All surgery is optional. You should not feel that you have to have surgery to validate your transition from M to F. You should have surgery because you want to have surgery and for no other reason.
Bottom surgery
This refers to genital reconstruction surgery (GRS), ie. a penectomy and orchidectomy to remove the male genitalia and plastic surgery (vaginoplasty, clitoroplasty, labioplasty and repositioning of the urethra) to provide you with a genital appearance that is virtually indistinguishable from natal born women. The phases of the operation are done in one procedure under general anaesthetic and takes about five hours. The Looking Glass Society has a great section on the variety of surgical methods and their advantages and disadvantages.
When considering bottom surgery, manage your expectations. Post-surgery interviews reveal that 98% of transwomen are satisfied with the physical results of their surgery. However, the surgery is irreversible so you need to consider the emotional implications carefully. You will not be able to have children after surgery (unless you make a deposit with a sperm bank first), you may find that your relationship with your partner changes dramatically post-surgery, with potential loss, and genital surgery won’t change how people behave towards you in public life.
There are no surgeons available on the island to undertake this procedure so you will need to go to the UK or abroad if you want GRS. If you are being treated through the NHS, you will be offered a list of approved surgeons to choose from. If you wish to go privately, you can choose from surgeons in private practice all over the world. However, you will need to research the best person for your needs and your budget.
Do your research. Look at the numerous blogs and YouTube videos uploaded by transwomen describing their experiences. Visit some of the forums for transwomen and post questions asking about their experiences. Don’t forget to ask about any emotional reactions to the surgery as well as the physical results. Most transwomen are happy to share this information.
Other surgery
This comes in several parts. The Looking Glass Society explains the range of surgical options available to transwomen. It is exceedingly rare for any of these procedures to be funded through the health service. If you wish to undergo one of these options, you should be prepared to fund it privately.
You will not be surprised to learn that there are no surgeons with the required skills to perform these operations in the island. You are therefore looking at travel costs again and, because of the complexity of some procedures, several trips to the UK or abroad may be needed.
Facial feminising surgery and rhinoplasty
This refers to plastic surgery to feminise the face and/or remodel the nose. Some transwomen find that, even after HRT, their facial features retain a heaviness that is masculine in appearance and does not allow them to pass as they would like to. Cosmetic surgery can help to alleviate this problem.
Thyroid chondroplasty (tracheal shave)
For transwoman who have a very prominent ‘Adam’s Apple’, this procedure can reduce it by making a small horizontal incision in a natural crease-line on the neck and removing part of the thyroid cartilage.
Augmentation mammoplasty (breast enlargement)
Even after one or two years on HRT, some transwomen are unhappy with the breast growth resulting naturally. They, therefore, consider having implants. There are a number of options available now that are alternatives to silicone so do your research to find out which would suit your requirements best.
Hair transplantation
HRT will thicken the existing hair but many transwomen who transition later in life find that they retain a male pattern hairline. Hair transplantation can be effective in “filling in” the gaps at the front of the hairline to produce a more feminine line.
The same advice applies to these surgeries as for GRS: manage your expectations and do your research thoroughly.
Trans* Jersey 
A helpful article but one or two additional facts need to be considered. GRS in the UK has a protocol: you must have a referral for surgery from two qualified GMC affiliated clinicians who are specialists in gender issues. These referrals can only be given when you meet the ‘eligibility criteria’ of the GI clinic/practice you attend and this has nothing to do with time. Many think 2 years is the minimum and complain bitterly when others get a referral only alter 15 months.
When you do get the referrals the waiting time for GRS can be over a year. You will be seen by your surgeon to see if you are healthy enough for the surgery: you must have the correct body mass index, not smoking, report any allergies and that you have someone to support you for your after care as you will be house-bound for two weeks and can’t drive for 6. HRT will be suspended 6 weeks prior and resumed a month post op. A testosterone suppressant may be given during this period – depending on your blood chemistry results.
What is often forgotten is that in a full procedure you will have to dilate for life. A cosmetic option is often ignored and many clinicians think this has the advantage of ‘lower maintenance’ but it still has erotic function.
On a purely personal point, I can thoroughly recommend Mr Phil Thomas at Nuffield Health, Brighton. His nursing team is led by the fantastic Liz Hills. There are no cases of MRSA there and I was sent home after the weeks’ stay without complications armed with just a packed of paracetomol. Liz taught me to care for myself so home nursing here was not needed. The level of care in Brighton is world class – Mr Thomas was even correcting other surgeons’ work when I was there!
I didn’t mean this to sound like an advert but he does work in Charing Cross a well but the other surgeon, James Bellringer has left so things are uncertain there at the moment. Liz told me that Mr Thomas is training a surgeon at Brighton and in her words: “he’s going to be brilliant”.
Good luck.
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Thank you for this extra information, Dee. Are you able to confirm for others whether the requirements are the same if you go public or private?
Also, requirements may be different if you elect to go for your GRS privately to another country.
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Hi Vic, Being public or private makes no difference if your clinician has a GMC number. All GMC clinicians have a licence to practice and many well work both in the NHS and privately. This includes GPs, psychiatrists, psychologists and consultants. The crucial thing to understand is that a patient has rights if the clinician has a GMC number. A complaint by a patient to the GMC is more likely to hinder a private practice because they have fewer filtering processes than a PCT in the UK where there are departments to deal with complains before it gets to a GMC review. My specialist GP in Wimpole street has conditions imposed on him but in my FOI request to the GMC they couldn’t differentiate whether private clinicians have more/less complaints than NHS clinicians because they go by clinician rather than by sector. I’m not sure if the GMC follow agreed practices in national/international gender care protocols when making a judgement against a clinician or if they simply see malpractice as the sole criteria. ‘Do no harm’.
Going abroad for treatment is something I have little knowledge of other than one anecdotal case history. While I was at Nuffield Health in Brighton, there was a lady who had spent about 40,000 Euros on two trips to Thailand for her two surgeries which had to be corrected by Phil Thomas in the UK. Post op care abroad means additional expenses if the surgery has complications and who knows where the legal issues are drawn? I tend to think that surgery abroad is risky but generally, all PCTs and private practices in the UK follow agreed protocols in gender care which are reviewed by the RCP as well as medical conferences and clinical reviews. It’s an evolving art form! Love, Dee
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