Overview
Why Choose Cleveland Clinic for Gender Affirmation Surgery?
Comprehensive care for transgender patients involves a wide spectrum of services, ranging from routine medical visits to the physical transition process. Few hospitals are equipped to provide such care. Even fewer hospitals offer surgical care for patients wishing to undergo gender affirmation surgery. Over the last several years, we have been actively expanding the surgical services Cleveland Clinic offers to gender and sex-minority patients.
Our team follows the World Professional Association for Transgender Health (WPATH) guidelines to ensure patients are appropriate surgical candidates. We require that patients live full time as their self-affirmed gender for more than one year, that they have undergone cross-sex hormone therapy for at least one year, and that they have letters of support for surgical transition from two mental health professionals who are well-versed in transgender patient care. Patients who have met these criteria are deemed appropriate surgical candidates. They cannot be smokers or be excessively overweight, and they must be medically optimized for surgery if they have medical comorbidities.
Our volume of patients increases each month, and with this growth, we continue to expand our caregiver team to be able to accommodate our patients’ needs.
Treatments & Procedures
Male Gender-Affirming Surgeries
Hysterectomy
This procedure includes removal of the uterus and cervix as well as the fallopian tubes and ovaries in those patients who do not desire future fertility. The procedure is often performed laparoscopically using three 5mm incisions on the lower abdomen. Hysterectomy is often performed as an outpatient procedure, but some patients may require one night stay in the hospital.
Requirements for Surgery:
- WPATH guidelines must be met.
- Patients must have a support person to bring them home from the hospital.
Insurance Coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Masculinizing/Defeminizing Chest Reconstructive Surgery (Mastectomy)
This procedure includes removal of breast tissue with masculinizing chest contouring and nipple grafting in some cases. Chest surgery is sometimes performed as an outpatient procedure but some patients may require one night stay in the hospital.
Requirements for Surgery:
- WPATH criteria must be met.
- BMI requirements are determined by your surgeon.
- Patient must be nicotine/tobacco-free.
- Patients must have a support person to bring them home from the hospital.
Insurance Coverage: This procedure is sometimes covered by insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Female Gender-Affirming Procedures
Breast Augmentation
This procedure involves enlargement of the breasts with an implant. Various techniques may be used to perform this procedure, and they are surgeon and patient dependent. Breast augmentation is often performed as an outpatient procedure but some patients may require one night stay in the hospital.
Requirements for Surgery:
- WPATH criteria must be met.
- BMI requirements are determined by your surgeon
- Patient must be nicotine/tobacco-free.
- Patients must have a support person to bring them home from the hospital.
Insurance Coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered.
Orchiectomy (Surgical Removal of the Testes)
Orchiectomy is a procedure done to remove the testes which alleviates genital dysphoria in some patients and eliminates the need for androgen (testosterone) suppression and optimize the effects of estrogen. The procedure is done through a 3cm incision along the scrotum. Undergoing this procedure will not interfere with the possibility of having future vaginoplasty. Orchiectomy is performed as an outpatient procedure.
Requirements for Surgery:
- WPATH guidelines must be met.
- Patients must have a support person to bring them home from the hospital.
Insurance Coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Vaginoplasty (Female Genital Reconstructive Surgery)
Vaginoplasty surgery involves creation of the vulva (outer female genital structures) with or without a vaginal canal. Patients may opt to have a “zero depth” vaginoplasty procedure which involves creation of the outer genitals (labia, clitoral hood, urethral opening) only without a vagina. The procedure requires an inpatient stay in the hospital and if a full-depth vaginoplasty is performed, there is a required stay at a nearby hotel. For zero-depth procedures patients should expect to be in Cleveland for 3-4 days after the surgery and for a full-depth procedure, 7-10 days after surgery.
Requirements for Surgery:
- WPATH criteria must be met.
- BMI <32.
- Patient must be nicotine/tobacco-free.
- Patients must have a support person to stay with them during their hospital and hotel stay.
- Copy of your most recent primary care medical records.
- Genital hair removal must be completed for surgery. Your consultation can be scheduled once 50% of hair removal is completed.
Insurance Coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Cost of Postoperative Stay: As part of your recovery, you will be staying at the Intercontinental Hotel, which is attached to the Cleveland Clinic Main Campus. The Transgender Surgery Program has a special rate for our patients with the hotel. The cost of the hotel stay is out-of-pocket, as insurance does not cover this expense for your surgery. Rates are subject to change each year, but please plan for a minimum of $2,000 for the hotel stay.
Your complete postoperative recovery will be about 6-8 weeks but this varies with each individual. We're happy to complete FMLA and STD paperwork if applicable.
Phalloplasty/Metoidioplasty
Requirements for Surgery:
- WPATH criteria must be met.
- BMI <32.
- Patient must be nicotine/tobacco-free.
- Patients must have a support person to stay with them during their hospital and hotel stay.
- Copy of your most recent primary care medical records.
- Genital hair removal must be completed for surgery. Your consultation can be scheduled once 50% of hair removal is completed.
Insurance Coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Cost of Postoperative Stay: As part of your recovery, you will be staying at the Intercontinental Hotel, which is attached to the Cleveland Clinic Main Campus. The Transgender Surgery Program has a special rate for our patients with the hotel. The cost of the hotel stay is out-of-pocket, as insurance does not cover this expense for your surgery. The total cost will vary depending upon the procedure and the number of stages needed. Rates are subject to change each year, but please plan for a minimum of $2,000 for the hotel stay, however, depending upon your personalized plan, the overall cost may be higher.
Your complete postoperative recovery will be about 6-8 weeks but this varies with each individual. We’re happy to complete FMLA and STD paperwork if applicable.
Tracheal Shaving Surgery (Chondrolaryngoplasty)
A tracheal shaving procedure involves reduction of the thyroid cartilage to reduce the size of the Adam’s apple. It is performed as an outpatient procedure.
Requirements for Surgery:
- There is no WPATH criteria.
- Patients must have a support person to bring them home from the hospital.
Insurance Coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Facial Feminization Procedures
Facial feminization surgery (FFS) involves several surgeries that can be done to feminize the facial features. These procedures include but are not limited to: rhinoplasty, forehead contouring, jaw angle reduction, chin width reduction, lowering the hairline, hair transplantation, cheek augmentation, lip augmentation and upper lip shortening. Some procedures are performed as outpatient procedures while others require an inpatient stay.
Requirements for Surgery:
- There is no WPATH criteria.
- Patient must be nicotine/tobacco-free.
- Patients must have a support person to bring them home from the hospital.
Insurance Coverage: This procedure is very specialized and often not covered by insurance plans. Please contact our office with any questions.
Meet Our Team
Our surgical providers at Cleveland Clinic offer a wide range of gender-affirming procedures, including:
Gynecology & Urology
Plastic & Reconstructive Surgery
Head & Neck Surgery
Clinical Speech-Language Pathologist
- Michelle Adessa, BM, MS, CCC-SLP
- Emma Laurash, MS CCC-SLP
What to Expect
Before & After Photos
See before and after photos of patients who have undergone gender-affirming surgeries, including breast augmentations, facial feminizations, mastectomies and vaginoplasty.
Special Considerations for Vaginoplasty Surgery & Phalloplasty/Metoidioplasty
Out of state residents: You may want to include your pre-operative day as well as the days you will be in the hospital in your hotel reservation if you are traveling from afar; this will allow a safe and comfortable place for you to perform your peri-operative preparations as well as provide your guest with a place to stay nearby while you are in the hospital.
Transportation After Surgery: You must have a family member, friend or caregiver drive you home from surgery as medical transportation cannot be used upon hospital discharge.
Postoperative appointments: There will be several postoperative appointments after your surgery depending on what type of surgery you have. Your surgical team will review these with you as you get closer to surgery. Please make sure that you have a driver for any postoperative visit that is within 2-4 weeks of your surgery.
Patient Checklist for Vaginoplasty & Phalloplasty/Metoidioplasty
- Nicotine/nicotine-related product free (minimum 3 months).
- Free of any non-prescribed substances including marijuana (minimum 3 months).
- Hair removal completed, free of regrowth.
- Two letters of support from qualified mental health providers dated within the past 12 months.
- Funds available for postoperative stay.
- Companion to accompany you for postoperative stay.
- Relationship with a mental health care provider who will see you 4-6 weeks after your surgery.
We are happy to share a list of qualified hair removal providers as well as qualified mental health providers upon request. Once all criteria have been met, we will be happy to schedule a formal surgical consultation.
WPATH Guidelines
The World Professional Association for Transgender Health promotes the highest standards of health care for individuals through the articulation of Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People. The SOC are based on the best available science and expert professional consensus.
The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment.
Cleveland Clinic requires that all patients seeking the following gender affirming surgical services, must obtain a letter from a licensed mental health professional (counselor, social worker, etc.) that meets WPATH Guidelines:
- Chest surgery (breast augmentation, masculinizing mastectomy) - 1 letter must be obtained.
- Male hysterectomy/vaginectomy - 2 letters must be obtained.
- Orchiectomy (surgical removal of the testes) - 2 letters must be obtained.
- Vaginoplasty (female genital reconstructive surgery) - 2 letters must be obtained.
- Phalloplasty/metoidioplasty - 2 letters must be obtained.
WPATH Guidelines for Gender Affirming Surgeries
- Age of majority (<18)*.
- Hormone therapy for 12 consecutive months unless medically contraindicated or if there is documentation in the medical record explaining why hormone therapy is not part of the transition journey.
- Living in gender role full time for minimum of 12 consecutive months.
- Demonstrated the capacity to make a fully informed decision and consent for treatment and the ability to comply with medical instruction.
- Demonstrated understanding of surgery and the implications of this irreversible step.
- Stable mental health, sufficiently self-aware, and successfully managing identified issues with depression.
- Letters of referral from a qualified mental professional (depending on the surgery, 1 or 2 letters may be required).
*Exceptions made for adolescents seeking masculinizing chest surgery; decisions made on a case-by-case basis.
Appointments & Location
For more information about the program or to make an appointment, please contact the Transgender Surgery Program at 216.445.6308.
The Cleveland Clinic Transgender Surgery Program has also partnered with several community mental health practices and program in our area and our coordinator will be happy to provide you with a provider or practice referral should you need one outside of Cleveland Clinic.
Location
Cleveland Clinic Main Campus
9500 Euclid Ave.
Cleveland, Ohio 44195
