Gender-Affirming Surgery

OHSU patient Molly Palmer.
Molly Palmer has much lower anxiety and better health after embracing her true gender. She received care for her transition — as well as for multiple sclerosis — at OHSU. “I’ve felt like a woman my whole life,” she says.

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, including options within the following types. We also welcome you to request a procedure that isn’t listed on our pages.

Top surgery:

Bottom surgery:

Bottom surgery options also include:

  • Penectomy
  • Scrotectomy
  • Scrotoplasty
  • Urethroplasty
  • Vaginectomy

Additional gender-affirming options:

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

Hysterectomy

At OHSU, our gynecologic surgeon, Dr. Lishiana Shaffer, specializes in hysterectomies (uterus and cervix removal; often combined with oophorectomy, or ovary removal) for gender-diverse patients. She does 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.

Dr. Lishiana Shaffer.
Dr. Lishiana Shaffer is an expert gynecologic surgeon. Her specialty areas include caring for transgender and gender-nonconforming patients.

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.

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.

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.

Adam’s apple reduction (laryngochrondoplasty)

Dr. Joshua Schindler.
Dr. Joshua Schindler

Dr. Joshua Schindler, an ear, nose and throat doctor who does Adam’s apple and vocal surgeries, completed his training at Johns Hopkins University.

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.

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.

Face and body 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.

Face options:

  • 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)

Body options:

Hormone treatment may not result in fat distribution consistent with your gender. We offer liposuction and fat grafting to reshape areas of the body.