Scope and procedures
The best known of these surgeries are those that reshape the genitals, which are also known as genital reassignment surgery or genital reconstruction surgery (GRS). However, the meaning of "sex reassignment surgery" has been clarified by the medical subspecialty organization, the World Professional Association for Transgender Health (WPATH), to include any of a larger number of surgical procedures performed as part of a medical treatment for "gender dysphoria", "transsexualism" or "gender identity disorder". According to WPATH, medically necessary sex reassignment surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation including breast prostheses if necessary, genital reconstruction (by various techniques which must be appropriate to each patient and certain facial plastic reconstruction." In addition, other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial electrolysis.
A growing number of public and commercial health insurance plans in the United States now contain defined benefits covering sex reassignment-related procedures, usually including genital reconstruction surgery (MTF and FTM), chest reconstruction (FTM), breast augmentation (MTF), and hysterectomy (FTM). In June 2008, the American Medical Association (AMA) House of Delegates stated that the denial to patients with gender identity disorder of otherwise covered benefits represents discrimination, and that the AMA supports "public and private health insurance coverage for treatment for gender identity disorder as recommended by the patient's physician." Other organizations have issued similar statements, including WPATH, the American Psychological Association, and the National Association of Social Workers.
Differences between trans women and trans men SRS
The array of medically necessary surgeries differs between trans women (male to female) and trans men (female to male). For trans women, genital reconstruction usually involves the surgical construction of a vagina, whereas in the case of trans men, genital reconstruction may involve construction of a penis through either phalloplasty or metoidioplasty. In both cases, for trans women and trans men, genital surgery may also involve other medically necessary ancillary procedures, such as orchiectomy or vaginectomy.
As underscored by WPATH, a medically assisted transition from one sex to another may entail any of a variety of non-genital surgical procedures, any of which are considered "sex reassignment surgery" when performed as part of treatment for transsexualism. For trans men, these may include mastectomy (removal of the breasts) and chest reconstruction (the shaping of a male-contoured chest), or hysterectomy and bilateral salpingo-oophorectomy. For some trans women, facial feminization surgery and breast augmentation are also medically necessary components of their surgical treatment.
People with HIV or hepatitis C may have difficulty finding a surgeon able or willing to perform surgery. Many surgeons operate in small private clinics that cannot adequately treat potential complications in these populations. Some surgeons charge higher fees for HIV and hepatitis C-positive patients; other medical professionals assert that it is unethical to deny surgical or hormonal treatments to transsexuals solely on the basis of their HIV or hepatitis status.
Other health conditions such as diabetes, abnormal blood clotting, and obesity do not usually present a problem to experienced surgeons. The conditions do increase the anesthetic risk and the rate of post-operative complications. Surgeons may require overweight patients to reduce their weight before surgery, any patients to refrain from hormone replacement before surgery and smoking patients to refrain from smoking before and after surgery. Surgeons commonly stipulate the latter regardless of the type of operation.