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# Sexual reassignment surgery

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Sexual reassignment surgery (SRS) is the surgical procedure by which a person's physical appearance and function is changed to that of the other sex. This is part of a treatment for gender identity disorder, involving surgery involving the internal / external sex organs, and removal of the breasts as is the case involving persons born with a female body. Also, other procedures can be labeled SRS, like the enhancement of breasts of people born with a male body, re-shaping of facial features, or surgery to lift the voice. Re-shaping of the facial features of persons identifying as female is more commonly referred to as facial feminization surgery[?] or FFS.

Other names include: sex change operation, gender reassignment surgery, genital reassignment surgery.

The person will have the apparent anatomical structures and function of the new sex and must take hormones (testosterone or estrogen) to maintain muscle and bone integrity and characteristic form. They are unable to reproduce due to the lack of actual sex glands (testes or ovaries), except through prior sperm banking or embryonic freezing, which still require a genetic female as the birth mother (See Reproductive technology.).

Persons who pursue sexual reassignment surgery are usually referred to as transsexual; "trans" - to go or travel between points; "sexual" - pertaining to the sex of a person. More recently, also persons pursuing SRS sometimes call themself transgender instead of transsexual.
Transsexuals prior to surgery are often referred to as pre-operative; those who have already had the surgery may be referred to as post-operative or simply identified by the sex and sexual status to which they have ascribed. Not all transsexual people are able to or choose to have sexual reassignment surgery (for several reasons, for example financial reasons, due to the high cost of such surgery, or medical reasons), although they live constantly in their target gender role; these are called non-operative transsexuals.

It can be extremely difficult to get sexual reassignment surgery. Most jurisdictions and medical boards require a minimum duration of psychological evaluation and "cross-living" (living as a member of the target gender full time), sometimes called the Real Life Experience (RLE) or Real Life Test (RLT) before SRS is permitted. However, transgendered people are often not allowed to change the listing of their sex in public records until SRS is completed. (See legal aspects of transsexualism.)

In many countries or areas, an individual's pursuit of SRS is often governed, or at least guided, by documents called Standards of Care for Gender Identity Disorders (SOC). This most widespread SOC in this field is published and frequently revised by the Harry Benjamin International Gender Dysphoria Association (HBIGDA). Standards of Care usually give certain very specific "minimum" requirements as prerequisites to SRS. For this and many other reasons, both the HBIGDA-SOC and other SOCs are highly controversial and often maligned documents among transgender patients seeking surgery. Some alternative local standards of care exist, such as in the Netherlands, Germany and Italy. Much of the criticism about the HBIGDA-SOC applies to these as well, and some of these SOCs (mostly European SOC) are actually based on much older versions of the HBIGDA-SOC. Other SOCs are entirely independent of the HBIGDA. The criteria of those SOCs are even more strict than the latest revision of the HBIGDA-SOC.
The majority of qualified surgeons North America and many in Europe adhere almost unswervingly to the HBIGDA-SOC or other SOCs.

Primary male-to female (MTF) procedures fall under one of two categories: penile inversion[?] or (less commonly) colovaginoplasty. Either of these procedures is usually followed by a minor cosmetic surgery called labiaplasty. Occasionally these basic procedures are complemented further with feminizing cosmetic surgeries or procedures that modify bone or cartilage structures, typically in the jaw, brow, forehead, nose and cheek areas (facial feminization surgery[?] or FFS). Electrolysis and lasers are used to permanently remove body hair. Some MTF individuals may elect to have voice surgery altering the range or pitch of the person's vocal chords. Estrogens by themselves are not able to alter their voice range or pitch. Voice lessons are available to train the MTF to practice feminization of their speech. Tracheal shaves are available to reduce the cartilage in the area of the throat to conform to more feminine dimensions. As a general rule, the earlier the individual undergoes Hormone Replacement Therapy (HRT), the fewer the procedures that are required to reverse the effects of primary and secondary sexual characteristics and development.

Many female-to-male (FTM) individuals do not opt for genital reassignment surgery, but only require a double mastectomy (removal of breast) and shaping of a masculine chest and hysterectomy (removal of internal female sex organs). Genital reassignment procedures use either the female clitoris, which is enlarged by androgenic hormones, or rely on skin grafts[?] and erectile prostheses[?]. The latter usually include multiple procedures, more expense and with a less satisfactory outcome, in terms of replicating nature. Testosterone is able to deepen the voice of the FTM transsexual prior to SRS and give FTMs a male hair pattern including beard and male pattern baldness.

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