Surgical treatment options for gender dysphoria

Gender-affirming surgery refers to surgical procedures that change a person's anatomy and body function to be more aligned with their gender identity. When carefully personalized and appropriately performed, these procedures can play a significant role in treating gender dysphoria. However, gender-affirming surgery is not part of the journey for all transgender and gender-expansive people.


At Main Line Health, we work alongside patients to identify surgical procedures that will help achieve their goals. Our specialized team of surgeons currently offer:

  • Facial feminization—a variety of procedures that help reshape the structure of the face to give it a more feminine appearance
  • Thyroid cartilage reduction (tracheal shave)—surgery to reduce the size of the Adam's apple
  • Chest (top) surgery—surgery to reshape the chest to have a more feminine appearance (breast augmentation) or a more masculine appearance (bilateral mastectomy)
  • Vaginal construction—reconstructive surgery to create a vagina, labia, and clitoris; in some circumstances, a vagina is not desired and only the labia and clitoris will be created (vulvoplasty)
  • Penile construction—reconstructive surgery to create a penis (phalloplasty) and scrotum (scrotoplasty)
  • Body contouring—surgery to reshape the body to appear more feminine or more masculine
  • Hysterectomy—surgical removal of the uterus and ovaries
  • Vaginectomy—surgical removal of the vagina
  • Orchiectomy—surgical removal of the testes (testicles)
  • Voice and pitch surgery—surgery to change the sound of the voice

Eligibility criteria for gender-affirming surgery

Our surgical team follows the World Professional Association for Transgender Health (WPATH) standards of care, which outline criteria for certain gender-affirming surgeries, including letters of readiness (one or two, depending on the procedure).

  • If two letters are required, they must be from two separate mental health professionals, each with at least a master's degree. Primary care providers, endocrinologists, and other medical or surgical specialists cannot provide letters of readiness unless they hold a degree in a mental health specialty.
  • For your convenience, you can download a template for a letter of readiness.

Before contacting the Main Line Health Comprehensive Gender Care Program to request a consultation for gender-affirming chest (top) or genital (bottom) surgery, we recommend that you review the WPATH criteria for these procedures, which are summarized below:

WPATH criteria for gender-affirming chest (top) and genital (bottom) surgery

Top surgery: breast augmentation or bilateral mastectomy

  • Age 18 years or older
  • Ability to make a fully informed decision about treatment
  • Persistent, documented gender dysphoria
  • 12 continuous months of feminizing hormone therapy for breast augmentation to optimize breast tissue growth prior to surgery; no hormone requirement for bilateral mastectomy
  • One (1) letter of readiness

Bottom surgery: vaginoplasty or phalloplasty

  • Age 18 years or older
  • Ability to make a fully informed decision about treatment
  • Persistent, documented gender dysphoria
  • 12 continuous months of feminizing or masculinizing hormone therapy
  • 12 continuous months of living full time in a gender role congruent with one's gender identity
  • Two (2) letters of readiness

If you are interested in scheduling a surgical consultation, have questions about your eligibility, or want to know more about gender-affirming surgeries at Main Line Health, our gender services nurse navigator will be happy to assist you.

To learn more about the Main Line Health Comprehensive Gender Care Program or to schedule an appointment with a gender care specialist, please call 484.337.5329 for a consultation.