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)
  • Body contouring—surgery to reshape the body to appear more feminine or more masculine
  • 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 Gender Care Program to request a consultation for gender-affirming chest (top) 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

  • 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

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

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