match the positioning of the penis.
  • Some FTM patients may desire urethra lengthening to allow urinating from a standing position, but this process is optional
  • The vagina can remain or be removed depending on the patients' preference
  • This procedure will create a “neopenis” that may or may not maintain an erection on its own and is unlikely to provide penetrative sex.


    Once a neopenis is created through a metoidioplasty, FTM patients can use a phalloplasty to improve the appearance and function of their new genitals. A 5-8 inch skin graft is taken from the back, thigh, arm or abdomen to elongate the neopenis.


    The labia is used to create a scrotum, and FTM patients can have further surgery at a later date to include testicular implants.

    Follow Up Surgery

    For FTM patients looking for a full transgender transformation, many choose to have a penile implant fitted after the initial surgery to maintain erections and perform penetrative sex.

    Transgender Bottom Surgery Male to Female

    MTF surgery is offered through three main methods:

  • non-penile inversion vaginoplasty
  • penile inversion
  • rectosigmoid (colon graft)
  • Each surgery works differently to remove the penis during transgender surgery male to female.

    Non-Penile Inversion Vaginoplasty

    This technique - also known as the Suporn technique or Chonburi Flap - works similarly to a penile inversion, but uses the scrotal tissue to create a graft which is later used to create the vaginal lining and labia majora. The penal tissue is then used to create the labia minora and clitoral hood - and is often considered to be the best surgery to maintain sensitivity as well as create the most realistic and attractive genitals.

    Penile Inversion

    The penile skin is used to create a neovagina, whilst the scrotum is used to create labia - meaning most post-op transgender women still have good genital sensation. The operation is popular and one of the more simple - however, the neovagina doesn’t self lubricate. Additional procedures during the surgery, such as using the remaining scrotum tissue to extend the debt of the vagina and the intact mucosal urethra from the penis to line the vagina for assistance with self lubrication.


    Transgender women who didn't receive high levels of testosterone thanks to hormone blockers, often require a rectosigmoid to make up for the lack of penile and scrotal tissue. The procedure includes using a part of the intestine to elongate the neovagina. The transgender transformation is also common with cisgender women to help elongate the vagina.