The Transgender Dictionary
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Surgeons

(also: surgery)

Table of Contents

Introduction

This page is intended to provide miscellaneous information for various things related to surgeons and surgery. For information on specific surgeries relating to to transgender topics, simply navigate via the hyperlinks either throughout the dictionary portion of this website, or below in the section regarding different types of surgeon. This website may also contain miscellaneous information regarding certain surgical procedures that are not yet commonly available, resources regarding financing transgender operations, and information regarding anesthesia.

Most of the pages on this site should have relevant links at the bottom of the page with sources, and ways to find additional information relevant to the surgery discussed on that individual page. This page is for miscellaneous information, or information that applies to multiple different types of surgeries.

General Information

There are various terms used in the transgender community regarding different types of surgery. "Bottom surgery" or "lower surgery" commonly refers to surgeries that have to do with genitalia. "Top surgery" commonly refers to surgeries that have to do with the chest.

Not everyone has the most conventional or common types of surgical gender transition. Nullification refers to having certain "removal" type surgeries without having a "replacement" type surgery. Salmacian typically refers to having a desire to obtain an unconventional genital set.

Neither this page, nor the individual pages dedicated to discussing particular surgeries will contain all possible information on the surgeries discussed. If you are planning on getting any kind of surgery in the future (transgender related or not) always be sure to do your research. I am not a medical professional.

Unfortunately, there is transphobia in the medical world. There are surgeons who specifically seek out transgender patients to give them "botch jobs" deliberately. Make sure to look up the name of your surgeon ahead of time, and look for reviews and photos from people who have actually gotten that surgery from that surgeon. Due in part to this, there is a lot of fearmongering in relation to the quality of transgender surgeries, and what the outcomes of these surgeries typically look like. If you are considering getting surgery of any kind, it is a good idea to look at healed results from your surgeon of choice (it is rare that any surgery, gender-related or not, looks perfect immedeatly after getting it). All surgeries require some period of rest and healing.

There is also often a lot of transphobia in the form of medical gatekeeping. Sometimes it can take a very long time for a transgender person to obtain the surgeries that they desire. In some places, a patient is required to attend therapy and recieve multiple letters of recommendation and multiple gender dysphoria diagnoses to have certain surgeries. The exact requirements will vary.

Types of Surgeons

There are many types of surgeons trained to deal with the multitude of matters regarding the complexities of the human bodies. Many surgeons will diagnose patient issues themselves, or patients may be referred to see a relevant doctor regarding their condition.

Anesthesia

Most surgeries require the patient to undergo some sort of anesthesia. Anesthesia refers to various medications known as anesthetics that are used to prevent a patient from experiencing pain during procedures or surgery. Anesthetics block nerves at the site of the procedure from sending signals from reaching the brain. The length of time you are under anesthesia depends on the type of surgery you undergo. Anesthesia is not technically a pain killer, it just prevents you from experiencing pain.

The anesthesia care provider will typically discuss interview you prior to surgery (either over the phone or in person) to review your health history and determine any potential complications. Make sure that you discuss any herbal supplements or vitimans that you may be taking. It is advised to stop drinking or eating for at least 8 hours prior to surgery unless directed to do otherwise, however certain types of anesthesia (such as general anesthesia) require that you fast for a longer period of time. The length of time should be discussed during that interview.

Anesthesia can impair judgement for up to 24 hours, which is why it is not advised to consume anything else that can also impair judgement after undergoing surgery. This inculdes but is not limited to refraining from smoking cannabis, drinking alcohol, or any pain medications not approved by your doctor. Stop taking viagra at least 24 hours before your procedure.

If you have previously experienced nausea while under anesthesia, or think that you may be prone to nausea, you can tell your your provider and they can give you anti-nausea medications. While under anesthesia, vital signs such as blood pressure, pulse, blood oxygen level, and heart rate are all monitored by an anesthesiologist. The anesthesiologist will also monitor for issues such as potential allergic reactions.

Potential side effects from anesthesia include fatigue, headache, muscle pain, nausea/vomiting, pharyngitis (sore throat), chills, itching, difficulty urinating, or pain/tenderness/redness/bruising at the injection site. Most of these effects go away on their own after 24 hours (as anesthesia can remain in your system for up to approximately 24 hours). Everyone reacts differently to anesthesia.

Certain factors such as nerological disorders, seizures, advanced age, sleep apnea, lung disease, high blood pressure, arthritis, heart disease, diabetes, kidney disease, or a family history of malignant hyperthermia can increase the risk of complications during anesthesia. Malignant hyperthermia is a rare, inherited condition where a patient has a dangerous reaction to anesthesia involving fever and muscle contractions. It is important to know if you have a family member with this condition, so that you can alert your anesthesiologist as to what drugs to avoid having this reaction.

Nerve damage is rare, but temporary or permanent neuropathic pain, numbness or weakness. Older patients are prone to postoperative delirium, a condition that causes confusion for roughly a week. Sometimes, postoperative delirium can cause long-term memory and learning issues.

Call your provider if you have recently had anesthesia and are experiencing slurred speech, difficulty breathing, dysphagia (difficulty swallowing), swelling, extreme itchininess, or numbness or paralysis anywhere in your body.

General Anesthesia

General anesthesia can be administered via either anesthetic gases or IV medications.

General anesthesia causes a patient to be insensitive to pain or stimuli. It also results in the patient being unconcious. You are typically given a drug that keeps your body still so that it does not move during surgery. An endotracheal breathing tube is placed down your trachea (windpipe) by the anesthesiologist to allow you to breathe while unconcious. A laryngeal mask airway (LMA) may also be used to assit with breathing. General anesthesia is typically used during invasive procedures or surgeries for the abdomen, head and chest.

After surgery, you will be moved to a recovery area to rest and recover from surgery. No responsible provider will allow a patient to drive themself home after undergoing a procedure involving general anesthesia (due to the delirium the medications involved can cause), so make sure that you have a ride to take you home. Remember to always rest the rest of the day after surgery (and for the rest of the healing time as directed by your surgeon). Abstain from alcohol, do not make any important or legal decisions, do not drive or operare equipment, or take any medications not approved by your provider. You may be given a stool softener, as general anesthesia can result in delayed bowel and bladder functions.

1 out of every 1,000 patients who undergo genderal anesthesia experience what is called anesthetic awareness. This is where the patient is aware of what is happening, but is unable to move or communicate. The cause of anesthetic awareness is unknown.

Atelectasis (collapsed lung) is a rare condition where air sacs in the lungs can deflate or fill with fluid. This can occur while during surgery that involves a breathing tube.

Local Anesthesia

Local anesthesia is used for minimally invasive procedures where the patient remains awake. Local anesthesia numbs a small section of the body. Local anesthesia is typically injected by a nurse near the area that needs to be treated. Although you will not feel pain while under local anesthesia, you may feel pressure. If feeling the pressure causes anxiety, the patient can be administered a sedative to help with said anxiety.

Local anesthetics include things such as novocaine, which is used in dental care.

Regional Anesthesia

Regional anesthesia blocks pain in a large part of the body. This is also known as a peripheral nerve block. Regional anesthesia may be administered alongside sedation, or by itself. This type of anesthesia may block pain in a hand, foot, or arm.

Local anesthesia is injected near a cluster of nerves to numb a larger region (or area) of the body. The body part can remain numb for up to 36 hours.

Neuraxial (Spinal or Epidural)

Neuraxial is a type of anesthesia that is injected near the spine and numbs the lower half of the body. With both regional and neuraxial, you can choose the level of conciousness that you will be in during your procedure. An epidural is commonly used during childbirth.

Sedation

Also known as "twilight sleep" this type of anesthesia heavily relaxes you, but not to the point of being unconcious. You are unlikely to remember a procedure done under sedation. You may nap, but will be able to wake up if needed and communicate during the procedure.

Cannabis & Anesthesia

It is recommended to stop using marijuana products 72 hours before surgery. Do not smoke pot the same day of surgery. This is because it can interfere with the anesthesia in terms of causing respiration, cardiovascular, and pain management issues. If you smoke or otherwise consume any kind of cannabis products, and are planning to get surgery of any kind, discuss your usage with your surgical team. It is vital that your anesthesiologist have all necessary information to be able to assess risk factors, and make appropriate plans for care before, during, and after surgery. Your surgical team exists to keep you safe while under surgery, not to judge you. Do not withhold vital medical information before undergoing surgery.

Smoking weed can cause heat-related damage to the throat and airway. Marijuana smokers can have wheezing, coughing and chronic bronchitis. These are all things that can negatively impact someone, especially while under anesthesia.

Damage caused to the airways from cannabis use can cause issues in terms of placing a breathing tube. Smoking marijuana can cause swelling of the uvula (uvulitis). This swelling can make it more difficult for a breathing tube to be placed. This can also sometimes result in the patient being required to stay on a breathing machine for some time after surgery, due to issues with removing the breathing tube. A patient being a heavy cannabis user can also cause a need for more medications than typically required to be administered. The risk of respiratory infections is also increased.

The effects that weed has on heart rate and blood pressure has the potential to increase the risks of a heart attack and/or stroke while under anesthesia (especially if smoked the same day as surgery). Marijuana can affect the amount of pain medication required to provide relief following a surgical operation (you can require more medication for a longer period of time). Cannabis can affect your risk for nausea/vomiting (it can be increased). It can affect the likelihood of cannabis withdrawal symptoms after surgery. Marijuana usage has the potential for adverse interactions with other medications.

Certain perscribed cannabinoid-based medications should not be stopped prior to surgery, such as dronabinol, nabilone, or epidiolex.

As cannabis use is underresearched in general, there are many unknowns regarding the risks relating to cannabis use and surgery.

Cigarettes & Anesthesia

It is recommended not to smoke cigarettes, as smoking cigarettes can coronary heart disease, stroke and lung cancer (both for yourself and the people around you who are forced to breathe in your secondhand smoke). While everyone can agree that there are endless health benefits to not smoking cigarettes, and there will never be a better time to quit smoking than the moment you're reading this, this section is regarding how smoking can affect you while under anesthesia.

It is much harder for an anesthesiologist to keep a cigarette smoker breathing while under anesthesia than someone who does not smoke cigarettes. Being a smoker makes it more likely that bronchodilator medications like albuterol will have to be used during surgery. Smoking reduces bloodflow and slows the healing process, causing incisions to be more likely to become infected. This ie because the carbon monoxide in the body of people who smoke robs tissues of the oxygen they need to heal.

Smoking increases the risk of heart failure, heart attack and dying from heart disease. Tabacco harms heart and blood vessels, disturbs normal heart rhythms, contributes to inflammation, and increases both blood pressure and heart rate. Smoking cigarettes puts you at a 77% greater risk of having a heart attack after surgery than people who don't smoke.

Smoking prior to surgery is associated with higher rates of intensive care unit admissions, emergency readmissions, and longer inpatient stays.

If you are planning on getting surgery, consider it a convenient excuse to quit smoking for good. The earlier you quit smoking before surgery, the lower your risks will be.

Inpatient Vs Outpatient

The terms "inpatient" and "outpatient" get thrown around a lot in regards to surgery, but what do these terms mean? Simply put an "inpatient" procedure requires that the patient stays overnight at the medical facility where the surgical procedure took place. The number of days a patient stays at the hospital during an inpatient procedure depends on the procedure. An "outpatient" procedure is a procedure where the patient is at the medical facility for less than a day. The length of time spent at the medical facility during an outpatent procedure will vary depending on the surgical procedure.

Australia-Based Resources

United Kingdom-Based Resources

United States-Based Additional Resources

Find Surgeons & Learn More About Surgery

Bad Experiences

For lack of a better location on this site for posting bad experiences with particular surgeons, here you go. (Obviously this is not every bad surgeon that exists, but it contains some bad experiences as I come across them, or as they are submitted to be added. Like mentioned previously, always do research on whatever surgeon that you end up going to, even if they are mentioned elsewhere on this website in a positive manner. Always be careful with who handles your body in any context.)