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Gender-Affirming Surgery

Gender-affirming surgery (GAS) is the operative component of multidisciplinary gender-affirming care. WPATH Standards of Care v8 (2022) includes guidance on surgery and postoperative care.[1] ACOG Committee Opinion 823 addresses inclusive care, hormone therapy, and preventive care;[2] the Endocrine Society's 2017 guideline addresses endocrine treatment and surgery-related decisions and referrals;[3] and the AAFP policy, updated in 2026, addresses primary care and access to gender-affirming care.[4] This atlas section covers only the genitourinary and reconstructive-urologic component of GAS. Top surgery, facial feminization and voice surgery are outside the reconstructive-urologic scope and are covered on the corresponding clinical-conditions pages in Special Populations.

The decision space divides into three cohorts. Each has its own tabbed Decision Framework and searchable Treatment Database.

  • Masculinizing SurgeryMetoidioplasty and phalloplasty, from choosing a pathway to staged surgery and long-term urologic care.
  • Feminizing SurgeryVaginoplasty and related feminizing operations, from choosing a technique to dilation and long-term care.
  • Non-Binary / NullificationMatching genital surgery to non-binary patients' goals, including nullification and preservation options.

For the clinical-condition-style write-ups (eligibility, perioperative-hormone management, regret data, lifelong follow-up, mental-health and access barriers, and the non-GU components: top surgery, FFS, voice), see the dedicated articles in Special Populations: Gender-Affirming Surgery.

Cross-cutting Foundations references: Radial Forearm Free Flap, Anterolateral Thigh Flap, Peritoneal Flap, Vastus Lateralis Flap, Buccal Mucosa Graft, Genital Reconstruction Principles, and Pharmacology — Gender-Affirming Hormone Therapy.

References​

1. Coleman E, Radix AE, Bouman WP, et al. "Standards of Care for the Health of Transgender and Gender Diverse People, Version 8." Int J Transgend Health. 2022;23(Suppl 1):S1-S259. doi:10.1080/26895269.2022.2100644

2. American College of Obstetricians and Gynecologists. "Health Care for Transgender and Gender Diverse Individuals: ACOG Committee Opinion, Number 823." Obstet Gynecol. 2021;137(3):e75-e88. doi:10.1097/AOG.0000000000004294

3. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline." J Clin Endocrinol Metab. 2017;102(11):3869-3903. doi:10.1210/jc.2017-01658

4. American Academy of Family Physicians. "Care for the Transgender and Gender Nonbinary Patient." Policy statement, updated May 2026. Official policy.