What is sex reassignment surgery?
Sex reassignment surgery (SRS) is a range of procedures that alter a person's physical characteristics to match their gender identity. This form of gender-affirming care is a crucial step in the medical transition process for transgender people, marking a public and personal confirmation of their identity.
SRS can include procedures that modify:
- facial features;
- ctive organs;
- secondary sexual characteristics.
A patient’s sex reassignment surgery may include a single or several medical procedures. The number of surgeries a transgender person undergoes depends on their personal goals and wishes, as well as doctors’ medical advice.
You may also hear sex reassignment surgery called:
- gender-affirming surgery;
- gender-confirming surgery;
- gender reassignment surgery.
What is gender-affirming care?
Gender-affirming care is a holistic approach to healthcare that recognizes and supports an individual's gender identity, especially within the transgender community. This type of care encompasses a wide range of medical, psychological, and social services. Key components include:
- hormone therapy;
- surgical interventions (SRS);
- mental health support;
- voice therapy;
- social support services.
Gender-affirming care aims to improve the well-being and quality of life of transgender people by addressing their specific health needs and reducing gender dysphoria.
What is a gender clinic?
Gender clinics offer specialized healthcare services for transgender, nonbinary, and gender-diverse individuals. They administer medical and surgical interventions to help patients transition to their identified gender.
What types of sex-reassignment surgery do gender clinics provide for patients globally?
Bookimed partners with over 20 gender-affirming clinics worldwide, offering access to expert care and a supportive environment for your transition journey. Global gender clinics provide a variety of surgeries for those who desire to match their bodies with their gender identities.
Bottom Surgery
Also known as genital reconstructive surgery, this medical procedure aims to match the physical appearance and functionality of a patient's genitalia with their identified gender.
For male-to-female (MTF) transition, gender confirmation clinics offer the following options:
👉 Learn more about MTF bottom surgery here.
Available bottom surgeries for female-to-male (MTF) transition include:
- phalloplasty — constructing a penis from other body tissues;
- metoidioplasty — forming a smaller penis from existing genital tissue.
👉 Read our guide to MTF bottom surgery.
Top Surgery
Top surgery enhances the feminine or masculine characteristics of the patient’s chest. Depending on the gender that the patient is transitioning to, sex change hospitals can employ one of the following techniques:
- MTF top surgery. Breast augmentation using implants for a more feminine chest.
- FTM top surgery. Mastectomy and chest contouring for a flatter, more masculine chest appearance.
👉 Learn more about how top surgery works.
Facial Reconstructive Surgery
At gender-affirming clinics, surgeons often perform operations to modify facial features for a more feminine or masculine appearance. Approaches include:
👉 Learn what you need to know about FFS and FMS.
Voice Surgery
This type of surgery modifies patients’ vocal pitch — raising it for MTF transitions and lowering it for FTM transitions. Gender clinics often pair this procedure with voice therapy to help patients harmonize their voices with their authentic selves.
How to choose the best hospital for gender reassignment surgery?
🏅 Accreditation and credentials. Look for gender clinics accredited by reputable health organizations. Accreditation ensures the hospital meets high standards of care and safety.
🩺 Experienced surgeons. Research the doctors' experience and qualifications. Look for specialists who have performed a significant number of gender-affirming surgeries and have a proven track record of success.
📝 Patient reviews. Seek out feedback from former patients to receive insight into the gender clinic’s quality of care and patients’ satisfaction with gender-affirming procedures.
✅ Comprehensive care approach. Choose a sex change hospital that offers a holistic approach to gender-affirming care, including pre-surgery counseling, post-operative support, and follow-up care.
📷 Before-and-after photos. Request to see before-and-after photos of previous surgeries performed by the gender surgeons. This will give you an idea of their skill level and the results you might expect.
🤝 Consultation process. It is crucial to have a thorough and informative consultation process. The best gender clinics will make you feel heard, respected, and comfortable asking questions about the procedure, risks, and expected outcomes.
How much is transgender surgery?
Globally, the cost of gender-affirming surgery can range from $5,000 to $75,000, depending on the specific procedure, country, and hospital.
- In the US, costs are the highest, ranging between $25,000 and $75,000 on average (reach up to $134,000 for FTM bottom surgery).
- In the UK, prices fall between $10,000 and $75,000.
- Turkey presents the most affordable options, with sex change operations costing from $5,000 to $15,000.
- In Thailand, costs vary between $10,000 and $22,000.
- In Mexico, prices start at $9,500.
👉 Read our detailed guide on transgender surgery costs.
Is gender-affirming surgery covered by insurance?
Coverage for gender-affirming surgery varies by health insurance policy and provider. In regions with progressive health policies, many insurance plans do provide for these surgeries. However, the extent of coverage can differ significantly. Insurance plans usually do not cover gender-affirming procedures deemed solely cosmetic. Most insurance companies will request documentation, like letters of readiness or proof of persistent gender dysphoria.
What is the best country for gender reassignment surgery?
Bookimed has researched key countries where patients choose to get gender-affirming procedures. The table below presents a cross-country comparison across several parameters:
|
Country
|
Number of clinics
|
Average clinic rating
|
Average cost
|
Expertise
|
Accessibility of care
|
Waiting times
|
Cultural acceptance
|
|
Thailand
|
20+ specialized clinics and 100+ surgeons
|
⭐ 4.8/5
|
$8,000-$20,000 (MTF) | $12,000-$22,000 (FTM)
|
50+ years of expertise, leading surgeons with global recognition
|
High: Fast-track access for international patients. WPATH guidelines.
|
1-3 months
|
⭐⭐⭐⭐⭐ Very accepting: Transgender individuals are visible in media and public life; LGBT people have equal rights.
|
|
United States
|
30+ clinics
|
⭐ 4.9/5
|
$20,000-$59,000 (MTF) | $25,000-$134,000 (FTM)
|
70+ years of experience
|
Low: Regional disparities in access; 55% of trans people are denied insurance coverage.
|
6 months to 2 years
|
⭐⭐⭐⭐ Mixed: Acceptance is high in progressive cities but lower in rural and conservative regions.
|
|
United Kingdom
|
20+ specialized centers
|
⭐ 4.5/5
|
$15,000-$43,000 (MTF) | $50,000-$88,000 (FTM)
|
70+ years of experience
|
Moderate: NHS waiting lists create delays.
|
Up to 5 years
|
⭐⭐⭐⭐ Relatively supportive: Legal protections exist, but visibility and acceptance vary by region.
|
|
Turkey
|
45+ multi-specialty clinics offering SRS surgery
|
⭐ 4.6/5
|
$10,000-$13,000 (MTF) | $12,000-$15,000 (FTM)
|
Rapidly expanding expertise
|
Moderate: Limited to large cities, but clinics are focused on international patients.
|
1-4 months
|
⭐⭐⭐ Moderate: Gender clinics are progressive, but societal and legal protections vary.
|
|
South Korea
|
10+ specialized clinics
|
⭐ 4.7/5
|
$10,000-$16,000 (MTF) | $23,000-$30,000 (FTM)
|
70 years of experience; Surgeons known for aesthetic outcomes
|
High: Accessible for international patients with established medical tourism pathways
|
2-5 months based
|
⭐⭐⭐ Moderate: Social conservatism limits visibility, but medical settings are supportive.
|
|
Mexico
|
7+ specialized clinics
|
⭐ 4.5/5
|
$12,000-$24,000 (MTF) | $15,000-$40,000 (FTM)
|
70 years of experience; performs 1.7 million procedures a year
|
High: Less strict than in the US. Requires mental health letters and basic medical evaluations.
|
1-3 months
|
⭐⭐⭐ Moderate: Cultural acceptance is growing.
|
According to Bookimed’s research, Thailand stands out as the best country for gender reassignment surgery due to several key factors:
- 50+ years of surgical expertise. Thailand’s surgeons are among the most experienced globally. They are members of international organizations such as the World Professional Association for Transgender Health (WPATH), the International Society of Aesthetic Plastic Surgery (ISAPS), and the American Society of Plastic Surgeons (ASPS).
- Affordable care. Surgery costs in Thailand ($10,000-$22,000 on average) are 3 times more affordable than in the US or UK.
- Streamlined and fast access. Minimal waiting times (1-3 months) and visa-free entry for most countries allow international patients to receive timely care without extensive delays.
- Cultural support and acceptance. Thailand’s accepting environment and visible trans community provide a positive experience for patients. In 2024, Thailand became the second country in Asia to grant LGBTQ+ couples equal rights.
What are the regulations and requirements for gender reassignment surgery in different countries?
Gender reassignment surgery requirements vary across the globe. Thailand, Turkey, Mexico, and South Korea offer faster access with minimal delays and less stringent rules. The US, UK, Australia, and New Zealand impose stricter regulations and have higher demand, with wait times reaching up to 5 years in the UK and even 30 years in New Zealand.
To help you choose the right destination, here’s a comparison of countries patients frequently travel to or from for gender reassignment surgery:
| Country |
Regulations |
Requirements |
| Thailand |
Most clinics follow WPATH standards. Clinics assist with medical documents, and pre-surgical evaluations are fast. |
✦ 1-2 letters from mental health professionals.
✦ 1 year of hormone replacement therapy (not always mandatory).
✦ Medical evaluation.
✦ Minimum age: 18+ (parental consent for minors). |
| United States |
Strict WPATH-based protocols, with regionally varying requirements and insurance-specific approval. |
✦ 1-2 mental health letters.
✦ 12 months of hormone therapy for genital surgery.
✦ Proof of living in the desired gender for 12 months.
✦ Minimum age: 18+ (minors with consent/court approval in some states). |
| United Kingdom |
NHS and private clinics follow WPATH standards, but NHS is stricter in approvals. They involve complex and time-consuming processes, with waiting lists often exceeding 5 years. |
✦ Medical documentation proving gender dysphoria.
✦ 1 year of hormone therapy.
✦ Proof of living in the desired gender for 1 year.
✦ Minimum age: varied from 16 to 18 across the UK. |
| Australia |
Regulated under national health guidelines with strict adherence to WPATH standards. Wait time is around 2 years. |
✦ 1-2 mental health letters.
✦ Minimum 12 months of hormone therapy.
✦ Proof of living in the desired gender for 12 months.
✦ Minimum age: 16 for top surgery, 18 for bottom surgery. |
| New Zealand |
Follows WPATH standards with long wait times. The waitlist for the first step alone—surgical assessment—spans 10 years. The wait time for surgery itself is 30 years. |
✦ 1-2 mental health letters.
✦ Well-documented gender dysphoria.
✦ Minimum 12 months of hormone therapy.
✦ 12 continuous months of living in the desired gender role.
✦ Medical evaluation.
✦ Minimum age: 18+. |
| Turkey |
Adheres to legal and medical requirements similar to European standards but with stricter approval processes for citizens. |
✦ 1 mental health letter.
✦ Hormone therapy documentation (for genital surgery).
✦ Mandatory hormone therapy for genital surgery.
✦ Medical evaluation.
✦ Minimum age: 18+. |
| South Korea |
Clinics follow structured protocols but are less stringent compared to Western countries. |
✦ 1-2 mental health evaluations.
✦ Optional hormone therapy.
✦ General medical evaluation.
✦ Minimum age: 18+ (parental consent on a case-by-case basis). |
| Mexico |
While there are no specific government restrictions on gender-affirming care, medical facilities may have their own criteria for performing SRS. |
✦ Diagnosis of gender dysphoria.
✦ Psychological evaluation.
✦ Living in the preferred gender for a certain period.
✦ Hormone therapy.
✦ Basic medical evaluation.
✦ Minimum age: 18+ (minors require parental consent). |
What is the best hospital for gender reassignment surgery?
Based on Bookimed’s research, the following hospitals and clinics rank among the best for gender reassignment surgery worldwide.
|
Hospital
|
Location
|
Best For
|
Procedures & Specialties
|
Cost
|
Why It’s a Top Choice
|
Rating
|
|
Bangkok Plastic Surgery
|
Bangkok, Thailand
|
A luxurious experience with Thailand’s #1 gender-affirming surgeon.
|
Bottom surgery (MTF/FTM), scrotal skin graft vaginoplasty, top surgery, facial feminization, body sculpting
|
$10,000 (includes surgery, general anesthesia, medications, consultations, and transfers).
|
✦ Led by Dr. Pichet Rodchareon, with 30+ years of experience and 3,000+ surgeries.
✦ Dr. Pichet is a member of ISAPS, ASPS, and WPATH.
✦ Private, hotel-style rooms with 24-hour in-room attendants.
|
⭐ 5
|
|
Men’s Health Clinics
|
Istanbul, Turkey
|
A highly specialized urology-focused approach.
|
Bottom surgery (MTF/FTM), functional urology, sexual health, scrotoplasty
|
$11,000 (includes surgery, 5-star hotel accommodation, airport-hotel-clinic transfers).
|
✦ Urology and sexology specialists.
✦ Dr. Baris Nuhoglu (27+ years of experience) has performed over 2,000 surgeries.
✦ Dr. Nuhoglu is an active member of the European Association of Urology, Turkish Urology Association, and Endourology Society.
|
⭐ 5
|
|
Wansiri Hospital
|
Bangkok, Thailand
|
High-tech hospital with innovative vaginoplasty techniques
|
MTF vaginoplasty (penile inversion, colon vaginoplasty, peritoneal vaginoplasty).
|
$10,000–$21,000 (includes surgery, pre-op exams, anesthesia, and wound care).
|
✦ 99% success rate for MTF surgeries.
✦ Handles 2,000+ patients annually. ✦ Famous patient: Fuschia Anne Ravena (Miss International Queen 2022).
|
⭐ 4.7
|
|
SAERO Plastic Surgery
|
Seoul, South Korea
|
Highly aesthetic facial feminization surgery
|
Facial feminization surgery (rhinoplasty, fat grafting, facelift, blepharoplasty, jaw/chin reduction), body sculpting
|
$6,000
|
✦ Specializes in plastic surgery.
✦ Surgeon with 22+ years of experience.
|
⭐ 5
|
How long do I need to stay in the country for gender reassignment surgery?
⏳Hospital stay: 3-7 days. For most sex change operations, you'll likely need a hospital stay ranging from 3 to 7 days. This period allows your surgical team to conduct the necessary medical exams, perform the procedure, monitor your initial recovery, manage any pain, and prevent complications.
⏳Stay in the country: 13-14 days. After leaving the gender clinic, you will have to stay in the country for about 13 to 14 days. This extended stay ensures you have access to your surgeon for follow-up appointments, where they can assess your healing, address any concerns, and guide you through the early stages of post-operative care.
How long is the recovery from transgender surgery?
On average, you will be able to resume your usual activities 4-8 weeks post-surgery. However, the recovery period largely depends on the type of gender-affirming surgery:
- Top surgery. Within 1-2 weeks, you may notice a decrease in swelling and discomfort. Steer clear of any strenuous activity for at least 1 month after breast augmentation or mastectomy.
- Bottom surgery. Usual activities can be resumed after 6 weeks, though follow-up visits will continue for a few months. Avoid sexual activities for 6 weeks post-phalloplasty and 12 weeks post-vaginoplasty.
- Facial feminization/masculinization. Initial swelling reduces within 2-4 weeks after facial reconstructive surgery, but complete healing can take up to 4 months.
- Voice surgery. Recovery is about 3 weeks and requires absolute voice rest for the first 7 days.
How old do you have to be to get gender reassignment surgery?
The general requirement is that transgender patients must be at least 18 years old to undergo gender-affirming procedures. However, there are exceptions where younger people can access hormone therapy or surgery with parental consent and a comprehensive evaluation.
- Europe. Patients must generally be 18 to have gender reassignment surgery without parental or public authority consent. Exceptions include Slovenia (15), Scotland (16), and England (17).
- United States. The U.S. has a mixed legal stance, with 22 states banning gender-affirming surgery for minors.
What are the risks and side effects of gender reassignment surgery?
Gender-affirmation surgery, like any surgical procedure, carries potential risks and side effects. These may include:
- altered sensation;
- difficulty emptying the bladder;
- tissue necrosis;
- narrowing of the new vagina or urethra;
- scarring and delayed healing;
General surgery risks may also arise, such as:
- side effects of anesthesia;
- bleeding;
- clot formation;
- infections.
❗The chance of these risks is low in the hands of experienced surgeons. A study by the American Society of Plastic Surgeons suggests that 99.7% of trans people are satisfied with the surgery's outcome.
If the complications do arise, they are usually treatable with proper medical care and follow-up. Moreover, you can undergo revision surgeries to correct issues or if you are not fully satisfied with the results.
Is bottom surgery reversible?
Bottom surgery is designed to permanently change the body to align with a person's gender identity. Undoing these changes would require complex and extensive surgical intervention, which may not fully restore the original anatomy or function. Therefore, it's crucial to have a clear understanding of potential outcomes and be certain of your decision before proceeding.
How to get gender-affirming surgery with Bookimed?
💚Submit a request. Start by filling out a request on the Bookimed website. Provide details about your desired surgery and any specific preferences you have.
💚Consult with a Bookimed Manager. Our manager will contact you to discuss your needs, answer questions, and provide you with options.
💚Choose the perfect country and hospital. Based on your preferences and needs, your Bookimed manager will recommend the best countries and clinics specializing in gender-affirming surgery. They'll help you weigh the pros and cons to make an informed decision.
💚Receive a personalized cost estimate. Once you've selected a gender confirmation clinic, Bookimed will provide you with a customized cost estimate for your surgery.
💚Schedule your trip. Bookimed will help you schedule the surgery and plan your trip to the chosen gender clinic, ensuring a smooth and stress-free experience.
Resources
- Johns Hopkins Medicine. Gender Affirmation Surgeries. www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-surgeries
- Healthdirect. (2024). Gender affirming surgery. https://www.healthdirect.gov.au/gender-affirming-surgery
- Journal of General Internal Medicine. (2021). Identifying and Addressing Barriers to Transgender Healthcare: Where We Are and What We Need to Do About It. https://pmc.ncbi.nlm.nih.gov/articles/PMC8606364/
- BBC. (2024). Life on an NHS transgender waiting list. www.bbc.com/news/uk-england-68588724
- European Union Agency for Fundamental Rights. Access to sex reassignment surgery. https://fra.europa.eu/en/publication/2017/mapping-minimum-age-requirements-concerning-rights-child-eu/access-sex-reassignment-surgery
- Bloomberg. (2015). How Thailand Became a Global Gender-Change Destination. https://www.bloomberg.com/news/features/2015-10-26/how-thailand-became-a-global-gender-change-destination
- Human Rights Campaign. Map: Attacks on Gender Affirming Care by State. https://www.hrc.org/resources/attacks-on-gender-affirming-care-by-state-map
- Plastic and Reconstructive Surgery. (2023). Regret after Gender-Affirming Surgery: A Multidisciplinary Approach to a Multifaceted Patient Experience. https://pubmed.ncbi.nlm.nih.gov/36727823/
-
