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Gender affirming surgery

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What is gender affirming surgery?

Gender affirming surgery refers to a variety of procedures that some trans or gender diverse people may use to affirm their gender.

Surgery is just one option for gender affirming care. All trans and gender diverse people are unique and will choose to affirm their gender in a way that feels right for them.

Gender affirming care might include:

• Social affirmation, such as changing names, pronouns, hair or clothing.
• Legal affirmation, such as changing legal name or gender.
• Medical affirmation, with hormones or surgery.

Read more about gender incongruence, gender dysphoria , and gender affirming care here.

This article talks more about gender affirming surgery.

What happens during gender affirming surgery?

There are many different gender affirming surgeries and procedures. They may include making changes to your face, chest, genitals, or other body parts.

For people assumed male at birth, feminising surgeries may include:

• Breast augmentation with insertion of breast implants.
• Facial feminisation — changing the shape of any or all facial features.
• Vocal surgery — shortening the vocal cords for a higher, more feminine voice.
• Tracheal shave — reducing the size of the ‘Adam’s apple’.
• Fillers or liposuction, to achieve a more typically feminine shape.
• Orchiectomy, or removal of testicles.
• Bottom surgery or ‘genital reconfiguration surgery’, involving changes to the genitals.

Bottom surgery is called ‘genital reconfiguration surgery’. This was previously known as ‘sex reassignment surgery’ or ‘gender confirmation surgery’. The name change shows that your genitals don’t define your sex or gender.

Feminising bottom surgery may involve a combination of the following procedures:

• Removing the testicles (orchiectomy).
• Removing and reshaping tissue from the penis to make a vulva. This includes external labia or lips, and a clitoris. This is known as vulvoplasty.
• Shortening the urethra (tube that you urinate — wee — from).
• Creation of a vaginal canal (vaginoplasty). This is a complicated step which some people choose to skip. After surgery, vaginal dilators will need to be used to maintain the shape of the vaginal canal.

For people assumed female at birth, masculinising surgeries may include:

• Top surgery, with reduction or removal of breast tissue (mastectomy). This creates a flatter or more neutral chest. There are many different techniques used to achieve this.
• Liposuction to achieve a more typically masculine shape.
• Hysterectomy , or removal of the uterus (womb) and ovaries.
• Bottom surgery or genital reconfiguration surgery. This involves changes to the genitals.

Masculinising bottom surgery may involve a combination of the following procedures:

• Hysterectomy, if not already performed.
• Vaginectomy, or removal of the vagina.
• Creation of a penis, which may include metoidioplasty or phalloplasty.
• Metoidioplasty involves making a penis shape wrapping tissue around the clitoris after it is enlarged by testosterone hormone therapy.
• Phalloplasty involves making a larger penis with tissue from the arm, thigh, back, or abdomen. This involves lengthening the urethra to be able to urinate from the tip of the new penis. An inflatable penile implant may be inserted inside the penis to allow an erection.

Is gender affirming surgery right for me?

Choosing to undergo any surgery is a big decision. Everyone affirms their gender in different ways, and that may or may not include surgery.

Surgery is permanent so you need to make sure it’s the right choice for you. Surgery doesn’t make you more or less trans.

Before being able to access gender affirming surgery, you need to meet the criteria below:

• A history of gender incongruence (for 6 months or more).
• The ability to make a fully informed decision.
• Be over the age of 16 for top surgery, or 18 for bottom surgery. Some surgeons will provide surgery to younger people in very specific situations.
• Ensure that any physical or mental health conditions are well managed.

You will need letters of support from a mental health professional before having gender affirming surgery.

For top surgery, one letter is required. For bottom surgery two letters are required. For bottom surgery, you are also required to have ‘lived as your current gender’ for 12 months, meaning you have socially transitioned. The letter needs to state that surgery is appropriate for you and is likely to help affirm your gender and reduce any gender dysphoria that may be present.

If you are taking gender affirming hormones, or want to take hormones in the future, you should do this for 12 months before having surgery. This is to allow any significant body changes to occur before surgery.

Most people who have surgery are happy with their results and feel more comfortable in their bodies. But some people are disappointed with the results, or find that any gender dysphoria that was present is not fully resolved. Make sure you discuss any difficult feelings with your doctor or psychologist.

What questions should I ask before surgery?

It’s important to talk about the pros and cons of surgery in detail with your doctor. It’s a good idea to ask to see pictures of how other people look after surgery.

Questions to ask your surgeon include:

• What different surgical techniques are there?
• What are the pros and cons of each technique for me?
• What results can I expect?
• What are the possible risks and complications?

For help in having the discussion, visit healthdirect’s Question Builder .

What should I expect after surgery?

Surgical recovery can be long and uncomfortable. Your surgeon will be able to give you more information on what can be expected before, during, and after surgery. This might include spending time in hospital afterwards, any special dressings, surgical garments, or follow up care.

Make sure you do everything your doctor tells you and go to all follow-up appointments. This will help you get the best results from your surgery.

Having surgery is a big deal. Even if you’ve been looking forward to it and are happy with the result, it can still be quite confronting. It might take some time to get used to your new body.

Talk to your doctor if you are feeling any distress following surgery.

How much will gender affirming surgery cost me?

Gender affirming surgery can be very expensive. It can cost between $20,000 to more than $100,000, depending on which procedures you need.

Your surgeon will be able to tell you how much surgery will cost. The cost may include specialist visits before and after surgery, surgeon and anaesthetist fees, hospital and theatre costs, and any other products or services necessary.

Some costs may be covered by Medicare, such as specialist consults if you have a referral from your doctor. Unfortunately, most gender affirming surgery in Australia is done privately, meaning there will be large out-of-pocket costs.

You should ask your surgeon what Medicare item numbers they use. You can check the Medicare rebate at MBS Online .

Some private health insurance will also help with gender affirming surgery. If you have health insurance, it’s important to check with your health fund first about your level of cover. There is a range of health insurance comparison sites available online, such as privatehealth.gov.au .

Legal matters

Changing your gender on your passport, licence, Medicare card or birth certificate all require separate processes. These vary between states and territories. In some states and territories, you must have undergone specific types of gender affirmation surgery to change the gender marker on your birth certificate.

You can find out more about the specific processes at TransHub .

You are legally protected by the Sex Discrimination Act from discrimination on the grounds of sexual orientation, gender identity or intersex status. Visit the Australian Government Attorney-General’s Department for more details.

Where can I get more information on gender affirming surgery?

• TransHub has information about gender affirming surgery.
• The Gender Centre (NSW) provides resources and support.
• Transgender Victoria has resources and links to other services.
• The Australian Professional Association for Trans Health (AusPATH) lists some providers.

Learn more here about the development and quality assurance of healthdirect content .

Last reviewed: June 2022

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Masada Private Hospital Part of Ramsay Health Care

 > 

Trans Surgery

The team at Masada Private Hospital are passionate about the positive impacts reconstructive surgery can have on people’s lives.

Masada Private Hospital is proud to work with leading plastic and reconstructive Specialised surgeons,  Mr Alan Breidahl , Mr Andrew Ives ,  Mr Cheng Lo , Mr Gideon Belcher and Mr Stephen Kleid , each whom provide high-quality, comprehensive and compassionate care for those seeking trans surgery.

Why Masada?

Our exceptional nursing and support team and world class equipment makes our hospital a place where our surgeons can provide top quality patient care.

Masada Private Hospital’s philosophy is to provide a range of services to support the needs of every community member. Everyone is entitled to the highest level of respect. Our hospital offers a comfortable, welcoming, and discreet place for you to receive quality health care.

For more information about our Hospital  contact us .

Surgical options at Masada

Trans feminine genital reconstructive surgery.

This category of surgeries are performed to create female genitalia.  

Vaginoplasty

A vaginoplasty, which takes about 3-4 hours to perform, involves using the skin of the penis to create a lining of the perineum (opening to the vagina), and the lining of the vagina. Scrotal skin, if required, is used to line the top part of the vaginal cavity.

The testicles are removed. The head of the penis is used to create the neo-clitoris, so that most patients can retain the ability to have an orgasm post operatively.

Length of stay and recovery time

The usual length of stay is around 5-6 nights depending on which surgery you had. Dressings are removed on day 3.

If you are interstate, you will need to plan to stay in Melbourne for around 14-18 days in total.

Total recovery time can take up to 12 weeks, however most patients are able to resume work after 6 to 8 weeks or so, depending on your occupation and the surgery you have had.

Labiaplasty

Similar to a vaginoplasty, the labiaplasty involves the creation of a vaginal dimple instead of a neovagina. The final result looks the same as a vaginoplasty however patients do not have to dilate since they have no cavity.

Orchiectomy

An orchiectomy is a procedure that removes the testes. This procedure can be used to stop the production of testosterone or sperm, affirm gender or remove the need to taken an anti-androgen.

You will either stay overnight or be discharged on the same day – this will vary depending on your surgeon.

Recovery can take from 2 to 8 weeks. You won’t be able to do any strenuous activity, lift heavy objects or drive for at least a few weeks.

The specific instructions for your recovery will vary from surgeon to surgeon and depending on where and what specific surgical techniques are used.

Trans Masculine Genital Reconstructive Surgery

This category of surgeries are performed to create male genitalia.

Phalloplasty

A phalloplasty is a surgical procedure where a penis is created from existing tissue, this could be leg or forearm or elsewhere from the body. A phalloplasty is a multi-staged surgery that may include a variety of different procedures, including creation of the penis, lengthening the urethra to allow for standing urination, creating the tip (glans) of the penis, creation of the scrotum, removal of the vagina, uterus and ovaries and placing erectile and testicular implants.

These surgeries may be broken down into as many as three to four stages, with a period of several months to a year between each stage.

Please note, each staged surgical plan is unique to each patient and may or may not include some/all of the above procedures.

You may stay in hospital up to 2 weeks after each surgery with ongoing outpatient assessment once you’ve discharged. Healing from phalloplasty can take time so it’s vital to plan time to rest and recover for approximately 5-6 weeks. Please speak to your specialist about recovery times relevant to you.

Chest Reconstructive Surgery

Chest reconstructive surgery / top surgery.

The purpose of this surgery is to create a more masculine or androgenous chest. This includes contouring of the chest wall, removal of breast tissue and skin excess, reduction and repositioning of the nipple areolar complex, minimalization of chest wall scars and obliteration of the inframammary fold.

Length of stay and recovery time 

The usual length of stay in hospital is one night however this will differ from surgeon to surgeon. You will need to rest for about two weeks, with no heavy lifting or strenuous exercise for approximately 6 weeks.

Trans Feminine Breast Augmentation

The purpose of this surgery is to increase breast size to create a feminine chest. This procedure is likely to include breast implants.

Recovery from breast implants may take between 4-6 weeks, or several weeks longer depending on the surgical procedure. Often the surgery is conducted as a day procedure however this is dependent on your chosen surgeon.

Your surgeon may advise you to not do any strenuous activity or heavy lifting for the first 3 weeks, and wear compressing clothing, sports bras or specially designed garments, for the first month. You will wear dressings until you meet your surgeon for a check-up.

Facial Surgery

Facial surgery is the name for a range of surgeries that can be used to alter the appearance of the face and neck.

Plastic and reconstructive surgeons specialising in facial reconstruction are available at Masada Private Hospital. These surgeons can support patients with facial feminisation and masculinisation.

Surgical options

• Brow Lift (Browplasty)
• Cheek Enhancement
• Forehead reduction (and hairline lowering)
• Lip lift and reshaping
• Scalp Advancement

The length of stay and recovery time will depend on the type of surgery you undergo. Please consult your specialist for personalised information.

Ear, Nose & Throat Surgery

Ear, Nose and Throat surgeons can cater to specific surgeries to alter the appearance of a person’s nose (Rhinoplasty) or to reduce the prominence of a person’s Adam’s Apple.

Tracheal Shave (Chondrolaryngoplasty)

Chondrolaryngoplasty, also known as tracheal shave, is a procedure to reduce the prominence of the thyroid cartilage by trimming the cartilage and bone through a small incision on the neck (beneath the chin) to decrease the prominence of the Adam’s Apple. It is a common surgical procedure in the facial feminisation process. The procedure takes about 30 to 60 minutes.

For safety, patients will stay in hospital overnight, or at least 8 hours if they have no insurance, to observe for swelling and breathing difficulties.

There are no special post-operative instructions, apart from keeping the dressing dry for 3 days, then you may shower and get it wet.

• Rhinoplasty

Rhinoplasty surgery is a procedure whereby a surgeon reshapes and/or straightens your nose to appear more masculine or feminine. In trans nasal surgery or rhinoplasty, your surgeon will strive to create a natural-looking and unique nose.

The length of your recovery period after nose surgery will depend on your anatomy, general health and the specifics of your procedure. Whilst it depends on your surgeon, you will usually spend at least one night in hospital. The general rule is that you should allow at least 4-6 weeks for initial recovery following your surgery. Be sure you get adequate rest, good nutrition and don’t smoke.

You’re in good hands

Mr Andrew Ives

Mr Andrew Ives , is highly skilled with extensive experience and a passion for the positive changes that plastic surgery can make in people’s lives. He feels privileged to have such a rewarding career.

With years of experience behind him, Mr Ives provides top class surgical services. He also fully understands the human element that comes with surgery, offering personalised advice to support you to reach your surgical goal.

He performs between 170 – 200 gender re-assignments per year. Mr Ives' Nurse consults with all the surgical patients preoperatively and post operatively. All the patients must consult with a Psychiatrist or Clinical psychologist to obtain a WPATH report, before proceeding with surgery.

Mr Ives will take the time to understand your past medical history, general health and journey to date before providing advice on the operations available to you. 

Learn more  about  Mr Andrew Ives .

Trans surgeries conducted:

• Trans masculine/non-binary chest reconstructive surgery
• Trans feminine genital reconstructive surgery - Vaginoplasty, Labiaplasty, Orchidectomy
• Bilateral breast augmentation

A/Prof Cheng Hean Lo

A/Prof Cheng Hean Lo is a specialist plastic & reconstructive surgeon. He is the current Head of Department of Plastic & Reconstructive Surgery at Western Health, and is a senior medical staff at the Victorian Adult Burns Service (The Alfred).  His areas of particular interest include burn surgery and gender affirming surgery.

Learn more  about  Mr Cheng Lo

• MtF & FtM chest reconstructive surgery (including TOP surgery)
• MtF genital reconstructive surgery (including orchidectomy, labiaplasty, vaginoplasty)..

Mr Alan Breidahl

Mr Alan Breidahl is a specialist in post-traumatic and cleft lip-associated Rhinoplasty and has over 20 years clinical experience in all areas of Plastic and Cosmetic Surgery, including skin cancer, hand surgery, facial trauma and reconstruction, rhinoplasty, otoplasty, blepharoplasty, face lift, breast augmentation and reduction, liposuction and abdominoplasty procedures.

Learn more about Mr Alan Breidahl.

Surgeries conducted:

• Facial feminisation surgery
• Facial masculinisation surgery

Mr Gideon Blecher

Mr Gideon Blecher is an Australian qualified Urologist and Andrologist. As a surgeon who looks after male reproductive and sexual health issues, he has the experience and knowledge to manage complex problems. He has completed several years of overseas fellowship subspeciality training, in both andrology as well as robotic oncology in some of London’s most esteemed hospitals.

Mr Blecher specialises in a variety of areas including erectile dysfunction, penile prosthetic surgery, Peyronie’s disease, genital reconstruction, male infertility, male incontinence, testicular and penile lesions, as well as sexual dysfunction and general urology.

Learn more  about  Mr Gideon Blecher .

• Vaginoplasty, Labiaplasty
• Orchidectomy

Mr Stephen Kleid

Mr Stephen Kleid is an experienced Ear, Nose and Throat ENT Surgeon (Otolaryngologist) based in Melbourne with a passion for Septo-rhinoplasty, Septoplasty and a strong interest in Rhinoplasty Revision.

Mr Kleid trained at Melbourne University, then completed surgical training at various hospitals including Royal Melbourne, Royal Children’s, The Eye and Ear and St Vincent’s.

Learn more about Mr Stephen Kleid.

• Tracheal Shave – reduction of Adam’s Apple

How to book or refer

A referral from a medical professional is required to have a consultation with a plastic and reconstructive surgeon. Please speak to your GP about a referral to the specialist of your choice.

Assessment prior to Surgery

Assessment and documentation of persistent gender dysphoria by a qualified mental health professional is necessary for initiation of surgical treatments.

Each procedure has a different set of criteria recommended to enable surgery to occur – these criteria are set by the World Professional Association for Transgender Health (WPATH). Further, each surgeon may have a different protocol they follow.

They key criterion are:

• Persistent, well documented gender dysphoria;
• Capacity to make a fully informed decision and to consent for treatment
• Age of majority
• If significant medical or mental health concerns are present, they must be reasonably well controlled
• In some circumstances, hormone therapy is a perquisite.

Psychiatrists and psychologists who can complete specialist gender-related mental health assessments. Please ask your GP for a referral to your chosen mental health professional.

Support networks

Below please find a list of the key organisations that provide services. This is not an exhaustive list and there are many other support services that operate within each state.

If you require immediate help and you are in Australia, please call 000. If you need counselling support now please contact Lifeline on 13 11 14, Suicide Call Back 1300 659 467 and/or Mens Line Australia 1300 78 99 78. 

Gender Support – Aleph Melbourne

Alep Melourne offers a safe and inclusive environment for people in the Jewish community who are gender diverse. If you are transgender, gender-fluid, gender questioning, gender neutral or gender queer, then you are welcome here.

Visit - https://aleph.org.au/gender-support/

Genderqueer Australia – Genderqueer peeps

Genderqueer Australia began in 2010 as a peer support group for Gender Questioning, Genderqueer and Trans people, and their family and friends.

We now inform genderqueer, gender diverse and LGBTIQ+ of events, information and call-outs.

Visit - https://www.genderqueer.org.au/

Rainbow Families

Rainbow Families Inc is the peak organisation supporting LGBTQ+ parents and their children. It works to reduce discrimination and disadvantage faced by children of LGBTQ+ parents so they can thrive and shine and is a support network for parents and carers, as well as future parents and carers.

The purpose of Rainbow Families is to build a community that fosters resiliency by connecting, supporting and empowering LGBTQ+ parents and their children.

Visit - https://www.rainbowfamilies.com.au/

Seahorse Club Victoria (seahorsevic.com.au)

Seahorse Victoria Inc was formed in 1975 as a support and social group for the Victorian transgender community and is the longest running organisation of its type in Australia.

Visit - https://seahorsevic.com.au/

Spectrum Intersections - The Rainbow Neurodiverse Group

The Rainbow Neurodiverse Group are a free peer led group for people 18 and over who identify as neurodiverse and on the LGBTIQA+ Spectrums.

This is a safe space and learning environment for people without fear of judgement, misunderstanding, harassment or abuse.

Visit - https://www.spectrumintersections.org

Transfamily

Transfamily is a peer support group for parents, siblings, children, extended family, partners, and friends of trans and gender diverse people.

They offer an understanding environment for friends and family of trans and gender diverse people to share experiences, ask questions, seek advice and support. They are based in Melbourne, Victoria where the group meets monthly, however support is extended and offered to the wider Victorian and Australian population whenever possible.

Visit - https://www.transfamily.org.au/

The Shed is a Melbourne based support group for trans masculine people, including AFAB people who are non-binary and those who are questioning or exploring their gender.

We meet up to support each other and build resilience through sharing personal experiences of trans life.

Visit - https://www.theshedsupport.org.au/

General Enquiries 03 9038 1300 Fax 03 9038 1309

William Macaulay Counselling

Counsellor & psychotherapist.

Phone 0401 316 977

for enquiries or appointments

William Macaulay Counselling Perth

Psychotherapy   *   Counselling   *   Cognitive Behaviour Therapy   *   Psychology   *   Therapy

Gender Therapist Perth, WA

Gender Diverse & Transgender Counselling Perth

Coming out as transgender can be a challenging journey for a number of reasons, including discrimination, social stigma, and lack of support from loved ones. Accepting and embracing one's transgender identity can also be difficult for some individuals.

If you are unclear about your gender orientation or experiencing excessive fear, stress , anxiety or depression as a result of the reactions of others, it may be helpful to seek support from a gender therapist. While therapy cannot change one's gender identity, it can provide a safe space for individuals to understand themselves better and navigate the challenges associated with being transgender.

In this article, I aim to provide a brief overview of various gender-diverse and transgender issues, with the goal of fostering a better understanding of this complex and often misunderstood topic.

Wh a t is gender?

Gender is a multifaceted concept that goes beyond the traditional categories of male and female. While biological sex is determined by physical and reproductive characteristics, gender is a broader concept that encompasses cultural, social, and psychological aspects.

Traditionally, gender has been understood within a binary framework, consisting of two categories: male and female. However, many societies and cultures recognise that gender is not solely limited to these binary categories and that a spectrum of gender identities and expressions exists.

Gender identity refers to an individual's deeply ingrained sense of being male, female, or another gender. Some individuals may identify as transgender, indicating that their gender identity does not align with the sex assigned to them at birth. Others may identify as non-binary, signifying a status that is neither exclusively male nor female, existing somewhere in between or beyond both genders.

It is essential to approach gender with respect, openness, and an understanding that individuals have diverse experiences and identities. Gender is a complex and personal aspect of human identity that varies across cultures and individuals. Understanding and respecting various gender identities and expressions are crucial for cultivating an inclusive and equitable society.

Cisgender versus Transgender

Cisgender refers to individuals whose gender identity matches the sex they were assigned at birth. Transgender is a word that defines people whose gender identity differs from the sex they were assigned at birth. This could mean in between, the opposite of or something entirely different from the sex they were assigned at birth.

Important to note that being transgender is different from being gay. People who identify as transgender have the same range of sexual orientations as the general population, including being heterosexual, gay, lesbian, bisexual, pansexual or asexual.

Confused about your gender?

If you are confused about your gender, there are several options that you may want to consider. Important to note that there is no 'one size fits all' experience for people who identify as transgender. As everyone is different, these options should be matched against your current needs, level of comfort and support, age, mental health status, and financial circumstances.

Social transitioning

Accepting who you are:.

Accepting who you are is an important first step. It's okay to be unsure, and it's okay to take your time. Be patient with yourself. Acceptance may be a gradual process. Becoming well informed about transgender issues can help with the process.

Disclosure t o others:

It is your decision whom to confide in, when to do it and how. Do not pressurise yourself into talking about your gender before you feel ready to do so. Being transgender is normal, but it's not common. So, some people may react negatively at first and need some time to adjust. Try not to respond angrily or defensively. Acceptance may be a slow and gradual process. You may find reading my LGBT Coming Out article helpful.

Appearance:

Changing your appearance is another way in which you can experiment with expressing your gender. It may be important to you that your appearance aligns with your gender orientation. Ideally, your appearance should simply be whatever makes you feel comfortable.

Name change:

Sometimes people who identify as transgender decide to change their birth name to a name that better reflects their gender orientation. Important to note that it may take friends and family a while to adjust to using your new name. In Australia, you can change your name legally for any reason. However, if you are under 18 years of age, you will need parental consent.

Pronouns are other words we use as substitutes for people's names. There are gender pronouns such as he/his/him and she/her, as well as gender-neutral pronouns such as they/their/them. You may want to consider asking people to change to a gender-neutral pronoun when referring to you.

Speech pathology:

Speech pathology is vocal training to help change the pitch of your voice and speech patterns to something you're more comfortable with. There is no age restriction to access these services.

Medical tran sitioning

Medical transitioning is when a person who identifies as transgender decides to access medical options, such as hormones or surgery, to feel more comfortable in their own skin. As an experienced gender therapist, I can provide information and support on how to proceed with any of the following medical transitioning options.

Puberty blockers:

Puberty blockers are drugs that delay the onset of puberty, allowing you more time to figure out your gender identity. They work by blocking the hormones testosterone and estrogen that lead to puberty-related changes in your body. This stops things like periods and breast growth, or voice-deepening, Adam's apple and facial hair growth. 

Puberty blockers are most effective for people in the early stages of puberty. If you are under 16, this option may be worthwhile discussing with your parents and GP. Accessing puberty blockers requires psychiatrist approval, consent from both parents and an endocrinologist.

Hormone Replacement Therapy (HRT):

For many transgender people, hormone treatments are the first step in the process of transitioning and are often followed by surgical procedures. For others, taking hormones will be the only type of medical treatment they ever have. Hormone treatments for transgender people involve substituting the sex hormones of an individual's assigned sex with those of the opposite sex. For male to female, this means taking estrogens, and in some cases anti-androgens (to stop the production of male hormones), while for female to male, treatment means taking testosterone. Such treatments are used for two purposes: to reduce or eliminate secondary sex characteristics of an individual's assigned sex and to induce those of their new sex. Not all secondary sex characteristics will be eliminated or obtained, and the extent to which these goals are achieved varies from person to person. If the gonads (e.g. testicles or ovaries) are removed, sex hormone therapy is necessary for the remainder of the individual's life to avoid side- effects of hormone deprivation (e.g. Osteoporosis).

Research indicates that people who have undergone hormone therapy report both positive and negative aspects of the therapy. Careful thought and sound medical advice should, therefore, be considered before commencing with this option. Your GP, an endocrinologist or a psychiatrist can provide you with the appropriate guidance and information.

Gender affirming surgery:

As part of transitioning, surgery is sometimes performed on genitals, breasts and other physical features. While not considered the final stage of transitioning, as there is usually a period of adjustment post-surgery, surgery is often viewed as the central and major step in an individual's journey to transition. In Australia, access to surgery remains limited, and it is predominantly performed in Sydney and Melbourne.

Increasingly, studies have found that surgical interventions result in positive outcomes across a range of domains, including psychologically, socially, physically, and sexually. Extensive screening processes, psychological therapy and staged levels of treatment prior to surgery (e.g. hormone treatment, real-life test) are used to prepare the individual for the surgery and minimise the chances of regret after irreversible surgical procedures. Although disappointment after surgery has been reported to occur, satisfaction is generally high, and few have reported any regrets after such procedures.

Men tal health

Gender diversity in itself does not cause mental health problems. However, transgender and gender diverse individuals may experience a range of stressful occurrences that increase the likelihood of developing a mental health issue. Some may frequently experience harassment and stigmatisation, and sometimes violence because of social, cultural and religious norms. Some may become estranged from family and friends. Some may find it challenging to secure suitable employment and housing. And for some, the constant exposure to negative messages about their gender identity can have a devastating impact on their self-worth and wellbeing.

Sadly, these harmful exposures have resulted in people who identify as transgender experiencing higher rates of mental illness, self-harm, and drug and alcohol misuse , than the general population. A gender therapist such as myself can provide support and gender counselling to help you work through these issues.

Gender diverse terminology

As with any identity, individuals should choose their own language to describe or identify themselves. Always listen for and respect a person's self-identifying terminology. Also, the correct use of language to describe others demonstrates respect and encourages understanding. Here is a guide to some of the commonly used terms concerning gender:  

Crossdresser: a person who needs to express an alternative gender identity by dressing and being accepted in that role on a less permanent basis. Crossdressers are usually content with their biological sex.

Drag: a stage or theatrical performance involving a male performer dressed as a woman or a female performer dressed as a man to entertain others at bars or clubs.

Female to male (FtM): adjective to describe individuals assigned female at birth who are changing or who have change their body and/or gender role from birth assigned female to a more masculine body or role.

Gender binary: the classification of sex and gender into two separate categories of masculine and feminine. These two categories exclude many people who do not fit neatly into either category.

Gender dysphoria: distress that is caused by a discrepancy between a person's gender identity and that person's sex assigned at birth.

Gender expression: is how someone presents their gender to the world. This can mean through the way a person physically presents as well as the way they act. This can be through appearance, dress, mannerisms, speech patterns and social interactions.

Gender identity: refers to a person's internal sense of being male, female, something other or in between.

Gender nonconforming: adjective to describe individuals whose gender identity, role, or expression differs from what is normative for their assigned sex in a given culture and historic period.

Gender reassignment: the physical, legal and social process of transitioning gender – usually from the gender that society thinks the person should be to the individual's own sense of gender. This may include surgery, hormone treatment, a change of name, a different pronoun, and a change of birth certificate gender.

Internalised transphobia: discomfort with one's own transgender feelings or identity as a result of internalising societies normative gender expectations.

Male to female (MtF): adjective to describe individuals assigned male at birth who are changing or who have change their body and/or gender role from birth assigned male to a more feminine body or role.

Non-binary: a term used to describe individuals who may experience a gender identity that is neither exclusively male or female or is in between or beyond both genders.

Transgender: an umbrella term used to describe people who sit outside the gender binary of masculine and feminine, or whose gender identity is different from the sex assigned to them at birth.

Transsexual: a person whose gender identity is opposite to their biological sex. Many transsexuals will change their bodies through hormones and possibly surgery to better match their gender identity.

Transvestite: someone who dresses in clothes usually worn by the opposite sex for fetish or arousal purposes.

  🏳️‍⚧ T ransgender an d Gender Diverse Counselling and Support 🏳️‍⚧

How can seeing a gender therapist help? If you are confused or unclear about your gender identity and what this means for you or would like to discuss any of the issues raised on this page, please contact me to schedule an appointment. Overall, a gender therapist can play a crucial role in providing guidance, support, and resources as you navigate your gender identity journey , helping you achieve personal comfort and well-being. Click here to view the range of gender counselling services I offer .

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Renewed calls for medicare to cover gender affirmation surgery

A new report, highlighted by The Australian , calls for many of the operations required for gender affirming surgery to be covered by Medicare.

The Victorian report highlights there is a lack of surgeons in Australia who offer gender reassignment surgery which results in many people heading overseas to undertake the operations. The report argues that it would be better for more Australian doctors to offer the surgery to reduce the risk to people.

The report also calls for many of the operations to be covered by medicare arguing that it not simply a cosmetic procedure, but an essential step that leads people to live happier and more productive lives.

Calls to have the surgeries covered by Medicare are nothing new, the Tasmanian branch of the Labor party voted in favour of such a policy last year, and OUTinPerth published calls for a policy change back in 2012.

While not all people who are transgender choose to have gender affirming surgery, for those who do it can be a costly process with bill up to $70,000 and higher.

Recent studies have also shown that transgender people who want surgery, and are able to access it, also have lower mental health costs in the long run.

A study published in the American Journal of Psychiatry looked into ten years of data from Sweden, and focussed on 2,679 people who had been treated for gender incongruence. While the report found that people who suffer gender dysphoria had higher levels of mental health concerns, those who choose to undertake surgery had less mental health needs in the following years.

Co-author of the study Richard Bränström spoke to Newsweek and acknowledged that the results in Sweden may not be the same in other countries with different levels of medical support.

“This study was done in Sweden, a country with universal health care and relatively strong social welfare system. It is important to understand the situation of transgender individuals in other countries in the world and other regional settings.”

On August 1 2020 The American Journal of Psychiatry published a correction to the research highlighted in this article.

Following it’s initial publication the journal received many letters questioning the statistical methodology of the study and after reviewing their work the researchers found that; “the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison.”  The authors conceded that the results of their analysis had been overstated. 

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Gender-affirming hormones and surgery in transgender children and adolescents

Affiliations.

• 1 Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia; Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; School of Psychological Sciences, Faculty of Sciences, University of Western Australia, Perth, WA 6009, Australia.
• 2 Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia; Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, WA, Australia.
• 3 Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia; Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia.
• 4 Department of Plastic and Reconstructive Surgery, Perth Children's Hospital, Perth, WA, Australia.
• 5 Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia.
• 6 Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia.
• 7 Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia; Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Germany. Electronic address: [email protected].
• PMID: 30528161
• DOI: 10.1016/S2213-8587(18)30305-X

The Endocrine Society Clinical Practice Guidelines on the treatment of gender incongruent people recommend the use of gender-affirming cross-sex hormone (CSH) interventions in transgender children and adolescents who request this treatment, who have undergone psychiatric assessment, and have maintained a persistent transgender identity. The intervention can help to affirm gender identity by inducing masculine or feminine physical characteristics that are congruent with an individual's gender expression, while aiming to improve mental health and quality-of-life outcomes. Some transgender individuals might also wish to access gender-affirming surgeries during adolescence; however, research to inform best clinical practice for surgeons and other medical professionals is scarce. This Review explores the available published evidence on gender-affirming CSH and surgical interventions in transgender children and adolescents, amalgamating findings on mental health outcomes, cognitive and physical effects, side-effects, and safety variables. The small amount of available data suggest that when clearly indicated in accordance with international guidelines, gender-affirming CSHs and chest wall masculinisation in transgender males are associated with improvements in mental health and quality of life. Evidence regarding surgical vaginoplasty in transgender females younger than age 18 years remains extremely scarce and conclusions cannot yet be drawn regarding its risks and benefits in this age group. Further research on an international scale is urgently warranted to clarify long-term outcomes on psychological functioning and safety.

Copyright © 2019 Elsevier Ltd. All rights reserved.

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Genital electrolysis

Table of contents:.

Electrolysis hair removal is mainly used to remove facial hair, but it is effective on your whole body, including your genital region. Most surgeons who perform Surgical Reassignment Surgery (SRS) strongly advise having genital electrolysis before SRS. Attention: the anal region will not be treated.

Why genital electrolysis prior to SRS? Can’t I have my SRS without it?

Genital electrolysis is performed prior to SRS to avoid any problems with hair in your new vagina. In most patients, the area between the anus up to a part of the scrotum is going to be used to create the back wall of the vagina. The area from the scrotum up toward the base of the penis will also be used to build up the vagina. For most patients that require skin grafts for vaginoplasty, scrotal tissue is transplanted during SRS.

The most important reason to have the hair in that area removed is that there is a high risk of infection of the hair follicles. This risk may be higher even due to the friction that you will experience against that part of the skin during dilation but also during intercourse, for example. And since the skin is no longer exposed after surgery, because it is folded inward, it’s too late to remove the hair later on.

Many SRS surgeons emphasize that patients should have genital hair removal prior to SRS since it strongly influences the operation and its outcome. Some may not want to perform SRS if you still have hair in the area used for your neo-vagina.

Laser or electrolysis for your genital hair removal?

Although we have a laser hair removal machine at 2pass Clinic we strongly advise you to use genital electrolysis. Lasers have not been proven to be permanent, and since genital hair removal can often not be redone after the SRS operation, we argue there is no room for experimenting with unproven technology. 

Caution: Many surgeons use a “scrape” technique during surgery, where they scrape away the hair follicles, but results indicate this is not effective and complicates recovery (eg ingrown hairs). We recommend you rely on electrolysis.

How much hair needs to be removed from the genital zone before a Sex Reassignment Surgery (SRS)?

Vaginoplasty, using Penile Inversion, is the most common MTF genital surgery.

• This utilizes the penile skin to line the vagina, and the scrotal skin to create the labia.
• Some SRS surgeons use a perineal skin flap at the posterior end of the vagina, it is best to have electrolysis in this area.
• It is suggested to remove the hair around the base of the penis and the hair on the midline between the anus and the penis.
• If you plan to have genital electrolysis, please do consult with your surgeon as to his or her preferences.

Electrolysis How much hair needs to be removed

Should I remove more hair as a precaution?

As we explained, the marked area is the only area that will be used to build the vagina and hence the only area where it’s mandatory. If you have a lot of hair around this area, you can expect some hair growth near your vagina. This is no problem, it just depends on what you prefer. If you want to have more hair removed, you are free to do so for aesthetical reasons.

Practical: timeframe of genital electrolysis

• You should plan for genital electrolysis to take about a year, although some get it done sooner (7 months minimum). All parties should keep in mind that electrolysis is a gradual process and that it can take a year or more to completely clear an area.
• As the complete hair growth cycle of genital hair is between 5-7 months, you will need at least this timeframe to completely clear all hair.
• In the resting phase (telogen phase) of the hair cycle, killing the hair is less effective as it is not connected to the growth center of the hair (papilla). Unlike your facial hair, where about 30 percent of your hair is in the resting phase, in your pubic area this is 70 percent. This means electrolysis in this area is less ‘effective’ and takes a longer timeframe to completely clear the area.
• A hair of the genital area stays in the resting phase for about 12 weeks, then it is active for 2-4 months. Ideally, an interval of 6 weeks between different treatments is recommended to catch a sufficient new load of “active hairs” every session.
• On average you will need 6 cycles of electrolysis.
• We recommend completing your genital electrolysis at least six weeks before, and preferably even 8 weeks before your sex reassignment surgery, so your skin has time to heal in case a complication occurs (e.g. an infection), as it could take a month to clear up.

The average timeframe for genital electrolysis

• 6 weeks of rest
• Remaining hairs: come by every 6 weeks for 15 min of genital electrolysis to remove the hairs that still pop up if necessary

So on average, we need around 24 hours to clear your genital hair (so it will cost you around 2500 euro if you choose to do it with local anesthesia) and on average the total timeframe for this would be about 1 year.

Preparation for genital electrolysis

• Shave the genital region 10 days prior to your genital electrolysis—Because after all the hairs are shaved, only active hair follicles will grow back, which in turn allows us to be more effective (you don’t electrolyze the hairs that can not be killed in this stage anyway).
• Iso-betadine soap—Hygiene before and after treatment is paramount, as there is a high risk of skin infections from genital electrolysis. We advise using Betadine liquid soap in the shower the morning of your genital electrolysis. Also the days after genital electrolysis, this can be useful. You must be scrupulous about hygiene when getting genital electrolysis, especially if getting it performed close to your surgery date.

Your genital electrolysis

• It is normal to feel nervous and embarrassed prior to your first genital electrolysis session. Know that for us, this is a routine treatment, and we will try to make it as comfortable as possible for you.
• If possible, we use the machine’s highest settings for genital electrolysis to get a high killing rate. Since the hair cycle is slower than in the facial area, and it already takes longer, a high setting will make it go considerably faster. A side effect might be a higher risk of scarring. 
• The skin itself is soft, wrinkled and rubbery in texture, and the follicles can be very ‘tight’ in some clients. It is essential to carefully stretch the skin around the follicle that's being treated. It might be necessary to push the needle into the follicle more forcefully than in other areas. 
• Removing genital hair tends to be more painful than facial hair removal. With local anesthesia, pain can be reduced significantly. You may need to take additional steps to alleviate pain. Some have reported adequate pain relief with painkillers and/or EMLA (numbing cream), where others found local anesthetics necessary.
• Meticulous post-treatment skin care is essential to avoid infection and aid healing.

Recovery and aftercare

• After treatment, the skin may be red and even slightly swollen. This varies from patient to patient. It is extremely important to take care of hygiene when you get genital electrolysis, particularly if your treatment is close to your operation date.
• Skin is more prone to infection after electrolysis. We’ll provide lotion to avoid this and to help heal your skin after the treatment.
• Scrotal tissue may heal slower from electrolysis than other parts of your body.

Read more about aftercare .

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Frequently asked questions

Do you also remove hair from the genital zone before the sex reassignment surgery.

Yes we do, we strongly advise electrolysis before the operation because laser is not always permanent, and after the operation you won’t get a second chance to remove the hair. Read all about genital hair clearing .

Is electrolysis hair removal painful?

The short answer almost no electrologist dares to give you is: yes it is. Some people can bear it, others barely. The longer version: Everyone has their own tolerance to pain. Descriptions of the discomfort vary from “no worse than a mosquito bite,” to “like having a rubber band snapped against my bare skin hard.” Electrolysis can give a stinging and pricking sensation, and each hair has to go through it. The degree of it is also relative to the area of treatment. Certain spots, such as the upper lip, are known to be more sensitive than spots like the brows. But! Luckily we provide local anesthetics, with which you will barely feel any pain at all! More information about local anesthetics !

Can I shave my hair in between electrolysis hair removal sessions?

Yes, one of the common misconceptions about electrolysis is that you have to let the hair grow in-between sessions. In fact, you can treat the hair as you would usually, even shaving the legs or face. The hair doesn’t have to be any longer than 1-2 mm for electrolysis to be effective. Longer hair is even contra-productive because it makes insertions more difficult. It is important you stop shaving 3 days prior to your electrolysis session. We should emphasise that in contrast to popular belief, shaving off the hair will not thicken it, coarsen it or make it grow more rapidly.

Can I do Electrolysis at your clinic while recovering from the surgery?

Yes, you can. We suggest you book 1 day of electrolysis a few days after the surgery through our website . If you have a choice though it is probably a more comfortable option to book the electrolysis a few days before your surgery.

I suffer from psoriasis, can I still get electrolysis?

On active psoriasis, zone electrolysis is contra-indicated.

I suffer from PCOS (polycystic ovary syndrome), can I still get electrolysis?

It is not a contra-indication, but in some people it doesn’t really help because too much new hair is recruited. You can read about the details of electrolysis on people with hirsutism/PCOS .

Why can I not cancel my session less than two weeks in advance and get a refund like in a hotel?

We understand your concern. If you cancel 3 days of an intensive program less than two weeks before, we will not find another patient to replace you because people need to plan these types of things in advance (take time off from work, etc). So these 3 days we will have to pay our electrologist, but she will have no client to treat. It is simply a different cost and income model than in a hotel. A hotel needs approximately the same staff if there are a few people less or more. In contrast to hotels, we don’t have 300 rooms but just a few electrologists that are fully booked most of the time. It is actually the same policy we use as with our operations (but there the cancel time is less than one month instead of two weeks). We hope you understand our policy.

We are doing our very best to keep this information up-to-date. In case you see anything that no longer seems accurate, or in case you have a question, please fill out the form below!

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Home > HealthCARE > Scottish Gender Identity Services

Scottish Gender Identity Services

In Scotland, there are currently four NHS Gender Identity Clinics (GICs) – Glasgow Sandyford GIC (adults and young people), Edinburgh Chalmers GIC (adults), Aberdeen Cornhill GIC (adults), and Inverness Raigmore GIC (adults). There is also a private sector GIC for adults provided by Your-GP in Edinburgh.

Glasgow Sandyford GIC

Adult and Young Peoples Gender Identity Services, Sandyford, 6 Sandyford Place, Sauchiehall Street, Glasgow, G3 7NB

Website: https://www.sandyford.scot/sexual-health-services/gender-identity-service/

Sandyford GIC accepts GP and self-referrals for adults and young people from across all parts of Scotland. It is the only GIC for young people under 18 in Scotland.

The waiting time for a first appointment at the young peoples service is currently around four years.

The waiting time for a first appointment at the adults service is currently over five years.

Phone lines are open from 8:30am–11:30am Monday–Friday . Please call 0141 211 8137 for the adult service and 0141 211 8618 for the young person’s service during this time. (If you can’t get through to the gender service and need to speak to someone urgently try calling the Sandyford main switchboard on 0141 211 8130.)

You can email the Sandyford adult service on [email protected] and you can email the Sandyford young person’s service on [email protected]

Lothian Edinburgh Chalmers GIC

Chalmers Gender Identity Clinic, 2A Chalmers Street, Edinburgh, EH3 9ES

Website: https://www.lothiansexualhealth.scot/gender-identity-clinic/gic/

Chalmers GIC accepts GP referrals for service users aged over 17 living in NHS Lothian, NHS Borders and NHS Fife areas.

The waiting time for a first appointment is currently around two years.

Telephone: 0131 536 1570 , phone lines open 1pm-4pm Monday-Friday .

Chalmers GIC does not accept emails from patients. It will respond to emails from GPs.

Grampian Aberdeen Cornhill GIC

Grampian Gender Identity Clinic, Royal Cornhill Hospital, Cornhill Road, Aberdeen, AB25 2ZH

No Website.

Grampian GIC accepts GP referrals for service users aged over 18 living in the NHS Grampian area only.

Telephone:  01224 557651

You can email Grampian GIC on [email protected]

Highland Inverness Raigmore GIC

Highlands Gender Identity Clinic, Zone 14, Clinic 1 Raigmore Hospital Old Perth Road, Inverness IV2 3UJ

Website: http://www.highlandsexualhealth.co.uk/services/gender-identity

Highlands GIC accepts GP referrals for service users aged over 18 living in the NHS Highland area only.

Telephone: 01463 888300

Private Sector: Your-GP GIC

Your-GP is currently the only private sector GIC located in Scotland. Website: https://your-gp.com/gp-services/all-gp-services/gender-clinic/

National Gender Identity Clinical Network for Scotland

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WA’s ‘cruel’ Gender Reassignment Board to be abolished

T he state government will abolish the controversial Gender Reassignment Board under a bill to overhaul the “cruel” legal process for gender recognition and bring Western Australia in line with the rest of the country.

Premier Roger Cook announced the bill would be introduced on Tuesday, which will see the board scrapped and the removal of the requirement to undergo surgical reassignment to legally register a change of sex.

Under the proposed administrative process, the Births, Deaths and Marriages registrar will be responsible for determining the gender recognition on a birth certificate, which will be done via an application.

The only evidence required to support an application will be a letter from a medical practitioner or psychologist confirming the person has undergone the appropriate clinical treatment.

The new process, which will allow West Australians to identify as non-binary, will not be accessible to children under the age of 18 without the consent of both parents.

For children under 12, the gender on their birth certificate cannot be changed without the approval of the Family Court.

Those relocating to Australia from overseas will also be able to obtain a gender recognition certificate.

The bill also contains a host of safeguards, which will prohibit certain classes of offenders or people on community service orders from applying to change their gender on their birth certificate.

Cook said the social reforms, which have been promised for two years, were consistent with the recommendations made by the Law Reform Commission in 2018 and brought WA into line with other states and territories.

“It’s important that these reforms are done properly… everyone deserves respect and dignity and to have their legal identity aligned with their lived identity,” he said.

“These reforms are about dignity, but most importantly, they’re about equality.”

Attorney General John Quigley said the bill was hardly earth-shattering, conceding the rest of the country had already implemented the changes, but would bring WA “out of the dark ages”.

TransFolk of WA spokesperson Dylan Green welcomed the changes, describing the previous process as “humiliating”, “inhumane” and “cruel”.

The move was also backed by former AFL star Danielle Laidley, who said she had been deterred from legally changing her gender in her home state because the process was “archaic” and allowed someone else to tell her who she was.

But Green said while the proposed legislation was welcomed, it was not in step with best practice employed in other jurisdictions, which have done away with the need for clinical evidence in favour of a self-determination model.

“The abolition of the gender reassignment board will allow trans and gender diverse West Australians an approved pathway to align their legal documentation more closely with their gender identity,” Green said.

“But we will be making further recommendations to the government regarding the bridging regulations for this proposed bill and advocating for further reform that we have seen interstate.”

The number of applications to the board has skyrocketed over the past 15 years, from five in 2008/09 to 80 in 2022/23.

And Green said many were deterred by the process because it was often lengthy and very costly.

The reforms are the first tranche of the state government’s pledge to improve the lives of those in the LGBTQIA+ community, the second of which will focus on developing a new Equal Opportunity Act and a ban on gay conversion therapies.

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Vatican says sex reassignment surgery, surrogacy and gender theory threaten human 'dignity'

The Vatican has declared gender confirmation operations and surrogacy as grave threats to human "dignity", putting them on par with abortion and euthanasia as practices that violate God's plan for human life.

The Vatican's doctrine office on Monday published a 20-page declaration titled Infinite Dignity that was in the works for the past five years.

It was approved for publication by Pope Francis on March 25 after substantial revision in recent months.

In its most eagerly anticipated section, the Vatican reiterated its rejection of "gender theory" or the idea that one's gender can be "a self-determination".

It said God created man and woman as biologically different, separate beings, and said they must not tinker with that plan or try to "make oneself God".

"It follows that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception," the document said.

It distinguished between transitioning surgeries, which it rejected, and "genital abnormalities" that are present at birth or that develop later. Those abnormalities can be "resolved" with the help of health care professionals, it said.

The document's existence, rumoured since 2019, was confirmed in recent weeks by the new prefect of the Dicastery for the Doctrine of the Faith, Argentine Cardinal Víctor Manuel Fernández, a close confidante of Pope Francis.

He had cast it as something of a nod to conservatives after he authored a more explosive document approving blessings for same-sex couples that sparked criticism from conservative bishops around the world, especially in Africa.

While the new document rejected gender theory, it took pointed aim at countries — including many in Africa — that criminalise homosexuality.

It echoed Pope Francis's assertion in a 2023 interview that "being homosexual is not a crime", making the assertion now part of the Vatican's doctrinal teaching.

It denounced "as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation".

The document restated well-known Catholic doctrine opposing abortion and euthanasia.

It also added to the list some of Pope Francis's main concerns as pope: the threats to human dignity posed by poverty, war, human trafficking and forced migration.

A child's right to 'a fully human origin'

In a newly articulated position, the declaration said surrogacy violated both the dignity of the surrogate mother and the child.

While much attention on surrogacy has focused on possible exploitation of poor women as surrogates, the Vatican document focuses more on the resulting child.

"The child has the right to have a fully human (and not artificially induced) origin and to receive the gift of a life that manifests both the dignity of the giver and that of the receiver," the document said.

"Considering this, the legitimate desire to have a child cannot be transformed into a 'right to a child' that fails to respect the dignity of that child as the recipient of the gift of life."

The Vatican published its most articulated position on gender in 2019, when the Congregation for Catholic Education rejected the idea that people can choose or change their genders.

It insisted on the complementary nature of biologically male and female sex organs to create new life.

Gender fluidity was described as a symptom of the "confused concept of freedom" and "momentary desires" that characterise post-modern culture.

The new document from the more authoritative Dicastery for the Doctrine of the Faith quoted from that 2019 education document but tempered the tone.

Significantly, it did not repurpose the 1986 language of a previous doctrinal document saying that homosexual people deserve to be treated with dignity and respect but that homosexual actions are "intrinsically disordered".

Francis has made reaching out to LGBTQ+ people a hallmark of his papacy, ministering to trans Catholics and insisting that the Catholic Church must welcome all children of God.

But he has also denounced "gender theory" as the "worst danger" facing humanity today, describing it as an "ugly ideology" that threatens to cancel out God-given differences between man and woman.

"It needs to be emphasised that biological sex and the sociocultural role of sex (gender) can be distinguished but not separated," the new document said.

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Gender-affirming surgery threatens ‘unique dignity’ of a person, vatican says.

The Vatican has issued a strong warning against “gender theory” and said that any “sex-change intervention” risks threatening “the unique dignity” of a person, in a new document signed off and approved by Pope Francis.

Titled “Dignitas Inifinita” (Infinite Dignity) the declaration focuses on what it describes as a range of threats to human dignity, including poverty, the death penalty, war, assisted dying, abortion, sexual abuse and the abuse of women.

The text, published by the Vatican doctrine office on Monday, states that attempts to obscure “the sexual difference between man and woman,” including gender-affirming surgery, should be rejected. “It follows that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception,” it adds.

The document is largely a re-stating of Catholic teaching on these topics but does not seek to isolate one issue – such as abortion – but says it emphasizes the equal dignity of all people, regardless of their circumstances. On abortion, it strongly reiterates what the pontiff has said in the past, that the “defense of unborn life is closely linked to the defense of each and every other human right.”

The pope has spoken out strongly against gender ideology in the past,  describing it as “ugly”  for erasing what he says are distinctions between men and women. The latest Vatican document quotes Francis by describing it as a form of “ideological colonization.”

Related article Pope Francis calls for Gaza ceasefire as he leads Easter Mass following health concerns

It states that gender theory “intends to deny the greatest possible difference that exists between living beings: sexual difference” which it says is “the most beautiful and most powerful of them.” Gender-affirming surgery, it adds, is to be avoided because “the body serves as the living context in which the interiority of the soul unfolds and manifests itself” but the document says medical intervention is permitted for those with “genital abnormalities.”

While Francis has been critical of gender theory, he also provided pastoral support for transgender Catholics. The pontiff has met a group of transgender Catholics from Torvaianica, south of Rome, meeting them regularly, inviting them to a lunch in the Vatican along with 1,200 marginalized and homeless people and giving them front-row seats at one of this audiences.

The Vatican’s doctrine office – now led by a close ally of Francis, Argentinian Cardinal Victor Manuel Fernández – has also recently allowed for transgender people to act as  godparents at baptisms and witnesses to marriages , a change to a ruling in  2015 when the Vatican said transgender people could not act as godparents .

Not all Catholics have agreed with the Vatican’s criticisms of gender theory. The document was criticized by one LGBTQ+ Catholic group which said it “fails terribly” by only offering transgender and non-binary people “limited” dignity.

“While it lays out a wonderful rationale for why each human being, regardless of condition in life, must be respected, honored, and loved, it does not apply this principle to gender-diverse people,” Francis DeBernardo, of New Ways Ministry,  wrote .

The latest Vatican document identifies various “violations” to human dignity, including in the digital world, pointing to the trends where people’s personal lives are laid bare and “combed over” anonymously.

It cites the death penalty, which Francis has repeatedly condemned, and which it says “violates the inalienable dignity of every person.” The pope has  changed Catholic teaching to make the death penalty “inadmissible”   although this has been criticized by some conservative Catholics.

The document also addresses surrogacy, which it says “violates” both the dignity of the child and the woman, who “becomes a mere means subservient to the arbitrary gain or desire of others.” Pope Francis has recently called for the practice of surrogacy to be banned.

On assisted dying, the document reiterated the church’s opposition to euthanasia. “There is a widespread notion that euthanasia or assisted suicide is somehow consistent with respect for the dignity of the human person,” the document states. “However… it must be strongly reiterated that suffering does not cause the sick to lose their dignity, which is intrinsically and inalienably their own.”

Opposing criminalization of homosexuality

The Vatican explained that the 20-page document has been in preparation for five years and underwent various modifications to include “grave violations of human dignity in our time” and the pope’s teaching in this area.

The text strongly opposed the criminalization of homosexuality, something Francis spoke out against ahead of trip to Africa in 2023.

“It should be denounced as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation,” the text stated.

Cardinal Fernández, the prefect of the Vatican’s doctrine dicastery, presented the document to journalists at the Vatican, explaining that human dignity is a “central pillar” of Christian thinking.

On homosexuality, the cardinal said “even some Catholics” defend laws criminalizing homosexuality and said he was “shocked” to read a document from some Catholics supporting such legislation.

The latest document comes after Cardinal Fernández’s department sent shockwaves through the church by approving the move to allow the blessings of same-sex couples. He began his presentation at the Vatican on Monday by defending that document and insisting that an understanding of doctrine can develop and deepen.

He also pointed out that church opposition to abortion is not down to “fanaticism” but a consistent defense of the human person. He pointed out that the new document lists violence against women before abortion in its list of violations against human dignity.

This story has been updated with additional context

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Western Australia to Allow People to Legally Change Their Gender Without Medical Surgery

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A letter from a medical practitioner will be all it takes for a person to legally change their gender in Western Australia (WA) as the state moves to introduce a new bill for gender recognition.

The current law requires a person to undergo surgical reassignment and provide proof to the Gender Reassignment Board before being able to register a change of gender.

However, the centre-left Labor government said it would scrap the Gender Reassignment Board and introduce through the Registry of Births, Deaths, and Marriages a “new streamlined administrative process for sex and gender recognition.”

Under the proposed changes, individuals will only need a statement from a medical practitioner and psychologist certifying that they have “received appropriate clinical treatment in relation to the person’s sex or gender,” the government said.

People under 18 will face stricter rules including parental consent or permission from the Family Court of Western Australia in certain circumstances.

WA Premier Roger Cook hailed the progressive bill as a “significant legislative agenda,” demonstrating the government’s “commitment to developing WA’s first LGBTIQ+ inclusion strategy.”

“Everyone deserves the respect and dignity of being recognised as themselves, to have their legal identity align with their lived identity.”

Attorney General John Quigley said the legislation would bring WA in line with other states in gender recognition. Currently, WA and New South Wales (NSW) are the only Australian jurisdictions that require people to undergo medical reassignment to change their sex on birth certificates.

“The State Government remains 100 percent committed to new equal opportunity legislation and we will continue to engage with stakeholders in relation to this important reform,” Mr. Quigley said.

Additionally, the government said it was developing a new Equal Opportunity Act and “ban conversion practices—consisting of both a criminal prohibition and a civil response scheme.”

‘Anti-Women’ Reform

Think tank Women’s Forum Australia described the state’s ban on conversion practice as “the criminalisation or restriction of care for people struggling with gender dysphoria.”

“These regressive reforms endanger, discriminate against, and/or commodify and exploit women and children, and in some cases, put at risk the rights and freedoms of NSW citizens, and subvert best medical practice,” the women’s forum said.

“They are out of step with evolving research and developments taking place overseas.”

The group also argued that removing bans on commercial surrogacy would “encourage the commodification of vulnerable women as wombs for rent and children as products for sale.”

A petition titled “Protect Women and Children in NSW” by Women’s Forum Australia has garnered over 21,000 signatures.

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Ohio judge blocks ban on gender-affirming care for transgender minors—for now

An Ohio judge on Tuesday temporarily blocked an impending law that would restrict medical care for transgender minors in the Buckeye State.

The decision came weeks after the American Civil Liberties Union filed a lawsuit challenging the state on behalf of two transgender girls and their families. The measure prevents doctors from prescribing hormones, puberty blockers, or gender reassignment surgery before patients turn 18.

Attorneys contend the law violates the state Constitution , which gives Ohioans the right to choose their health care.

“Today’s ruling is a victory for transgender Ohioans and their families,” said Harper Seldin, staff attorney for the ACLU. “Ohio’s ban is an openly discriminatory breach of the rights of transgender youth and their parents alike and presents a real danger to the same young people it claims to protect.”

The legislation was set to take effect on April 24 after House and Senate Republicans  voted to override  Gov. Mike DeWine’s veto. Proponents of the bill contend it will protect children, but critics say decisions about transition care should be left to families and their medical providers.

Prep for the polls: See who is running for president and compare where they stand on key issues in our Voter Guide

The suit in Ohio mirrors efforts in other states to challenge laws that restrict gender-affirming care for minors. A federal judge struck down a  similar policy in Arkansas , arguing it violates the constitutional rights of transgender youth and their families. The state is appealing that decision.

“We protect children with various restrictions that do not apply to adults − from signing legal contracts to buying alcohol and tobacco and more,” Attorney General Dave Yost posted on X , formerly known as Twitter, after the lawsuit was filed. “As I promised during the veto override, my office will defend this constitutional statute.”

What does the Ohio bill do?

The bill allows Ohioans younger than 18 who are already receiving hormones or puberty blockers to continue as long as doctors determine stopping the prescription would cause harm. Critics say that’s not enough to protect current patients because health care providers could be wary of legal consequences.

The legislation does not ban talk therapy, but it requires mental health providers to get permission from at least one parent or guardian to diagnose and treat gender dysphoria.

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The bill also bans transgender girls and women from playing on female sports teams in high school and college. It doesn’t specify how schools would verify an athlete’s gender if it’s called into question. Players and their families can sue if they believe they lost an opportunity because of a transgender athlete.

The lawsuit doesn’t specifically challenge the athlete ban. But it argues the legislation flouts the constitution’s single-subject rule, which requires legislation to address only one topic. House Republicans introduced separate bills on gender-affirming care and transgender athletes before  combining them into one .

In Tuesday’s decision, Franklin County Judge Michael Holbrook indicated that the law could be tossed out because of a single-subject violation.

“It is not lost upon this Court that the General Assembly was unable to pass the (Saving Ohio Adolescents from Experimentation) portion of the Act separately, and it was only upon logrolling in the Saving Women’s Sports provisions that it was able to pass,” Holbrook wrote.

Panel clears ban on gender reassignment surgery for minors

Tuesday’s decision came one day after a legislative panel cleared the way for an administrative rule that will ban gender reassignment surgery for minors. Ohio health care providers say they do not perform that procedure on patients under 18.

The rule will take effect May 3.

More: Supreme Court, in an emergency order, lets Idaho enforce ban on transgender care

The measure was among several that DeWine proposed to regulate gender-affirming care after he vetoed the legislation. In testimony for Monday’s meeting, opponents argued that the rules overstep the administration’s authority and conflict with federal law.

“The proposed administrative rule changes are based on biased definitions, ignore well-established best practices, and restrict countless patients’ access to gender-affirming care,” said Mallory Golski, civic engagement and advocacy manager for Kaleidoscope Youth Center.

DeWine’s other proposals are still working their way through the rulemaking process. That includes a requirement for transgender minors to undergo at least six months of counseling before further treatment occurs. Another rule would require providers to report non-identifying data on gender dysphoria diagnoses and treatment.

Haley BeMiller is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

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Vatican blasts gender-affirming surgery, surrogacy and gender theory as violations of human dignity

The Vatican has declared that gender-affirming surgeries and surrogacy are grave violations of human dignity. A new document from the doctrine office puts them on a par with abortion and euthanasia as practices that violate God’s plan for human life. In its most eagerly anticipated section, the Vatican flat-out rejected “gender theory” or the idea that one’s gender can be changed.

The Vatican on Monday declared gender-affirming surgery and surrogacy as grave violations of human dignity, putting them on par with abortion and euthanasia as practices that reject God’s plan for human life. The Vatican’s doctrine office issued “Infinite Dignity,” a 20-page declaration that has been in the works for five years. After substantial revision in recent months, it was approved March 25 by Pope Francis, who ordered its publication.

The prefect of the Vatican’s Dicastery for the Doctrine of the Faith, Cardinal Victor Manuel Fernandez, presents the declaration ‘Dignitas Infinita’ (Infinite Dignity) during a press conference at the Vatican, Monday, April 8, 2024. (AP Photo/Gregorio Borgia)

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A copy of the 20-page “Infinite Dignity” declaration issued by the Vatican’s doctrine office sits on a journalist desk as the prefect of the Vatican’s Dicastery for the Doctrine of the Faith, Cardinal Victor Manuel Fernandez, meets the journalists during a press conference at the Vatican, Monday, April 8, 2024. (AP Photo/Gregorio Borgia)

VATICAN CITY (AP) — The Vatican on Monday declared gender-affirming surgery and surrogacy as grave violations of human dignity , putting them on par with abortion and euthanasia as practices that it said reject God’s plan for human life.

The Vatican’s doctrine office issued “Infinite Dignity,” a 20-page declaration that has been in the works for five years. After substantial revision in recent months, it was approved March 25 by Pope Francis, who ordered its publication.

From a pope who has made outreach to the LGBTQ+ community a hallmark of his papacy, the document was received as a setback, albeit predictable, by trans Catholics. But its message was also consistent with the Argentine Jesuit’s long-standing belief that while trans people should be welcomed in the church, so-called “gender ideologies” should not.

In its most eagerly anticipated section, the Vatican repeated its rejection of “gender theory,” or the idea that one’s biological sex can change. It said God created man and woman as biologically different, separate beings, and said people must not tinker with that or try to “make oneself God.”

“It follows that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception,” the document said.

It distinguished between gender-affirming surgeries, which it rejected, and “genital abnormalities” that are present at birth or that develop later. Those abnormalities can be “resolved” with the help of health care professionals, it said.

Advocates for LGBTQ+ Catholics immediately criticized the document as outdated, harmful and contrary to the stated goal of recognizing the “infinite dignity” of all of God’s children. They warned it could have real-world effects on trans people, fueling anti-trans violence and discrimination.

“While it lays out a wonderful rationale for why each human being, regardless of condition in life, must be respected, honored, and loved, it does not apply this principle to gender-diverse people,” said Francis DeBernardo of New Ways Ministry, which advocates for LGBTQ+ Catholics.

“It needs to be emphasized that biological sex and the sociocultural role of sex (gender) can be distinguished but not separated”

Nicolete Burbach, lead expert in social and environmental justice at the London Jesuit Centre, said the document showed the Vatican continues to fail to engage with queer and feminist approaches to the body “which it simply dismisses as supposedly subjecting both the body and human dignity itself to human whims.”

“I think the main difficulty faced by the document is that it attempts to affirm the church’s authentic commitment to human dignity in the face of a troubling history on the part of the church itself around attacks on that dignity,” said Burbach, a trans Catholic theologian who researches transness and the Catholic Church.

The document’s existence, rumored since 2019, was confirmed in recent weeks by the new prefect of the Dicastery for the Doctrine of the Faith, Argentine Cardinal Víctor Manuel Fernández, a close Francis confidant.

Fernández had cast the document as something of a nod to conservatives after he authored a more explosive document approving blessings for same-sex couples that sparked criticism from conservative bishops around the world, especially in Africa.

And yet, in an apparent attempt at balance, the document takes pointed aim at countries — including many in Africa — that criminalize homosexuality. It echoed Francis’ assertion in a 2023 interview with The Associated Press that “being homosexual is not a crime .”

The new document denounces “as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation.”

The White House said President Joe Biden, a devout Catholic, was “pleased” to see that the declaration “furthers the Vatican’s call to ensure that LGBTQ+ (individuals) are protected from violence and imprisonment around the world,” press secretary Karine Jean-Pierre said.

On the specifics involving gender theory, Jean-Pierre stressed that it was not Biden’s role to “litigate internal church policy.”

Asked how its negative take on trans people squared with Francis’ message of welcome, Fernández said the welcome remained but that the pope fervently believed that the idea that gender was fluid “rather than helping to recognize dignity, impoverishes the vision” of a man and woman coming together to create new life.

The document is something of a repackaging of previously articulated Vatican positions, read now through the prism of human dignity. It restates well-known Catholic doctrine opposing abortion and euthanasia, and adds to the list some of Francis’ main concerns as pope: the threats to human dignity posed by poverty, war, human trafficking, the death penalty and forced migration.

In a newly articulated position, it says surrogacy violates both the dignity of the surrogate mother and the child .

While much attention about surrogacy has focused on possible exploitation of poor women as surrogates, the Vatican asserts that the child “has the right to have a fully human (and not artificially induced) origin and to receive the gift of a life that manifests both the dignity of the giver and that of the receiver.”

“Considering this, the legitimate desire to have a child cannot be transformed into a ‘right to a child’ that fails to respect the dignity of that child as the recipient of the gift of life,” it said.

The Vatican had previously published its most articulated position on gender in 2019, when the Congregation for Catholic Education rejected the idea that people can choose or change their genders and insisted on the complementarity of biologically male and female sex organs to create new life.

The new document from the more authoritative Dicastery for the Doctrine of the Faith quotes from that 2019 education document, but tempers the tone. Significantly, it doesn’t repeat Vatican doctrine that homosexual people deserve to be treated with dignity and respect but that homosexual actions are “intrinsically disordered.”

In a news conference to introduce the document, Fernández acknowledged that the “intrinsically disordered” language was very strong. He suggested there might be a better way, “with other words,” to express the church’s vision of sex between husband and wife to create new life.

Francis has ministered to trans Catholics, including trans sex workers, and insisted that the Catholic Church must welcome all children of God.

But he has also denounced “gender theory” as the “worst danger” facing humanity today, an “ugly ideology” that threatens to cancel out God-given differences between man and woman. He has blasted in particular what he calls the “ideological colonization” of the West in the developing world, where development aid is sometimes conditioned on adopting Western ideas about gender.

Transgender activists immediately called the document “hurtful” and devoid of the voices and experiences of real trans people, especially in the distinction it makes between gender-affirming surgeries and surgeries on intersex people.

“The suggestion that gender-affirming health care — which has saved the lives of so many wonderful trans people and enabled them to live in harmony with their bodies, their communities and (God) — might risk or diminish trans people’s dignity is not only hurtful but dangerously ignorant,” said Mara Klein, a nonbinary, transgender activist who has participated in Germany’s church reform project.

Klein said the Vatican “hypocrisy” was furthered by the document’s approval of surgery on intersex people, “which if performed without consent especially on minors often cause immense physical and psychological harm.”

The document comes at a time of some backlash against transgender people, including in the United States where Republican-led state legislatures are considering a new round of bills restricting medical care for transgender youths — and in some cases, adults.

“On top of the rising hostility towards our communities, we are faced with a church that does not listen and refuses to see the beauty of creation that can be found in our biographies,” Klein said in an email.

AP writer Darlene Superville contributed from Air Force One.