gender reassignment surgery florida

Male to Female (MTF) in Miami, FL

Sex reassignment surgery (SRS), also called “gender reassignment surgery” (GRS) or “gender confirming surgery,” is a procedure designed to change transgender patients’ bodies so that their appearances better match their identities.

Although patients may choose to undergo SRS for a variety of reasons, many suffer from physical dysphoria, social dysphoria, or both. Physical dysphoria is a strong discomfort with the mismatch between identity and body, and social dysphoria is a strong discomfort with how other people perceive them. Patients desiring what we call “MTF” surgery include not just transsexuals, but anyone assigned male at birth who identifies as female, feminine, or a woman some or all of the time.

Breast Augmentation

The breast augmentation procedure provides patients with full breasts that project from the chest, and it can help transgender women achieve a more feminine physique. Breast augmentation for transgender patients is generally performed when hormone therapy fails to provide satisfactory enlargement of the breasts.

Since genetic male breast tissue is not much different from female breast tissue, transgender breast augmentation uses conventional breast augmentation techniques. This procedure is usually performed on an outpatient basis under general anesthesia and takes about one hour to complete.

Implant Type

Breast implants come in a range of materials, textures, and shapes.

Silicone implants consist of an outer silicone shell filled with cohesive silicone gel. New silicone implants, commonly called “gummy bear implants,” have been developed with a more highly concentrated silicone gel that reduces the risk of rupture and increases safety. Saline implants consist of a silicone shell filled with a sterile saltwater solution and can be filled after they are inserted into the breast pocket.

In addition to the material of the implant, patients also have the choice between smooth or textured implants and round or anatomically shaped (teardrop) implants.

During your consultation with Dr. Alexander, he will help you decide which incision location and implant type will best suit your needs.

Dr. Alexander will begin the breast augmentation procedure by making an incision for the implant to be inserted. The most preferable site for this incision is around the areola (the darker skin surrounding the nipple) because it allows for the most inconspicuous scarring. Dr. Alexander will then insert either silicone or saline implants, usually beneath the muscle for a more natural appearance and reduced risk of rippling. Once the implants are in place, the incisions will be sutured closed.

Following surgery, patients can expect to have some swelling and discomfort, which can be controlled with medication. Patients may also have a change in the sensation of their breasts immediately after surgery, but this usually resolves with time. Most normal activities can usually be resumed within a few days of surgery.

Removal of Loose Silicone From the Breasts

With the ever-growing popularity of plastic surgery comes the advent of risky and often illegal techniques to achieve a desired look. “Pumpers” are non-medical persons who inject loose silicone into areas of the body that the patient desires to augment. Unfortunately, loose silicone can migrate to different areas of the body and cause infection, disfigurement, scarring, and even death.

For patients who qualify, Dr. Alexander can remove loose silicone from the breasts, and in a few months he can perform breast augmentation surgery to safely and effectively achieve fuller breasts for the patient.

Brazilian Butt Lift for MTF Transgender Patient

This procedure adds curves to your figure by enhancing your rear end using your own fat tissue. The benefit of the Brazilian Butt Lift is that it removes unwanted fat from other areas, purifies it, and then transplants it to plump the butt. This procedure can give MTF transgender patients the attractive feminine backside they desire while slimming the surrounding areas.

Feminizing Rhinoplasty

Dr. Alexander utilizes a specialized technique known as feminizing rhinoplasty for transgender MTF patients who wish to attain a more feminine facial appearance. A more refined tip, narrower nasal bone, decreased nostrils or entire nose size, and an improved nasal profile are just some of the changes that can be achieved with this surgery.

At our South Florida offices, we welcome you to call 954-589-0722 to schedule a consultation or for any questions you may have concerning transgender procedures. You may also fill out our online virtual consultation form . As a well-known plastic surgeon in the transgender community, Dr. Timothy Alexander is vastly experienced in performing plastic surgery procedures for his transgender patients. He takes his time to dedicate himself to each individual’s needs and desires, and he is entirely confidential with the information of all of his clients.

*Although artificial and imperfect concepts, we use the terms “male,” “female,” “masculine,” and “feminine” to describe the characteristics that can be eliminated or achieved with this surgery.

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WE ARE PARTNERS IN LIFE AND OUR LIFE’S WORK

Dr. John L. Whitehead | Dr. Alain Ramirez

The Only Practice In The Miami Area Devoted Solely To Gender Affirmation

We are gay members of the LGBTQ+ community ourselves. We are fighting for the rights and happiness for transgender men and woman, as much as we fought for our own.

This Is A Safe Place To Restore You To Who You Were Meant To Be

This is a no judgement zone. No question is too embarrassing. No fear or worry we haven’t addressed. Holding your hand, being available by cell phone day and night – this is the kind of support we offer to our patients.

REAL DOCTORS. REAL MEDICINE

As board-certified physicians, we are proud of our education, training and credentials to address the complex issues around gender affirmation. As specialists we can provide the safest, most successful outcomes. We approach our work with a goal of balancing beauty with structure, function and comfort.

ON-SITE SURGICAL CENTER MAKES SURGERY MUCH MORE AFFORDABLE AND PRIVATE THAN USING A HOSPITAL

We are certified by the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF). The operating room maintains the same standards as the finest hospitals. Having more control over every element of the operating room gives us more ability to make you feel comfortable, safe and with the utmost privacy. It is also why our fees are so much less than they would be in a hospital setting.

WE ARE ADVOCATES FOR THE TRANSGENDER COMMUNITY

When we opened our practice, we had no idea of the challenges we would face with hospitals, insurance carriers and even members of the medical profession. We have helped make changes and continue to fight in support of the entire LGBTQ+ community.

“Although we’re seeing positive change, there is much work to do to help the transgender community gain their rights.”

Dr. John L. Whitehead

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the finest, non-surgical facial rejuvenation TO FEMINIZE OR MASCULINIZE THE FACE OR TO WIPE AWAY FLAWS AND AGE

Dr. Alain Ramirez is an artist when it comes to non-surgical facial rejuvenation. What all patients have in common is the desire to feel more attractive and more comfortable in their own skin.

FOR FAMILY AND FRIENDS

We want to be there for you, the loved ones of our transgender patients to provide resources, support and open conversation. We have found that with more credible information comes greater understanding which, of course, is the open door to mutual acceptance.

“It’s important to recognize that family and friends are going through a transition too. Everyone needs to be patient with one another.”

Anagloria Mora, PhD

Counselor and Specialist to the LGBTQ+ community

95% of our patients are from out of town & around the world

Our goal is for you to feel fully informed so you can make the best decision for you. Contact us for a virtual or in-person consultation and start the your life-changing conversation.

305.865.2000

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Male to Female Surgery in Miami

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• Male To Female Mtf

Dr. Rian Maercks is a top transgender surgeon in Miami who has developed aesthetic and augmentative techniques for male and female genitalia. His extensive expertise in natural aesthetics is not limited by gender or body part, and he has been well recognized for helping the transgender community with his procedures. If you were born male at birth but identify as female, you may be a strong candidate for MTF surgery. At The Maercks Institute, we provide world-class care and the resources necessary to support you through what can be an emotional time.

Transgender surgery: From male to female

The ultimate goal of gender reassignment surgery (i.e., gender confirming surgery or sex reassignment surgery) is to change the patient’s body so that their identity lines up with their appearance. Patients typically begin to consider gender reassignment surgery when they suffer from social dysphoria (strong discomfort in how others see them), physical dysphoria (strong discomfort in the mismatch between their physical body and their identity), or both. Whether you suffer from one or both of these conditions, we’re here to help. We can ensure that what you feel inside matches how you look outside.

Male to female vaginoplasty

The Maercks Institute’s sexual reassignment vaginoplasty involves a state-of-the-art, sensation-preserving creation of a self-lubricating neo-vagina with maximal depth and a fully sensate neo-clitoris with extended mucosal flaps and MACIE (Maercks Color-Corrected Intimate Enhancement) labiaplasty style labia majora and minora sculpting with structural fat grafting to ensure the most beautiful, feminine form for MTF transformation. This technique was developed by top transgender surgeon Dr. Rian Maercks. 

The FAVE procedure

Unlike conventional penile inversion techniques, the FAVE male to female surgery procedure allows customized tailoring to create the most feminine and natural-looking genital anatomy for each unique patient. Top transgender surgeon Dr. Maercks developed the FAVE procedure after his disappointment with the open and scarred appearance of conventional vaginoplasty techniques. After gaining experience with multiple techniques and combining his knowledge and experience with genital reconstruction, he devised the FAVE procedure to provide optimal aesthetic and functional results for trans women.

What are the FAVE enhancements?

The “E” in FAVE represents important enhancements that aren’t typically (or simply not ever) found in conventional vaginoplasty techniques. These enhancements include:

• Natural-looking clitoral hood origination. The FAVE male to female surgery procedure developed by top transgender surgeon Dr. Maercks achieves a natural-looking hood that has subtle folds on either side and originates from a subtle suprapubic mound — just like natural female anatomy.
• Optional urethral flap for enhanced natural vaginal lubrication. In the FAVE procedure, the long segment of the urethra that is usually thrown out can be integrated into the vagina. This helps with spontaneous lubrication.
• A scarless appearance. Conventional vaginoplasty techniques often result in significant, unattractive scars in the crease of the groin, but the freestyle flap design of the FAVE procedure allows either a completely hidden, “scarless” appearance or greatly minimized scarring.
• Internally oriented labia majora. Conventional vaginoplasty techniques pull the tissues in a “down and out” vector, which flattens the labia majora and spreads it apart. The FAVE procedure, however, allows a “closed” appearance of ideal aesthetics, which looks more natural. 
• 100% flap-derived vaginal vault. In conventional vaginoplasty techniques, surgeons often use skin grafts to augment the lining of the neo-vagina to allow for adequate vaginal depth. This can result in pain and the need for a revision procedure. In the FAVE procedure, novel flaps and novel arrangements are used to provide a redundantly large surface area to line the vaginal vault, eliminating the need for a graft. 
• Full-length true labia minora. The labia minora are largely neglected in conventional techniques, but in the FAVE procedure, the labia minora begins from the clitoral hood and travels with constant dimension all the way to the posterior of the vaginal opening, reflecting ideal feminine aesthetics. 

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Breast augmentation and mtf surgery.

This male to female surgery is designed to create breasts that deliver a more feminine physique. Hormone therapy may first be used to enlarge the breasts, but if this treatment option fails, many turn to breast augmentation to achieve the full, round breasts that project from the chest.

Because female breast tissue is very similar to male breast tissue, the process used is very similar to a typical breast augmentation MTF surgery. The procedure is usually performed under anesthesia on an outpatient basis and can be done in just under an hour.

The breast augmentation procedure

The procedure starts with an incision that is used to place the implant inside the chest. Implants are placed through incisions that can be made in several different areas of the body. The exact placement of your incisions will be determined during your consultation, but most patients prefer an incision site around the nipple (on the areola) because the scarring is less visible. However, there are other options available. Once the incision is made, the saline or silicone implant is placed through the incision site — typically underneath the muscle for reduced risk of rippling, and a more natural look. Once the implants are properly placed, the incision site is closed with sutures

Types of breast implants

Breast implant types vary in textures, shapes, materials, and sizes. Choosing the right one is a matter of deciding what’s right for your individual preferences. At The Maercks Institute in Miami, we offer both silicone and saline implants for our transgender patients.

• Silicone: A cohesive silicone gel is used to fill an outer silicone shell. These are often referred to as “gummy bear implants” and they offer decreased risks and better safety.
• Saline: A silicone shell is filled with a saltwater solution, and implants are filled after they are placed inside the body.

Patients may also choose between textured or smooth implants, as well as anatomically shaped or round implants. Getting the appearance you want is the most important outcome, and we can help you choose the right implants for what you hope to achieve.

After breast augmentation surgery, some discomfort and swelling is normal. This is easily controlled with pain medication.

While you may notice a change in breast sensation right after surgery, this issue is typically resolved within a few weeks. Most patients resume normal activities about a week after the procedure.

Did you receive loose silicone? We can help. 

Unfortunately, there are dangerous and illegal plastic surgery techniques out there — and many individuals fall prey to “medical professionals” offering to inject loose silicone in the body. These are known as “pumpers”, and they often do not have credentials to perform this service. This is very dangerous, as the loose silicone (if it even is silicone) can migrate to the rest of the body and cause scarring, infection, disfigurement, or even possible death. At The Maercks Institute, we work hard to keep the plastic surgery industry professional, classy, safe, and satisfying. If you’re dealing with loose silicone in your body, top transgender surgeon Dr. Maercks can remove it and perform a breast augmentation surgery just a few months later to ensure that you get the breasts you want without the risks that come from less-than-ideal providers.

Brazilian butt lift and MTF surgery

During a Brazilian butt lift, extra fat is removed from a part of the body where it’s not wanted (typically the abdomen or thighs), purified, and then injected into the buttocks to add feminine curves to your figure. This gives MTF patients a slimmer appearance while also enhancing curves that create a female appeal.

Rhinoplasty feminized

We use specialized techniques to feminize the face for MTF patients. One of the most effective procedures is rhinoplasty (a nose job). Dr. Maercks narrows the nasal bone, decreases the entire nose size and nostrils, refines the nasal tip, and improves the entire profile during surgery. This results in a more feminine, delicate appearance. 

Your MTF surgery consultation

There are many questions and concerns that our patients have before they undergo male to female surgery, and we are here to educate and help in any way that we can. We want you to feel good about the changes you’re making with your body, and our initial consultation can put any fears you have to rest. At The Maercks Institute in Miami, we offer only the best in care and services. No matter where you are in your journey to transitioning, we’re with you every step of the way from the moment you decide to work with us. While risks are inherent with all surgeries, we do our part to minimize your risks and keep you safe.

Why choose Dr. Maercks for MTF surgery in Miami? 

The Maercks Institute offers transgender patients access to state-of-the-art technology, the expertise of an experienced top transgender surgeon, and the absolute best in patient care. Board-certified president and medical director Dr. Rian Maercks is a cosmetic, plastic, and reconstructive surgery specialist who is double-fellowship trained and has a unique combination of specialized expertise in cosmetic breast and body procedures. His innovative approaches to both surgical and non-surgical procedures of the face and body have garnered him international recognition by surgeons and patients alike, and his undergraduate training in fine arts and philosophy created the framework through which he explores the world of medicine and plastic surgery. In addition, Dr. Maercks elevates the standard of patient care and safety through his work as medical director. If you’re interested in male to female surgery in the Miami area, come discover why Dr. Maercks has changed the lives of thousands of patients over the years. Schedule a consultation with us today. 

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Daniel Trotta is a U.S. National Affairs correspondent, covering water/fire/drought, race, guns, LGBTQ+ issues and breaking news in America. Previously based in New York, and now in California, Trotta has covered major U.S. news stories such as the killing of Trayvon Martin, the mass shooting of 20 first-graders at Sandy Hook Elementary School, and natural disasters including Superstorm Sandy. In 2017 he was awarded the NLGJA award for excellence in transgender coverage. He was previously posted in Cuba, Spain, Mexico and Nicaragua, covering top world stories such as the normalization of Cuban-U.S. relations and the Madrid train bombing by Islamist radicals.

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Gender Affirming Care in Florida: Current Rules of the Road

Special thanks to summer associate Sheridan Organ for her contributions to this article.

On May 4, 2023, the Florida Senate passed SB 254 by a sweeping vote of 83 to 23. This law, which imposes restrictions on gender-affirming care in Florida, took effect immediately upon Governor Ron DeSantis signing on May 17, 2023. Please see our previous blog  for a discussion of the statute.

Since May, the joint committee of the Board of Medicine and Board of Osteopathic Medicine (the Committee) has met several times to implement the law by developing and publishing emergency rules and informed consent forms. The most recent iteration of the emergency rules and informed consent forms were published by the Committee on August 22, 2023 for adults and July 5, 2023 for minors. As discussed below, the August 22, 2023 update removed the requirement for patients over the age of 18 to undergo a psychological evaluation from the informed consent forms for hormone replacement therapy (HRT).

Both payors and providers must understand the current requirements in Florida: (1) to ensure that no one is providing or paying for a prohibited items or services; and (2) to work together to find solutions for their patients and members who may experience a disruption in care during the implementation of the new law.

Emergency Rules

The statute requires the use of informed consent forms that the Committee had yet to issue. As a result, the Committee passed an emergency rule on June 2 allowing the renewal of previous prescriptions while the Committee finalized the consent form. Notably under the June 2 emergency rule, prescriptions could be renewed without using the informed consent forms for up to six months after the informed consent forms were issued. The Committee held several meetings to discuss and finalize the emergency rules and informed consent forms for both minors and adults. Subsequent emergency rules and the lengthy informed consent forms were issued on July 5, 2023, and again on August 22, 2023. The most recent iteration of the emergency rules merely updated the hyperlinks to the revised informed consent forms for adults.

Informed Consent Forms

In creating the informed consent forms, the Committee added in various requirements for issuing prescriptions to minors. These requirements include: x-rays of the hand each year to monitor and document the patient’s bone age progression, an annual bone density scan, and an annual mental health assessment by a Florida licensed psychiatrist or psychologist.

The Committee also added a requirement into the adult informed consent forms. Specifically, the original informed consent forms required a psychological assessment and supporting letter from a Florida-licensed psychiatrist or psychologist prior to beginning HRT and every two years thereafter.

After issuing emergency rules and informed consent forms, the Committee received notice from the Joint Administrative Procedures Committee (JAPC). JAPC is a joint standing committee of the Florida Legislature that is tasked with ensuring agency rules do not exceed the statutory authority upon which they are based. In its notice, JAPC stated that it suspected the Committee exceeded its authority in promulgating the above-mentioned practice standards for adults . JAPC explained that the statue only authorized the Board of Medicine and Board of Osteopathic Medicine to promulgate practice standards for gender affirming care provided to minors. During the last Committee meeting on August 3, the Committee acknowledged the notice and voted to remove the language requiring a visit with a psychologist or psychiatrist from informed consent process for adults. This was subsequently reflected in revised forms published on August 22, 2023. However, the Committee simultaneously noted that the requirement to see a psychologist or psychiatrist is consistent with the general standard of care for adult patients seeking gender affirming care.

Court Challenges

In addition to regulatory activity, this law has been challenged in a variety of different ways in court. In a recent lawsuit, Dekker v. Weida , 2023 WL 4102243 (N.D. Fla. 2023), Judge Robert Hinkle ruled that Florida’s prohibition on Medicaid coverage for treatment of gender dysphoria for transgender Floridians is unlawful and stated that the “State of Florida’s decision to ban payment for GnRH agonists and cross-sex hormones for transgender individuals is not rationally related to a legitimate state interest.” This final ruling ended a ban on using Medicaid funds that began in August 2022 and nullified the section of SB 254 that banned Medicaid coverage of gender-affirming care.

In addition to Dekker , another lawsuit, Doe v. Ladapo , 2023 WL 3833848 (N.D. Fla 2023), challenged the ban on puberty blocking prescriptions for minors. The court issued a preliminary injunction preventing the enforcement of Florida’s ban on minors being able to access puberty-blocking hormones. Specifically, the Court found that the minors risked irreparable injury through the “the unwanted and irreversible onset and progression of puberty in their natal sex” if the injunction was not issued. The complaint was later amended to include adults as plaintiffs and to seek class-wide relief for all trans minors and adults affected by the law. This case is ongoing and a hearing was recently scheduled related to the motion to certify a class on August 29.

Court challenges against SB254, including Doe v. Ladapo , will continue and impact the full scope and effect of this law on Floridians.

Looking Forward

In the last Committee meeting on August 3, the Committee assigned members from both the Medical Board and Osteopathic Board to consider ways the emergency rules should be updated when formulating the final, permanent rules. The Committee announced that it will solicit public comments on these permanent rules. The Committee set a tentative goal date for end of year to the issue the final rules.

Payor/Provider Convergence Blog Series

For additional resources on the intersection of payor/provider convergence and the issues that plague insurance and health companies, payors, and providers, click  here  to read the other articles in our series.

Foley is here to help you address the short- and long-term impacts in the wake of regulatory changes. We have the resources to help you navigate these and other important legal considerations related to business operations and industry-specific issues. Please reach out to the authors, your Foley relationship partner, our  Payor/Provider Convergence Area of Focus , or to our  Health Care Practice Group  with any questions.

Alexandra B. Maulden

Alexandra B. Shalom

Senior Counsel

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Florida to ban gender-affirming care under Medicaid for transgender recipients

The rule will take effect on Aug. 21.

Florida will soon bar transgender residents from using Medicaid to pay for gender-affirming care, according to the state's Agency for Health Care Administration . The rule goes into effect Aug. 21.

Several accredited medical institutions, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, alongside the U.S. Department of Health and Human Services say gender-affirming care can improve the mental health and overall well-being of gender-diverse people.

These organizations recommend gender-affirming care for the treatment of "gender dysphoria" -- when a person experiences emotional distress because their assigned sex at birth and gender identity don't align.

"Because gender-affirming care encompasses many facets of healthcare needs and support, it has been shown to increase positive outcomes for transgender and nonbinary children and adolescents," reads guidance from HHS. "Gender-affirming care is patient-centered and treats individuals holistically, aligning their outward, physical traits with their gender identity," the guidance continues.

However, the Florida Agency for Health Care Administration changed its rules Thursday. Medicaid can no longer be used to pay for medications and surgeries of those diagnosed with gender dysphoria in the state.

A 2019 study by the Williams Institute at UCLA School of Law found that about 32,000 of the roughly 152,000 U.S. trans adults enrolled in Medicaid at the time lived in states that denied coverage for gender-affirming care.

AHCA proposed the change in a June memo , recommending limitations on puberty blockers, hormones, sex-reassignment surgeries and "any other procedures that alter primary or secondary sexual characteristics."

AHCA proposed the change in a June memo, recommending limitations on puberty blockers, hormones, sex-reassignment surgeries and "any other procedures that alter primary or secondary sexual characteristics."

Joseph Ladapo, Florida's surgeon general, also released a memo in June on gender-affirming care.

He claimed treatments like sex-reassignment surgery, and hormone and puberty blockers are not effective treatments for gender dysphoria based on three cited studies that dispute the general medical consensus on the condition.

He said federal medical guidelines are “about injecting political ideology into the health of our children. Children experiencing gender dysphoria should be supported by family and seek counseling, not pushed into an irreversible decision before they reach 18,” he said in a statement.

MORE: Amid anti-LGBTQ efforts, transgender community finds joy in 'chosen families'

Almost simultaneously, the Florida State Board of Medicine voted on Aug. 5 to begin formulating a rule that would deny gender-affirming care to people under the age of 18 and require adults to consult with their doctors before receiving such care.

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In a recent press conference , Florida Gov. Ron DeSantis railed against gender-affirming care.

"You don't disfigure 10, 12, 13-year-old kids based on gender dysphoria," DeSantis said in a recent press conference. "I think these doctors need to get sued for what's happening."

He also made claims that children with gender dysphoria often regret their gender-affirming care; however, a 2021 study from researchers across the country found that the total number of people who regret their care is almost non-existent.

Health care providers have told ABC News that gender-affirming surgeries are not used on minors.

These moves led to outrage from LGBTQ groups and health care providers across the country.

"Science, medicine, and evidence-based approaches have demonstrated time and time again that transition-related care is medically necessary and life-saving care, and if this proposal is adopted, it will go against the recommendation of every major medical association," said Sarah Warbelow, Human Rights Campaign Legal Director in a statement . "The truth matters and so does protecting Florida's youth and their families."

Under DeSantis' leadership, Florida has continuously battled against professional and activist-based recommendations for gender inclusivity. Recently, several of the state's agencies openly dismissed nondiscrimination recommendations from the federal level. In July, the Parental Rights in Education law, dubbed the "Don't Say Gay" law , went into effect.

Supporters of the law say that children should not be learning about gender identity and sexual orientation in grades K-3. Critics say it will silence and shame LGBTQ identities in the classroom.

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Florida Restricts Doctors From Providing Gender Treatments to Minors

The state’s medical board, whose members are appointed by the governor, has barred doctors from prescribing gender care to new adolescent patients.

By Azeen Ghorayshi

Azeen Ghorayshi, who reports on science and gender, went to Orlando last week to watch the state medical board’s contentious hearing on transgender health care.

Florida has effectively banned medications and surgery for new adolescent patients seeking gender transitions after an unprecedented vote by the state’s medical board.

The move makes Florida one of several states to restrict what’s known as gender-affirming care for adolescents, but the first to do so through the actions of its Board of Medicine, whose 14 members were appointed by Gov. Ron DeSantis. The strategy circumvented the Republican-controlled State Legislature, which had twice declined to take up a bill aiming to restrict such treatment.

The board voted 6-3 (with five others not present) on Friday to adopt a new standard of care that forbids doctors to prescribe puberty blockers and hormones, or perform surgeries, until transgender patients are 18. Exceptions will be allowed for children who are already receiving the treatments.

The Florida Board of Osteopathic Medicine also voted to restrict care for new patients on Friday, but allowed an exception for children enrolled in clinical studies. Doctors who flout the rules risk losing their medical licenses.

“The chief point of agreement among all of the experts — and I must emphasize this — is that there is a pressing need for additional, high-quality clinical research,” Dr. David A. Diamond, a radiation oncologist and the chair of the board, said on Friday.

The decision followed months of heated discussion, including a tense and at times bitterly divided public meeting in Orlando last week featuring testimony from doctors, parents of transgender children and adults who have come to regret their transitions.

And it comes four days before the conclusion of the governor’s race in the state and as conservatives have adopted gender-related medical care for adolescents as a key issue on the national political stage. Mr. DeSantis, a Republican widely believed to have presidential ambitions, declared in a recent debate that such treatments would not be allowed in Florida. Before the medical board decided to craft the new standard, members received personal calls from the state’s surgeon general, Dr. Joseph Ladapo, urging them to do so.

Earlier this year, Florida became one of at least nine states to bar Medicaid coverage of gender-affirming care, affecting thousands of low-income adults and children.

Such treatments for adolescents typically include puberty blockers, which stall development, often followed by testosterone or estrogen to bring about secondary sex characteristics that better align transgender adolescents’ bodies with their experience of gender. A small but growing number of adolescent patients pursue surgeries, most often to remove their breasts. All treatments require parental consent and approval from physicians.

Major medical groups in the United States, including the American Academy of Pediatrics , have condemned state bans and insurance restrictions of such care as dangerous political intrusions into standard medical practice. Transgender adolescents struggle with high rates of depression and anxiety, and small studies suggest that such medical interventions can help ameliorate body-related distress and improve the adolescents’ well-being.

But the rapidly rising number of adolescents seeking such treatments and a lack of data on their long-term outcomes has also raised concerns among some clinicians worldwide. At the public meeting last week, board members made frequent references to changes in Europe, where some countries have recently limited which adolescents can receive puberty blockers and hormones.

The United States, in contrast, has taken an all-or-nothing approach. Arkansas and Alabama have passed laws making it illegal for doctors to provide any gender-related care to minors. In Texas, Gov. Greg Abbott ordered the state’s child welfare agency to investigate parents of transgender children on suspicion of child abuse. (These actions are facing court challenges from civil rights groups .)

Florida has taken a different path, instituting a ban through its medical board, which is overseen by the state’s Department of Health. The board is primarily responsible for licensing and disciplining doctors, but it sometimes also crafts health care guidelines.

Eight members of Florida’s board have donated a combined total of nearly $100,000 to Mr. DeSantis’s campaigns over the past decade. Four members have each donated more than $15,000.

The board’s vote on Friday raises questions about the role of a politically appointed body in controlling complex and highly personal medical decisions, particularly in an election year. The board typically focuses its actions on grave threats to public health, such as opioid abuse or procedures like so-called Brazilian butt lifts that have resulted in many patient deaths in Florida. In August, a lawyer for the health department acknowledged that the state had not received any patient complaints about gender-affirming care.

“I feel very strongly that this is a misuse of their power,” said Dr. Meredithe McNamara, an adolescent medicine physician at Yale who treats transgender children and testified at the meeting.

Mr. DeSantis nominated Dr. Ladapo, a physician and clinical researcher then at the University of California, Los Angeles, as surgeon general in September 2021. Together, the two men have repeatedly taken scientific uncertainty — be it about coronavirus vaccines or about gender-affirming care in adolescents — and wielded it to justify aggressive policies out of the mainstream medical orthodoxy.

A Republican state lawmaker in Florida introduced legislation in 2021 and again this year that would have criminalized the performing of gender-affirming surgery on transgender adolescents and would have made it a first-degree misdemeanor to prescribe puberty blockers and hormones. In both years, the bill did not advance in the state’s House of Representatives.

In April, Dr. Ladapo sent a letter to physicians in Florida recommending against prescribing gender-affirming medications and surgeries for minors as well as facilitating social transitions, such as changes in hair styles or pronouns. The memo spurred a state investigation that prompted the loss of Medicaid coverage of gender-related treatments for patients of all ages.

In June, Dr. Ladapo asked the state’s medical board to consider a ban, arguing that evidence for gender-affirming care in adolescents was “extraordinarily weak” and that it came with a “high risk for long-term, irreversible harms.”

Two months later, on the evening before the board was scheduled to vote on whether to craft its own rule, Dr. Ladapo called board members to check in, an unusual move, according to one member who requested anonymity because he was concerned about his privacy. Typically, he said, the board would decide to investigate physicians after receiving complaints, not at the behest of the surgeon general. The next day, the board voted to draft a new standard of care.

The Department of Health, which Dr. Ladapo oversees, said that there was nothing inappropriate about the surgeon general reaching out to the board members.

“I am not sure why it is shocking for the surgeon general to communicate with members of any board, which are overseen by the Department of Health,” Weesam A. Khoury, the deputy chief of staff of the department, said in an email. She added that Dr. Ladapo had also recently contacted members of the state Board of Osteopathic Medicine to check on their safety after they had received death threats related to this issue.

But the push to ban the care did not sit well with some members of the medical board. Dr. Kevin Cairns, a spine specialist from Fort Lauderdale, stepped down in October as the vice chair of the board because he was disappointed by the medical board’s actions on this issue, according to two people familiar with his decision.

At the meeting last Friday, with an audience of roughly 200 people, the board heard testimony from doctors who treat transgender adolescents, as well as from two critics who do not specialize in such care.

Dr. Kristin Dayton, a pediatric endocrinologist and the head of the youth gender program at the University of Florida in Gainesville, spoke about her experience treating transgender adolescents. After two other clinics in Florida stopped accepting new patients this year, Dr. Dayton’s clinic, which sees about 300 patients, became the only option for children seeking care in the state.

“Our patients report reduced suicidal ideation and increased satisfaction with their lives after being given access to gender-affirming hormone therapy,” Dr. Dayton said.

But she urged the board to consider that not all patients received medical interventions. “There is no one-size-fits-all model for care,” Dr. Dayton said.

Arguing in favor of restrictions, Dr. Riittakerttu Kaltiala, a professor of adolescent psychiatry at Tampere University in Finland, testified about leading the youth gender program in that country since 2011.

The vast majority of her patients were assigned female at birth and began experiencing distress about their gender identity later in adolescence, she said. And many of her patients with co-occurring psychological issues were not helped by the treatments, she said. In 2020, Finland began limiting puberty blocking and hormonal treatments for minors, prescribing them only to adolescents with clear diagnoses of gender dysphoria and expanding the availability of talk therapy.

“This is really my sincere understanding: that the evidence is lousy ,” Dr. Kaltiala told the board.

Following the testimony last week, the board opened the meeting to public comment, inviting nine people who had reversed their gender transitions, or detransitioned, to speak first. Many said their transitions had occurred during periods of intense psychological distress with little scrutiny from physicians.

“I actually developed more psychiatric issues the further I went into transition,” said Chloe Cole, 18, who speaks frequently to the news media and had testified in favor of the state’s Medicaid ban . She began testosterone treatment at age 13 and had surgery to remove her breasts at 15. A year later, she said, she realized that her transition was a mistake and stopped taking hormones.

Several parents spoke about how their children’s lives had been greatly improved with gender-related medical support. One mother, Hope McClay, described the path of her transgender daughter, now 9. “It would be psychologically damaging if she had to go through puberty as a male,” Ms. McClay said.

“We do not make these decisions lightly,” she added. “But these are the decisions that should be made by the families, not by the state and not by the board.”

Jude Speegle, the only transgender person who spoke, said he had known he was transgender since early childhood. “I suffered from suicidal ideation from the age of 10 to 26 and attempted suicide multiple times, thinking it was wrong to be who I was,” he said.

The Board of Medicine and osteopathic board were set to vote on Friday for the same change to the standard of care, opting to include an exception for any clinical research. But in a surprising move, the medical board struck the research exemption. That means there will be two standards in the state, one for medical doctors and another for osteopathic doctors, barring any future changes.

Anna Eskamani, a Democratic state Representative from Orange County, condemned the board’s decision during the public comment period. “I expect the legislature to be a political being, not the board of medicine,” she said.

The changes in the new standards will go into effect after a 21-day public comment period. Although the osteopathic board made an exception for children enrolled in clinical trials, no such studies have been started in Florida.

Patricia Mazzei contributed reporting.

Azeen Ghorayshi covers the intersection of sex, gender and science for The Times. More about Azeen Ghorayshi

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Surgeons Who Perform Gender-Affirming Surgery

Trans feminine Gender Affirming Surgery is becoming more and more common, but it can still be tough to find the right surgeon. The surgeons listed below are highly qualified plastic, reconstructive, urological and cosmetic surgeons who regularly perform gender-affirming procedures for those on the trans feminine spectrum. When choosing a surgeon, look for board certification, experience with transgender surgery, and a someone you feel confident and comfortable with.

Also see: Vaginoplasty Surgeons , Orchiectomy Surgeons

Featured Surgeons

Dr. Kathy Rumer

Dr. Kathy Rumer is an expert in transgender surgery, performing 200-250 MTF gender reassignment surgeries per year. Dr. Rumer also directs a 1-year gender surgery fellowship program. She offers the full range of male to female surgery procedures, including Vaginoplasty, Facial Feminization Surgery and Breast Augmentation. Read more »

Dr. Scott Mosser

Dr. Scott W. Mosser is a board certified and award-winning surgeon based in San Francisco who specializes in MTF/N Breast Augmentation and Body Feminization. He has worked with the transgender community for more than 10 years. Dr. Mosser is co-founder of the American Society of Gender Surgeons (ASGS), and Medical Director of the Gender Institute at Saint Francis Memorial Hospital. Read more »

Dr. Gabriel Del Corral

Dr. Del Corral is a double board-certified plastic and reconstructive surgeon who offers Vaginoplasty and other gender-affirming procedures at the Medstar Center for Gender Affirmation in Washington D.C. and Baltimore, Maryland. Fellowship trained in microsurgery, Dr. Del Corral also has expertise in reconstructive surgery, maxillofacial surgery and cosmetic surgery. He specializes in Gender Affirmation Surgery and has a particular interest in Vaginoplasty and Facial Feminization. More »

Dr. Scott W. Mosser is a board certified and award-winning surgeon based in San Francisco who specializes in MTF/N Breast Augmentation and Body Feminization. He has worked with the transgender community for more than 10 years. Dr. Mosser is co-founder of the American Society of Gender Surgeons (ASGS), and Medical Director of the Gender Institute at Saint Francis Memorial Hospital. More »

Dr. Danny Hanna

Dr. Hanna is a fellowship-trained Gender Surgeon based in Dallas, Texas. At the Hanna Gender Center, Dr. Hanna works exclusively with transgender and non-binary patients, offering gender-affirming genital surgeries as well as Breast Augmentation, Body Sculpting and Hair Grafting. More »

Newly Added Surgeons

Dr. Kenan Celtik

Dr. Celtik is a Reconstructive Urologist who specializes in gender-affirming Vaginoplasty. He is fellowship-trained in Gender Surgery and has completed 15 years of advanced medical education, including rigorous training in female pelvic reconstruction, robotic surgery and neurourology. Dr. Celtik's deep expertise and commitment to providing exceptional care and surgical outcomes make him a great choice of Vaginoplasty surgeon. He joined the Crane Center for Transgender Surgery in 2023 and is based in the San Francisco area. More »

Dr. Drew Marano

Dr. Marano is a fellowship-trained plastic and reconstructive surgeon in New York City who has deep expertise in Gender Affirmation Surgery. Dr. Marano is fellowship-trained in the full spectrum of gender-affirming procedures and is particularly passionate about Robotic Vaginoplasty and Facial Feminization Surgery. Dr. Marano's extensive training and dedication to provide the highest level of care make him a sound choice of surgeon in the New York metropolitan area. More »

Dr. Aneesh Gupta

Dr. Gupta is a triple board-certified cosmetic surgeon in Philadelphia who offers Breast Augmentation and Body Feminization surgery. Dr. Gupta's experience with gender-affirming care has informed how Jazzi Cosmetic Surgery has created a welcoming environment for all patients. Throughout your surgical journey, you can expect everyone you interact with at Jazzi to be friendly and professional. More »

Facial Feminization Experts

Dr. Joel Beck

Dr. Beck is a board certified plastic and reconstructive surgeon who has been offering gender-affirming facial surgery since 2003. Based in Charlotte, North Carolina, Dr. Beck is one of only a few FFS Surgeons in the Southeast. He also offers Breast Augmentation, Body Sculpting and Hair Grafting. More »

Dr. Gerhard Mundinger

Dr. Mundinger is a board-certified plastic surgeon with broad training and expertise in craniofacial and gender-affirming surgery. Dr. Mundinger joined the Austin branch of the Crane Center for Transgender Surgery in 2021, where he offers Facial Feminization Surgery, Vaginoplasty and Breast Augmentation. More »

Dr. Drew Schnitt

Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon based in South Florida. In practice since 2002, Dr. Schnitt's extensive experience in cosmetic and craniofacial surgery make him a great choice for Facial Feminization Surgery, as well as gender-affirming Breast Augmentation and Body Sculpting. More »

Dr. Josef Hadeed

Dr. Hadeed is a board certified, Duke University-trained surgeon who offers gender-affirming feminizing surgery in Beverly Hills, California and Miami, Florida. Dr. Hadeed's surgical offerings include Orchiectomy, Facial Feminization, Breast Augmentation and Body Sculpting. More »

Dr. Alexander Facque

Dr. Facque is a board-certified plastic surgeon in San Francisco, California who joined the Gender Confirmation Center's team in September 2020 as a full-time Associate Surgeon with deep expertise in Facial Gender Confirmation Surgery, Breast Augmentation and Body Sculpting. Dr. Facque was introduced to gender-affirming care in 2012 and now works exclusively with transgender and non-binary patients. More »

Dr. Thomas Satterwhite

Dr. Satterwhite is a Plastic Surgeon in San Francisco works exclusively with transgender and non-binary patients. Dr. Satterwhite performs Facial Feminization Surgery, Vaginoplasty, Breast and Buttock Augmentation, and Body Sculpting. More »

Dr. Toby Meltzer

Dr. Meltzer is a plastic and reconstructive surgeon who is widely recognized as one of the leading surgeons in the field of Gender Reassignment Surgery. Dr. Meltzer has been performing MTF Surgery since 1993 and has completed over 4000 gender affirming surgeries. He performs about 200 gender reassignment surgery cases per year in Scottsdale, Arizona. More »

Dr. Christopher Salgado

Dr. Salgado is a board-certified plastic surgeon in Florida who has deep expertise in Gender Affirming Surgery. In practice for more than 20 years, Dr. Salgado performs all aspects of male-to-female surgery, from Facial Feminization and Breast Augmentation to Vaginoplasty, giving patients the opportunity to experience a continuity of care throughout their surgical transition. After many years in academic practice, Dr. Salgado opened his private practice in Miami in 2019. More »

Dr. Eric Bensimon

Dr. Bensimon has dedicated his career to helping trans women seeking FFS. With over 15 years experience in FFS, Dr. Eric Bensimon is one of the world's most experienced surgeons practicing Facial Feminization Surgery. Dr. Bensimon is based in Montreal, Canada. More »

Dr. Praful Ramineni

Dr. Ramineni is a highly experienced, board-certified plastic and reconstructive surgeon who specializes in gender-affirming top and bottom surgeries. Dr. Ramineni has more than 15 years of experience as a surgeon and performs at least 600 procedures a year. He's known for not just his exceptional surgical skills and natural-looking results, but also for his caring bedside manner and great communication style. More »

Dr. Daniel J. Freet

Dr. Freet is a board certified Plastic and Reconstructive Surgeon who offers the full spectrum of MTF Surgery procedures at the University of Texas in Houston. Leading a multidisciplinary gender surgery team, Dr. Freet performs Gender Reassignment Surgery (Vaginoplasty), as well as Facial Feminization and Breast Augmentation. More »

Dr. Angela Rodriguez

Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. She is highly proficient in gender-affirming Vaginoplasty and has a special interest in Facial Feminization. Her commitment to transforming lives and passion for social justice drove her pursuance to master transgender surgery, but it's Dr. Rodriguez's surgical skills, bedside manner and results that patients love. More »

Dr. Curtis Crane

Dr. Crane is a board-certified plastic surgeon in Austin, Texas who has deep experience with the full spectrum of male-to-female Gender Reassignment Surgery procedures. Dr. Crane and his team perform approximately 130 Vaginoplasty surgeries every year, as well as Vulvoplasty, Facial Feminization and Breast Augmentation. More »

Dr. Richard Santucci

Dr. Santucci, who spent 18 years as one of the nation's most distinguished academic Reconstructive Urologists, hasn't looked back since turning his focus to Gender Affirming Surgery. Before joining the Crane Center for Transgender Surgery, Dr. Santucci served as the Director of the Center for Urologic Reconstruction and the Specialist-in-Chief for Urology at the Detroit Medical Center. Dr. Santucci's years of experience with complex genitourinary surgery uniquely qualifies him to excel at gender-affirming genital reconstruction. More »

Dr. Ashley DeLeon

Dr. DeLeon is a board-certified surgeon who specializes exclusively in Gender Affirmation Surgery. Dr. DeLeon was fellowship trained in gender-affirming procedures by Dr. Curtis Crane. Dr. DeLeon practices in Austin, Texas at the Crane Center for Transgender Surgery, one of the busiest gender surgery practices in the world. Dr. DeLeon's special focus is on male-to-female bottom surgery procedures: Orchiectomy, Vulvoplasty and Vaginoplasty. More »

Dr. Dev Gurjala

Dr. Gurjala is a board-certified plastic surgeon in San Francisco who offers the full array of male-to-female surgery. Prior to joining Align Surgical Associates in 2019, Dr. Gurjala performed gender surgery, microsurgery, and general reconstructive and aesthetic surgery for five years in the Kaiser Permanente system in California. More »

Dr. Michael Safir

Dr. Safir is a board-certified urologist in Los Angeles who specializes exclusively in gender-affirming bottom surgery procedures. With sub-specialty certification in Female Pelvic Medicine and Reconstructive Surgery (FPM-RS), Dr. Safir is one of a handful of urologists in the world with individual fellowship training and experience in both male and female genital reconstruction. He gained signicant experience performing gender-affirming genital procedures for five years at one of the highest volume gender surgery centers in the world. More »

Dr. John Henry Pang

Dr. Pang is a double board-certified plastic and reconstructive surgeon who has also completed fellowship training in Gender Affirming Surgery. Before joining Align Surgical Associates in San Francisco, Dr. Pang completed the Transgender Surgery training program at Mount Sinai in New York City. His practice is dedicated to providing the highest level of care for his transgender and non-binary patients. More »

Dr. Heidi Wittenberg

Dr. Wittenberg is an experienced Urogynecologist in San Francisco who works exclusively with trans and non-binary patients. Dr. Wittenberg is the director of MoZaic Care, which specializes in gender affirming genital and pelvic surgeries, and a Founder Surgeon and Co-Director for the first SRC accredited Center of Excellence in Gender Confirmation Surgery, at Greenbrae Surgery Center. More »

Dr. Adam Bonnington

Dr. Bonnington is a Gender Surgeon in San Francisco who has focused his career on working with underrepresented patient populations. He joined Dr. Heidi Wittenberg at MoZaic Care as a Surgical Associate in 2020 where he works exclusively with transgender and non-binary individuals. Dr. Bonnington performs Orchiectomy and Vaginoplasty. More »

Dr. Loren Schechter

Dr. Schechter is one of the country's foremost experts on gender-affirming surgery. He is the Medical Director of the Gender Affirmation Surgery Program at Rush University Medical Center in Chicago. Dr. Schechter's outstanding surgical skills and more than 20 years experience with transgender surgery have made him an in-demand surgeon. He offers the full spectrum MTF Gender Confirmation procedures, including Breast Augmentation, single-stage Vaginoplasty, and FFS. More »

Dr. Ellie Zara Ley

Dr. Ley is a board-certified plastic surgeon who had over 15 years of training and experience in plastic surgery, craniofacial surgery and microsurgery before completing Gender Surgery training. Now based in San Francisco, Dr. Ley provides superb surgical care for those seeking Vaginoplasty, Facial Feminization and other feminizing surgeries. More »

Dr. Kathy Rumer is an expert in transgender surgery, performing 200-250 MTF gender reassignment surgeries per year. Dr. Rumer also directs a 1-year gender surgery fellowship program. She offers the full range of male to female surgery procedures, including Vaginoplasty, Facial Feminization Surgery and Breast Augmentation. More »

Dr. John Whitehead

Dr. Whitehead offers gender affirming male-to-female surgery in Florida. Dr. Whitehead was trained in the art of gender reassignment surgery by Dr. Harold Reed, the now-retired urologist who practiced at The Reed Center for decades. Dr. Whitehead offers Orchiectomy, Vaginoplasty and Vulvoplasty. More »

Dr. Dmitriy Nikolavsky

Dr. Nikolavsky is a highly regarded Reconstructive Urologist and Gender Surgeon at SUNY Upstate Medical University in Syracuse NY. In addition to offering primary Vaginoplasty surgery, Dr. Nikolavsky is also an expert at treating post-operative urinary complications and provides long term follow-up care for patients who have had Vaginoplasty. Read more »

Dr. Jonathan Keith

Dr. Keith is a fellowship-trained Plastic Surgeon in New Jersey with expertise in Gender Reassignment Surgery. In 2018, Dr. Keith co-founded the first multidisciplinary clinical program for transgender patients in New Jersey. He is the first surgeon in New Jersey to offer the full range of gender-affirming procedures, including Facial Surgery, Vaginoplasty and Breast Augmentation. More »

Dr. Nick Esmonde

Dr. Esmonde is a Gender Surgeon in Portland, Oregon who has impeccable training in Gender Affirmation Surgery and whose practice is almost exclusively focused on helping transgender and non-binary patients. Dr. Esmonde offers the full spectrum of feminizing surgeries, from Facial Feminization to Vaginoplasty. More »

Dr. Christopher McClung

Dr. McClung is a board-certified urologist in Columbus, Ohio who specializes in gender-affirming Vaginoplasty. Dr. McClung's deep experience with complex urological reconstructions provided an ideal background for becoming a Gender Surgeon. He has now performed over 200 feminizing bottom surgeries and his practice is fully dedicated to providing gender-affirming surgical care. In addition to his urology and reconstructive expertise, Dr. McClung's patients also appreciate his gentle bedside manner. More »

Dr. Min Jun

Dr. Min Jun is an exceptionally trained Reconstructive Urologist and Gender Surgeon in San Francisco who specializes in Robotic Peritoneal Flap Vaginoplasty. Dr. Jun has completed fellowship training in both Reconstructive Urology and Gender Affirming Surgery. He worked with the Crane Center for Transgender Surgery in 2020-2023 and now has his own practice in San Francisco. More »

Surgeons in Thailand

Dr. Pichet Rodchareon

Dr. Pichet Rodchareon is a board-certified plastic surgeon in Bangkok who has extensive experience performing male-to-female Gender Reassignment Surgery. Dr. Pichet is considered one of top SRS surgeons in Thailand. His training includes plastic surgery, hand surgery, craniofacial and maxillofacial surgery. More »

Dr. Kamol Pansritum

Dr. Kamol Pansritum is recognized as one of the most experienced GRS Surgeons in the world, having completed over 5,000 gender reassignment surgeries, and more than 10,000 related surgical procedures for trans women since 1997. Dr. Kamol currently performs more than 200 MTF reassignment surgeries a year at his private hospital in Bangkok, Thailand. More »

More MTF Surgeons

Dr. Michelle Lee

Dr. Lee is a board-certified and fellowship-trained plastic surgeon with high proficiency in aesthetic and reconstructive procedures for the breast and face. Widely regarded as being one of the finest plastic surgeons in the Los Angeles area, Dr. Lee possesses the perfect combination of skill, artistry, experience and compassion, which makes her ideally suited to performing gender-affirming surgery. More »

Dr. Alvina Won

Dr. Won is a board-certified Cosmetic Surgeon who is committed to providing the highest level of compassionate care in a welcoming environment for all patients. Dr. Won gained significant experience with gender-affirming surgery during a year-long cosmetic surgery fellowship with Dr. Tony Mangubat, a 20+ year veteran of transgender surgery. Based in the Seattle area, just north of Seattle, Dr. Won now devotes part of her practice to performing MTF Breast Augmentation, Buttock Augmentation and Body Sculpting. More »

Dr. Laurel Chandler

Dr. Chandler is a Harvard fellowship-trained plastic surgeon who has received specialty training in gender-affirming breast surgery. During both her residency and fellowship training, Dr. Chandler worked with established gender surgeons to learn the aesthetic nuances of transgender Breast Augmentation. Dr. Chandler provides individualized care for a diverse range of patients, up to 90% of whom are transgender and non-binary. More »

Dr. Javad Sajan

Voted #1 Best Surgeon in Seattle in 2016 and 2017, Dr. Sajan is an internationally recognized Cosmetic & Reconstructive Plastic Surgeon whose specializations include Facial Feminization and Breast Augmentation. Dr. Sajan enjoys providing gender-affirming surgical care and is honored to play a role in his patients' transitions. More »

Dr. Daniel Jacobs

Dr. Jacobs is a board-certified plastic surgeon in San Francisco, California who joined the Gender Confirmation Center in July 2022. With more than 30 years of plastic experience and a practice that's dedicated to gender-affirming care, Dr. Jacobs is a sound choice for transfeminine and non-binary individuals seeking Breast Augmentation surgery. More »

Dr. Daniel Crane

Dr. Crane is a plastic surgeon in the Miami area who has expertise in breast, body and facial surgeries. He was one of only 30 residents selected from across the country to participate in a highly specialized aesthetic fellowship training program. In 2022, Dr. Crane joined Dr. Drew Schnitt's Inspire Aesthetics. His unique training in plastic and aesthetic surgery provides him with the knowledge and experience to help you achieve your surgery goals. More »

Dr. E. Antonio Mangubat

Dr. E. Antonio Mangubat is the Pacific Northwest's most sought-after surgeon for transgender surgery, with more than 20 years of experience performing procedures for trans women, including Facial Feminization, MTF Breast Augmentation, Body Sculpting and Hair Restoration. More »

Dr. Dustin Reid

Dr. Dustin Reid is a double board-certified plastic surgeon in Austin who offers Breast Augmentation, Body Feminization and Hair Restoration. Dr. Reid is committed to providing expert surgical care and guidance throughout your surgery experience. More »

Dr. Daniel Medalie

Dr. Daniel Medalie is a board certified plastic and reconstructive surgeon who has been performing gender-affirming surgeries since 1996. Based in the Cleveland area, he offers Breast Augmentation and Tracheal Shave procedures for transfeminine individuals. More »

Dr. Russell Sassani

Dr. Russell Sassani is a board certified plastic and reconstructive surgeon who has quickly become one of the most popular surgeons in the Southeastern United States for trans women. He performs Breast Augmentation, Facial Feminization and Body Sculpting in the Mami/Fort Lauderdale area. More »

Dr. Mark Youssef

Dr. Mark Youssef, Director of the Transgender Surgery Institute of Southern California, is a Cosmetic Surgeon in Santa Monica who helps clients on the trans feminine spectrum with Breast Augmentation, Body Feminization and Facial Feminization surgeries. He operates at his private surgery center, Younique Surgery Center in Santa Monica. More »

Dr. Hope Sherie

Dr. Hope Sherie is a board-certified cosmetic surgeon who has extensive training in MTF surgery procedures. Dr. Sherie offers trans women the highest level of surgical care at her practice in Charlotte, North Carolina. Procedures available include Orchiectomy and Breast Augmentation. More »

Dr. Charles Lee

Dr. Charles Lee is a board-certified plastic and reconstructive surgeon who has deep expertise in microsurgery and breast surgery. In practice since 2003, Dr. Lee offers MTF Top Surgery at Crane Center for Transgender Surgery in San Francisco. More »

Dr. Alan Dulin

Dr. Alan Dulin is a board-certified surgeon who has many years of experience performing Male-to-Female Surgery in the Dallas area. Dr. Dulin offers transgender women Breast Augmentation & Body Contouring, Facial Feminization Surgery and Orchiectomy. More »

Dr. Scott Harris

Dr. Scott Harris is a board-certified Surgeon with years of experience performing Male to Female Surgery in Texas. Known for his meticulous attention to detail, Dr. Harris offers a number of feminizing surgeries for trans women, including Facial Feminization Surgery, Breast Augmentation and Body Sculpting procedures. More »

Dr. Cassie Nghiem

Dr. Nghiem is an Ivy League-educated, fellowship-trained plastic surgeon in Washington, D.C. who specializes in Gender-Affirming Surgery, including Breast Augmentation and Facial Feminization. She works closely with her patients to deliver the best quality care that is aligned with their goals. Known for her advanced surgical skills, Dr. Nghiem's patients also love her friendly personality and kind demeanor. More »

Dr. Manish Champaneria

Dr. Manish Champaneria is a board-certified surgeon with extensive training and experience in plastic surgery and a special focus on reconstructive breast procedures and Facial Feminization. Dr. Champaneria practices in San Diego, California. More »

Dr. Walter Lin

Dr. Walter Lin is a fellowship-trained Plastic Surgeon in San Francisco who performs Breast Augmentation for transfeminine individuals. Dr. Lin's expertise in the areas of microsurgical reconstruction of the extremities, breast, and lymphatic systems has greatly contributed to his skill with gender-affirming Breast Augmentation. Dr. Lin joined the staff of Buncke Clinic and the San Francisco Transgender Institute in 2017. More »

Dr. Jeffrey Marvel

Dr. Marvel is a board-certified cosmetic surgeon who has developed a great reputation in Nashville and Central Tennessee for his technical skills, attention to detail and natural-looking results. Since 1997, Dr. Marvel and Marvel Cosmetic Surgery's dedicated staff have offered top-notch hospitality and care for patients seeking a wide range of cosmetic procedures, including Facial Feminization, Breast Augmentation and Hair Grafting. More »

Dr. Eric Emerson

Dr. Eric Emerson is a Board-Certified Plastic Surgeon with over 20 years experience specializing in breast surgery, body contouring and facial surgery. Dr. Emerson is a sound choice for trans women seeking breast augmentation and body and facial feminization surgery in the Carolinas and eastern United States. More »

Dr. Gregory Swank

Dr. Gregory Swank a board-certified, Duke University-trained surgeon who offers male-to-female surgery in North Carolina. Dr. Swank's surgical offerings for trans women include Breast Augmentation, and Body and Facial Feminization. More »

Dr. Michael Beckenstein

Dr. Michael Beckenstein is a double-board-certified Plastic Surgeon in Birmingham who is pleased to offer his expertise and skills in cosmetic and reconstructive surgery to the MTF community in Alabama and throughout the Southeast. Dr. Beckenstein specializes in Breast Augmentation as well as Hair Restoration. More »

Dr. Helena Guarda

Dr. Helena Guarda is a board-certified Plastic and Reconstructive Surgeon who is committed to offering Breast Augmentation and Feminization Surgeries as part of her LGBT-friendly practice in Suffolk, Virginia. Dr. Guarda is excited to work with patients from all parts of Virginia, as well as those coming from nearby states such as North Carolina, Maryland, West Virginia, Tennessee, and Kentucky. More »

Dr. Elliot Jacobs

Dr. Jacobs is a nationally-recognized, board-certified plastic surgeon in Boca Raton, Florida with more than 30 years of experience in breast and facial surgeries. Dr. Jacobs offers MTF Surgery procedures at his private, modern and fully accredited surgical suite. More »

Dr. Rex Moulton-Barrett

Dr. Rex Moulton-Barrett is a double board certified cosmetic, plastic and reconstructive surgeon in the San Francisco Bay Area who has been performing MTF Breast Augmentation surgery since 2010. Read more »

Dr. Vartan Mardirossian

Dr. Vartan Mardirossian is a surgeon in South Florida who specializes in Facial Feminization Surgery. Dr. Mardirossian has extensive training and experience performing Facial Feminization procedures, including 7 years of training under renowned FFS surgeon Dr. Jeffrey Spiegel . Read more »

Last updated: 04/03/24

Access Gender-affirming Hormone Therapy in Florida

Trans-inclusive healthcare is now even more affordable with qualified insurance coverage from cigna.

Plume Membership

$32/month + copays with qualified insurance*, or self-pay for $99/month**.

Your Plume Membership Includes:

• Virtual, gender-affirming care with trans-informed providers
• Estrogen+ or Testosterone prescriptions*
• Treatment-specific lab orders and analysis*
• Letters for name or gender marker changes
• Medical letters of support for gender-affirming surgeries
• Access to our six-week support series led by members of the trans community
• Trans-led care team, available at every step of your journey

*Prescriptions, copays, and labs are not included and are priced based on insurance coverage.

**Self-pay pricing includes appointments and select lab costs. Prescription costs are not included.

You must be 18 years old or older to access Plume services. Some states have additional restrictions on age or services available.

Letter of Support

$150 one-time fee.

• One digital video appointment with a healthcare provider
• A one-time medical letter* of support for surgery with a one week turnaround time
• Access to your trans-led care team through our app

*Please note we cannot provide a behavioral health letter of support from a therapist at this time. Letters are included for active members.

Trans-led healthcare

From gender-affirming hormone therapy and transition support to medications for anxiety and depression, it can be hard to find one clinic or doctor who understands how to care for you. That’s why we founded Plume, a virtual home for transgender, nonbinary, and gender non-conforming people.

We offer a range of healthcare services, including prescriptions for estrogen or testosterone. At Plume, you can be your authentic self and get the gender-affirming care you need. You don’t have to teach your doctor how to care for you—instead, you can let your Care Team support you with a unique care plan that is customized to your transition goals.

We’ll always respect your gender identity, pronouns, name, and gender expression, and we’ll always put your wellness first. We’re here for you when you’re ready.

Appointments In Days, Not Months

Plume doesn’t impose arbitrary gatekeeping like therapists letters or barriers to life-saving care. Membership with Plume provides everything you need to start, continue, and maintain your gender-affirming hormone treatment. We know everyone has different goals for their transition, and we’re here to help you navigate your journey.

Get Started With Plume

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Top Florida Hospital System to Perform Genital Surgery on Minor Transgender Children

The University of Miami Health System is on record admitting that they will perform surgical procedures, including gender genital affirming surgery and double mastectomies on transgender children as long as one parent consents.

UM Health provides an array of LGBTQ+ Services to transgendered persons, such as gender-affirming hormone therapy, gynecology, mental health, plastic surgery, primary care, and voice treatments.

According to its website , physicians will perform procedures on children, including cosmetic and plastic surgery, with the following stipulations:

“Patients under the age of 18 will need parental consent for genital procedures. For patients with Gender Identity diagnosis, our physician staff will follow the guidelines of the World Professional Association of Transgender Health (WPATH). These guidelines are established to ensure that you are fully prepared for surgery. They recommend one/two referral letters prior to undergoing surgery. These letters must be from an experienced mental health professional, who you have worked with for over a year. Letters must state that gender-affirming surgery is the correct course of treatment for the patient.”

A source, who wishes to remain anonymous, spoke to a representative on the phone regarding gender-affirming surgery for her 16-year-old daughter seeking to transition to a male. The representative advised that initial consultations are done with the plastic surgeon, Dr. Sarah Denker.

The representative also confirmed that UM would perform a double mastectomy or "top surgery" on a girl as young as 16 years old.

As for genital surgery, the representative indicated that the surgeon could discuss those options during an in-person consultation.

Parental Objection

When asked whether consent is required from both parents, Lauren Foster, Director of Concierge and LGBTQ+ Services in the Office of Patient Experience, advised that consent from one parent is enough. She reiterated that even if the other parent is opposed to these permanent medical procedures being performed on their child, their facility only requires one parent’s consent.

In other words, a parent who does not believe that this life-changing surgical procedure is appropriate for their child may be excluded from the decision-making process, and may have little recourse to prevent the procedure from taking place. It also means that the surgery may be performed without one parent's knowledge.

Genital Surgery on Minors

UM Health’s website clearly states that its doctors perform genital surgery, also called “bottom surgery,” on minor children with at least one parent's consent.

However, this practice appears to contradict recommendations from major medical organizations. The Endocrine Society, for example, does not recommend genital surgery for minors.

In fact, Boston Children’s Hospital makes it abundantly clear that “all genital surgeries are only performed on patients age 18 and older.”

As reported by the Tampa Bay Times, the Chief of Pediatric Endocrinology at the University of Florida, Dr. Michael Haller, confirmed the American Academy of Pediatrics has established a standard of care for transgendered youth, which dictates that genital surgeries should only be offered to people 18 and above.

The University of Miami may be violating this standard of care.

State Policy

Governor Ron DeSantis has been adamantly opposed to the practice of performing permanent surgery on transgender youth. During a press conference in August, Gov. DeSantis said, “They talk about these very young kids getting gender-affirming care. What they don’t tell you what that is that they are giving very young girls double mastectomies, they want to castrate these young boys — that’s wrong.”

In response to a petition by the Florida Department of Health, the Florida Board of Medicine is now in the process of developing rules for treating transgender children.

The topic has been a major policy debate in Florida, particularly regarding State-providers like Medicaid and whether gender reassignment treatments should be covered. In August, DeSantis signed a law banning Medicaid from covering gender reassignment procedures.

Are Florida Tax Dollars Funding These Procedures?

While the University of Miami Health System is a private institution, it receives many subsidies and funding from the State of Florida. In fact, Florida’s 2022 “Freedom First Budget” included millions of dollars allocated to UM’s Health System.

The question remains whether Floridians are indirectly footing the bill for radical genital surgeries on minors. While monies are directly allocated to specific needs, could the health system's administrators ultimately decide to reallocate those taxpayer dollars to fund other departments?

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Transgender Top Surgery

If you are in the process of transitioning from male to female or female to male, it is important to find a compassionate and talented plastic surgeon who can provide the breast transgender surgery you need to achieve the look you desire. Dr. Polecritti at The Julian Institute of Plastic Surgery has years of experience working with transgender patients to help them embrace a new vision for their appearance. If you are searching for a plastic surgeon in the Tampa, Florida area, look no further than Dr. Polecritti!

Female to Male Top Surgery

Female to male top surgery is an important component of the gender reassignment procedure for transsexual men. It creates a more masculine chest contour and resizes and repositions the nipples and areolas if needed. Top surgery gives trans men the gift of living with more comfort and confidence than ever before. The surgery can also improve essential psychological and social function throughout the gender reassignment process.

Female to male top surgery for patients with smaller breasts begins with a subcutaneous mastectomy. This is a skin-sparing breast removal which leaves the skin, areola, and nipple intact while carefully removing the unwanted breast tissue from an incision under each breast. For patients with larger breasts or extra or drooping skin in the breast area, it is best to remove excess skin and breast tissue in the crease of the pectoralis muscles, then replace the nipples and areolae through grafting.

Male to Female Top Surgery

Male to female top surgery is also an essential part of the gender reassignment surgery procedure for transsexual women. The ultimate goal of male to female top surgery is to help patients align their physical characteristics with their internal sense of self. Overall, the procedure delivers the sensual, shapely, and undeniably feminine appearance that transsexual women desire. This boosts confidence and self-esteem significantly during the gender reassignment process and beyond!

Breast implants are used to achieve the male to female top surgery. Breast augmentation enhances the size and contour of the breasts by implanting saline or silicone implants in the chest. There are many different methods available to place implants, such as using a periareolar incision along the circumference of the areola or a transaxillary incision in the natural folds of the armpit skin. Augmentation surgery itself only lasts about an hour, after which time the six-week recovery process begins.

Whether you are in search of superior male to female or female to male top surgery, Dr. Polecritti at The Julian Institute of Plastic Surgery in Spring Hill, Florida can provide all the support and expertise you need throughout your gender reassignment process. He is committed to helping transgender men and transgender women align their physical and internal identities to enjoy a life filled with joy and confidence. Call (352) 606-4754 now to schedule your consultation!

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Medindia » News » Research News » A Global Comparison: Best Countries for Gender Reassignment Surgery

A Global Comparison: Best Countries for Gender Reassignment Surgery

Purpose and Procedures

Chest surgery (top surgery) for ftm transitions:, phalloplasty for ftm transitions:, breast augmentation for mtf transitions:, facial feminization surgery (ffs) for mtf transitions:, vaginoplasty for mtf transitions:.

Turkey Emerges as a Budget-Friendly Destination

Latin america offers competitive prices.

Belgium: Affordable and Progressive in Europe

The u.s.: highest costs and legal challenges.

• Expert Q&A: Gender Dysphoria - (https://www.psychiatry.org/patients-families/gender-dysphoria/expert-q-and-a)

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

A Franklin County judge on Tuesday temporarily blocked an impending law that would restrict medical care for transgender minors in Ohio.

The decision came weeks after the American Civil Liberties Union filed a lawsuit challenging House Bill 68 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."

House Bill 68 was set to take effect 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.

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.

“This is just the first page of the book,” Attorney General Dave Yost said Monday. “We will fight vigorously to defend this properly enacted statute, which protects our children from irrevocable adult decisions. I am confident that this law will be upheld.”

What does House Bill 68 do?

House Bill 68 allows Ohioans younger than 18 who 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.

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 that House Bill 68 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.

The measure was among several that DeWine proposed to regulate gender-affirming care after he vetoed House Bill 68. 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.

Tuesday, April 23, 2024

Tax payer funded gender reassignment surgeries prompt questions about military readiness.

• by: Tracy Beanz

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