Gender-Affirming Surgery

OHSU surgeons are leaders in gender-diverse care. We provide specialized services tailored to the needs and goals of each patient. We offer:

  • Specialists who do hundreds of surgeries a year.
  • Plastic surgeons, urologists and other specialists who are leading experts in bottom surgery, top surgery and other gender-affirming options.
  • Vocal surgery with a highly trained ear, nose and throat doctor.
  • Peer volunteers who can provide support during visits.
  • Welcoming care for every patient, every gender and every journey.

Our surgical services

We offer many gender-affirming surgery options for transgender and nonbinary patients. We also welcome you to request a procedure that isn’t listed on our pages.

Quick links to options on this page: [link each to the corresponding URL]

Top surgery:

Bottom surgery:

Bottom surgery options also include:

  • Penectomy
  • Scrotectomy
  • Scrotoplasty
  • Urethroplasty
  • Vaginectomy

Preparing for surgery

Please see our patient guide page to learn about:

  • Steps to surgery
  • WPATH standards of care
  • The letter of support needed for some surgeries

For patients

Request services

Other questions and concerns

Refer a patient

Adam’s apple reduction (laryngochrondoplasty)

Laryngochrondoplasty is also known as Adam’s apple reduction or a tracheal shave (though the trachea, or windpipe, is not affected).

A surgeon removes thyroid cartilage at the front of the throat to give your neck a smoother appearance. This procedure can often be combined with facial surgery.

Thin incision: At OHSU, this procedure can be done by an ear, nose and throat doctor (otolaryngologist) with detailed knowledge of the neck’s anatomy. The surgeon uses a thin incision, tucked into a neck line or fold. It can also be done by one of our plastic surgeons, typically with other facial surgery.

In an office or an operating room: Our team can do a laryngochrondoplasty in either setting, which may limit a patient’s out-of-pocket expenses.

OHSU also offers Adams’ apple enhancement surgery.

Body contouring

OHSU offers body-contouring surgery to create a more masculine or feminine shape. Surgery uses liposuction, fat grafting or both.

Requirements:

  • 18 or older.
  • Mental health letter of support.
  • If on hormone therapy, at least two years on a stable dose.
  • Body mass index (BMI) over 20 and under 35. Those with a BMI under 20 won’t have enough fat for liposuction. Those with a BMI over 35 will have fat inside the belly that can’t be removed with liposuction.
  • Surgery must target areas that affect gender perception.
    • For transmasculine patients, this includes liposuction to hips and thighs.
    • For transfeminine patients, it includes liposuction to the waist, sides, hips and buttocks. Liposuction to the belly and sides alone is considered cosmetic.

You must not need skin removal, such as in a tummy tuck, arm lift or thigh lift. These are considered cosmetic.

Facial surgery

Hormone therapy can bring out desired traits, but it can’t change the underlying structure or remove hair follicles. Our highly trained surgeons and other specialists offer options. Patients usually go home the same day or spend one night in a private room.

  • Browlift (done with the forehead)
  • Cheek augmentation
  • Chin surgery (genioplasty), including reductive, implants or bone-cut options
  • Eyelid surgery
  • Face-lift, neck lift
  • Forehead lengthening
  • Forehead reduction, including Type 3 sinus setback and orbital remodeling
  • Hairline advancement (done with the forehead)
  • Jawline contouring
  • Lip lift and/or augmentation
  • Lipofilling (transferring fat using liposuction and filling)
  • Nose job (rhinoplasty)

Genitoplasty

OHSU offers genitoplasty to create a gender-neutral look in the groin area.

This surgery may include:

  • Removing the penis (penectomy)
  • Removing the testicles (orchiectomy)
  • Reducing or removing the scrotum (scrotectomy)
  • Shortening the urethra
  • Removing the uterus (hysterectomy)
  • Removing the vagina (vaginectomy)

The procedure takes several hours. Patients can expect to spend one to two nights in the hospital. Recovery typically takes six to eight weeks. Patients are asked to limit walking and to stick to light to moderate activity for four weeks. They should wait three months before bicycling or strenuous activity.

Genitoplasty cannot be reversed. Risks can include:

  • Changes in sensation
  • Dissatisfaction with the final look
  • Infection
  • Healing problems

Removing the penis and testicles or the uterus also affects the ability to conceive a child. OHSU fertility experts offer options such as freezing eggs and connecting patients with a surrogacy service.

Hysterectomy

At OHSU, we specialize in hysterectomies (uterus and cervix removal; often combined with oophorectomy, or ovary removal) for gender-diverse patients. We do more than 150 a year.

We also offer a Transgender Gynecology Clinic with a gender-neutral space. Services include surgery. Referrals and appointments are made through the OHSU Center for Women's Health, though the space is not in the center. Call 503-418-4500 to request an appointment.

Some patients choose hysterectomy to:

  • More closely align their bodies with their gender identity.
  • With ovary removal, to remove a main source of the hormone estrogen.
  • To end pain caused by testosterone therapy that shrinks the uterus.
  • To end the need for some gynecologic exams, such Pap smears.

Preparation: We usually recommend a year of hormone therapy first, to shrink the uterus. We don’t require a year of social transition.

Most often, we use a minimally invasive laparoscope and small incisions in the belly. We usually recommend removing fallopian tubes as well, to greatly reduce the risk of ovarian cancer.

Most patients spend one night in the hospital. Recovery typically takes about two weeks. You’re encouraged to walk during that time but to avoid heavy lifting or strenuous exercise.

Hysterectomy is usually safe, and we have a low rate of complications. Risks can include blood clots, infection and scar tissue. Because of a possible link between hysterectomy and higher risk of cardiovascular disease, your doctors may recommend regular tests.

Removing the uterus also ends the ability to carry a child. OHSU fertility experts offer options such as egg freezing before treatment, and connecting patients with a surrogacy service.

Nipple reinnervation

OHSU offers targeted nipple-areola complex reinnervation, or TNR for short. TNR saves or restores sensation in the nipple and areola during gender-affirming mastectomy (breast removal).

Some patients choose TNR to:

  • Keep chest sensation
  • Reduce the risk of ongoing pain or numbness
  • Improve quality of life
  • Preserve sexual function

TNR isn’t right for everyone. It can be a good option if saving sensation is important to you. Discuss it with your surgeon.

In TNR, the surgeon:

  • Preserves nerves
  • Grafts more nerve length if needed
  • Fans out nerves to expand sensation in the nipple area
  • Connects chest nerves to the nipple area

TNR doesn’t change the typical recovery from mastectomy, a same-day surgery. Your nipple area may be extra sensitive for a few months. We offer patients a sensory rehabilitation program to improve results.

Extra sensitivity in the nipple area is the main risk of TNR compared with a standard gender-affirming mastectomy. A small portion of patients have reduced sensation. Others have more sensation after surgery.

Oophorectomy

Having a gynecologic surgeon remove one or both ovaries is often done at the same time as a hysterectomy. We do nearly all these surgeries with a minimally invasive laparoscope and small incisions in the belly.

Most patients spend one night in the hospital and return to their regular routine in about two weeks.

The ovaries produce estrogen, which helps prevent bone loss and the thickening of arteries. After removal, a patient should be monitored long-term for the risk of osteoporosis and cardiovascular disease.

We encourage patients to keep at least one ovary to preserve fertility without egg freezing. This also preserves some hormone production, which can avoid early menopause.

Orchiectomy

At OHSU, expert urologists do orchiectomies (testicle removal). Patients may choose this option:

  • To remove the body’s source of testosterone
  • As part of a vaginoplasty or vulvoplasty (surgeries that create a vagina and/or vulva)
  • To relieve dysphoria (some patients choose only this surgery)

Removing the testicles usually means a patient can stop taking a testosterone blocker. Patients may also be able to lower estrogen therapy.

The surgeon makes an incision in the scrotum. The testicles and the spermatic cord, which supplies blood, are removed. Scrotal skin is removed only if the patient specifically requests it. The skin is used if the patient plans a vaginoplasty or vulvoplasty.

You will probably go home the same day. Patients can typically resume normal activities in a week or two.

Reducing testosterone production may increase the risk of bone loss and cardiovascular disease, so we recommend regular tests. Without prior fertility treatment, orchiectomy also ends the ability to produce children. Serious risks are uncommon but include bleeding, infection, nerve damage and scarring.

Vocal surgery

Many patients find that hormone therapy and speech therapy help them achieve a voice that reflects their identity. For others, vocal surgery can be added to raise the voice’s pitch.

Voice therapy: Patients have voice and communication therapy before we consider vocal surgery. Your surgeon and your speech therapist will assess your voice with tests such as videostroboscopy (allowing us to see how your vocal cords work) and acoustic voice analysis.

Effective surgery: We use a surgery called a Wendler glottoplasty. It’s done through the mouth under general anesthesia. The surgeon creates a small controlled scar between the two vocal cords, shortening them to increase tension and raise pitch. Unlike techniques that can lose effectiveness over time, this surgery offers permanent results.