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.