How to Obtain Gender Affirming Surgery as an Adult in Illinois
Navigating the journey toward gender-affirming surgery can feel overwhelming. While the process can vary for each individual, we’ve created the below outline to help empower those seeking guidance. By understanding the general steps and learning about resources available in your area, our hope is that you can take the next steps towards your most joyful and authentic self with greater confidence and ease.
How to Get Started
#1 CONSULT WITH A SURGEON (OR TWO)
Schedule consultations with one or more surgeons to discuss your specific goals, available procedures, and any concerns you may have.
You should contact the surgeon's office by phone or through their website to find out when you could see them and what the consultation fee is. If you're planning to pay out-of-pocket for surgery, the consultation fee is often applied to the final cost of your surgery if you plan to go ahead with that surgeon. If you’re using insurance, the fee is usually covered.
An in-person consultation may be required by your surgeon before your surgery date. However, many surgeons have embraced technology and are able to offer teletherapy alternatives to the in-person consult.
Some useful questions to ask during your consult include:
Do you accept my insurance?
What available procedures do you offer that could help me obtain my goals?
What is your cost for these procedures without insurance coverage?
When and how will you contact my insurance provider with necessary procedure information to verify my coverage?
Do you have a BMI requirement?
What sort of medical clearance will be required?
What other pre-surgical assessments will be necessary?
Will I need to have any blood work done or do any other lab tests prior to surgery day?
How soon and/or how far out are you currently scheduling procedures?
Do you currently have a wait list?
Are you board-certified? As a Plastic Surgeon or General Surgeon? (See Surgeon Credentials)
Are you a member of WPATH?
Do you have specific training in gender-affirming surgeries?
How long have you been working with transgender/gender-nonconforming patients?
Do you work exclusively with transgender/gender-nonconfirming patients?
How did you get involved with trans healthcare?
How many of these surgeries have you performed?
Will you be doing the surgery yourself or will less experienced surgical residents take part?
Will you provide a letter for getting my gender marker changed on ID documents?
What kinds of gender-affirming practices has your office adopted? Will I be referred to by my preferred name and pronouns?
How long will the surgery take?
What type of facility will my surgery be performed at? (Ex. Ambulatory/Day surgery clinic, local hospital, academic medical center.)
Do any of the nursing staff at the facility have specific training for working with transgender/gender-nonconforming patients?
Can I see a portfolio of before/after photos for your patients? (If the answer is no, consider finding another surgeon.)
Do I need to stop taking any of my medications before surgery?
Will you be providing detailed, written pre-op and post-op instructions?
How much long-term follow-up do you do of patients, in terms of determining patient-satisfaction?
While meeting with multiple surgeons can be time-consuming, it will be worthwhile to ensure you find a surgeon who aligns with your goals and whom you trust to perform your gender-affirming surgery.
#2 CHOOSE YOUR SURGEON
Chicago-area trans-affirming surgeons can be found and contacted via the “Additional Local Resources” links below.
Some helpful considerations in choosing a surgeon include:
Before/after photos. Private practice surgeons often have before and after photo galleries on their websites so you can evaluate their techniques and get an idea of how your post-op body might look. Surgeons who work at large medical centers typically do not post photos online but will be happy to show you photos at your consultation. If a surgeon is unwilling or unable to show you post-operative photos, consider this a red flag. This isn't something that you should just take someone's word on—this is your body.
Surgeon reviews. These reflect patients' actual experiences with surgeons, as well as staff interactions. Reviews are subjective though so keep in mind that your experience may not match what you read in reviews. You can generally find surgeon reviews on Facebook, TransBucket.com and Reddit.
A surgeon's credentials. Medical credentials can be confusing. In this how-to guide, you'll find out how to empower your surgeon search with license and certification lookup tools and get clear answers about what board certification and other credentials really mean.
Location. While surgeon location might not be the strongest determining factor in choosing a surgeon, there are many benefits to working with a surgeon who is closer to home. That said, you may need to travel to find the best surgeon for you. If you do travel for your gender-affirming surgery, you'll need to factor in the added expense of travel and accommodations, for both yourself and your caretaker.
Length of wait list. Believe it or not, there are surgeons with wait lists that exceed two years. However, the length of a surgeon's wait list doesn't necessarily indicate their skill so don't assume that surgeons with shorter wait lists aren't good at what they do or that surgeons with longer wait lists are better. Private practice surgeons typically have shorter wait lists compared to surgeons employed by large medical centers. If you're prioritizing getting a surgery date as soon as possible, the length of a surgeon's wait list will factor heavily into your decision.
Once you have met with and chosen a surgeon you feel comfortable with, they will also be able to provide you with specific details regarding the remaining steps below.
#3 OBTAIN ANY NECESSARY MEDICAL CLEARANCE & ADDITIONAL PRE-SURGICAL ASSESSMENTS
Most surgeons (and insurance companies, if you plan to use insurance) require assessments from mental health professionals before approving surgery. The goal of these assessments is to evaluate your understanding of the procedure, its risks and benefits, and your overall mental health.
CCP is proud to provide evaluation letters for both gender affirming surgery and hormone treatments*. If you are in need of an evaluation, please reach out to us here and we will be happy to serve you!
Your surgeon may inform you that you additionally need to obtain medical clearance from your primary care provider (PCP) and/or other specialists to ensure that you are physically healthy enough to undergo surgery.
If you do not already have a PCP that you are comfortable with, you should ask your surgeon to provide you with referrals that they trust.
*CCP therapists can also provide assessments and evaluation letters for Emotional Support Animal clearance; various Immigration needs including but not limited to U-Visas, T-Visas, VAWA, Hardship Waivers, and Asylum; and Infertility Assessments for those looking to undergo IVF or IUI. Learn more here.
#4 SCHEDULE & PREPARE FOR YOUR SURGERY
Once you've completed the necessary assessments and received medical clearance, you can schedule your surgery with your chosen surgeon!
After your surgery is scheduled, you should focus on the following things:
Getting your post-op supplies ready. This handy checklist of medical supplies, convenience items, supplements and more gives an example of how to get organized for top surgery recovery.
Making travel arrangements. If you're traveling any distance to your surgeon, you'll want to think about how you'll get there and back and where you'll stay.
Finding a caregiver. You'll need someone to accompany when you leave the surgery facility and they'll need to stay with you for a minimum of 24hrs.
Arranging time off from work or school. If you're in the USA, look into applying for FMLA (Family and Medical Leave Act).
Preparing your home/recovery space. Stock the kitchen with snacks and easy to make and/or pre-prepared meals and ensure that things that you'll need are within reach without having to exert too much effort. Tidy up so you won't be tripping on things.
Lastly, be sure to take some time for you. It's common to have a high degree of stress before surgery so it's really important to make sure that you take time for yourself and get lots of rest in the weeks leading up to your big day.
#5 POST-OPERATIVE CARE
Follow your surgeon's recommendations for post-operative care, which should include follow-up appointments and ongoing support from your healthcare team.
You will also need to allow your body ample time to rest and recover. It's essential not to rush the healing process and to gradually resume your normal activities as advised by your surgeon. During this period, we also recommend engaging in regular counseling sessions or joining support groups to help process the emotional aspects of your recovery and address any mental health challenges that may arise during this period.
Some useful questions to ask your surgeon about post-operative care include:
What complications am I at risk for?
What symptoms should I be on the lookout for?
Who do I contact if I think I have a complication?
If a complication happens, what is the protocol for managing it?
Do any of my medical conditions increase complication risks?
If coming from out of town: How long will I need to stay in town after surgery?
If coming from out of town: Do you have arrangements with any hotels for reduced-cost stays for patients?
When will my post-op appointments be?
What medications will I be prescribed after surgery?
Do you provide free or reduced-cost revisions if they're necessary?
Deciding on Using Your Insurance vs Self-Pay
If you're planning to use insurance to pay for your surgery, you'll first need to find out if your insurance will in fact cover it. You can call your insurance company, state Medicaid program or Medicare representative but be aware that agents don't always have accurate information. It can be useful to double-check the full text of your health plan and look for exclusions and/or specific coverage language that includes transition-related care. You can also login to your insurance provider's portal or check your member handbook to find surgeons who are in-network with your plan.
Most surgeons’ offices include a team dedicated to insurance and billing. This includes an Insurance Specialist who will submit all the needed information to your insurance company to verify benefits, submit a prior authorization, or work to obtain a letter of agreement, if needed. The Insurance Specialist should also be able to provide guidance on navigating any fees, deductibles, and out-of-pocket maximums, among other variables.
If you can't find an in-network provider, you have the option to utilize your out-of-network benefits. In this case, you would be responsible for covering the cost of surgery minus the portion covered by insurance. Most insurances cover about $2000-$2500 in this circumstance, but you would need to confirm your specific out-of-network benefits and/or reimbursement directly with your insurance provider.
Paying out-of-pocket, when possible, is usually a much faster route to getting a surgery date. Self-pay patients do not have to abide by insurance rules, and they also don't have to wait for insurance to approve their surgery.
If you're planning to pay for your surgery out-of-pocket but don't have enough savings, you'll want to investigate fundraising ideas such as how to increase your savings, apply for grants, and learn best practices for crowdfunding. Check out the TransGuys.com Comprehensive Guide to Surgery Fundraising for tips about how to raise money for surgery.
QUESTIONS TO ASK YOUR SURGEON IF YOU’RE USING INSURANCE
What types of insurance do you accept? (Medicare, Medicaid, private insurance)
How much success does your office have getting pre-authorization for gender-affirming surgery insurance coverage?
If you don't take insurance, is your office able to assist with filing for an insurance reimbursement?
QUESTIONS TO ASK YOUR SURGEON IF YOU’RE PAYING OUT OF POCKET
What is the total cost? Does it differ by procedure?
Does this include the surgeon's fee, facility fee and anesthesiologist fee?
Does the cost include any post-op medical supplies?
Does the cost include post-op appointments?
Is there a down payment required to secure a surgery date?
Does the cost need to be paid in full before my surgery date?
Do you offer a payment plan?
Do you accept medical financing via CareCredit, etc.?
How much should I budget for post-operative medications?
Types of Gender Affirming Surgery
The below lists were taken from UI Health’s Gender Affirming Surgery website.
Feminizing/Demasculinizing Procedures
Breast Augmentation — Breast Augmentation is an enhancement of the breast tissue with either silicone or saline implants or fat grafting. It is recommended that patients take their Estrogen hormone therapy for 1–2 years prior to surgery to maximize breast growth before surgically augmenting the breast. This helps to ensure proper placement of the implant underneath the breast tissue and allows the surgeon to adjust sizing for a symmetrical augmentation. During your initial surgical consultation, your surgeon will discuss surgical options and discuss your goals for breast size. This is usually an outpatient surgery, and you will go home the same day.
Orchiectomy – An orchiectomy is the removal of the testicles, with the intent to stop the production of testosterone in the body. The testicles not only make testosterone, but they are also the factory and storage for sperm, so removing them prevents future harvest of sperm. If you are considering Fertility preservation, sperm may be harvested either prior to, or during the surgery. However, the surgeon must know that this is your intention in advance, prior to booking the surgery. This is an irreversible procedure. Orchiectomy can be performed as a solo procedure, or in combination with vaginoplasty or penectomy. If performed as a solo procedure, this is typically outpatient surgery, and you will go home the same day.
Vaginoplasty – A vaginoplasty is the creation of a vaginal canal as well as the external feminine genitalia of labia minora, labia majora, and clitoris. The procedure often utilizes your existing genital anatomy to create the structures listed above, commonly referred to as "penile inversion vaginoplasty.” Alternative options include using a portion of your colon or peritoneum to create the vaginal canal. This is a surgery that requires an inpatient hospital stay for approximately one week.
Facial Feminization – Various surgical procedures can be performed to demasculinize or feminize facial contours and features in accordance with the patient's goals. At your consultation, you and your surgeon will discuss areas of interest and potential surgeries which may be done in combination or as separate procedures. Examples of such procedures include, but are not limited to, Rhinoplasty, Brow Lift, Frontal Sinus or Orbital Contouring, Jaw Contouring, Genioplasty, Face Lift, and Hairline Advancement.
Body Contouring – Though bodies come in all shapes and sizes, there are some curves typically ascribed as feminine curves such as wider hips, rounder buttocks, smaller waist, or “hourglass” shape. Likewise, an “A-frame” shape or less curvature in the hips and thighs is generally perceived as more masculine. Though hormones affect where fat is distributed on the body, body contouring may help you achieve the body shape that feels natural to you. You and your surgeon will discuss your personal goals as well as areas of your body that increase your dysphoria. This is usually an outpatient surgery, and you will go home the same day.
Pitch Altering Surgical Therapy – The goal of this surgery is to raise vocal pitch for a more feminine or less masculine voice. The Wendler glottoplasty shortens the vocal cords (folds) so they can vibrate at a higher frequency. Since the pitch of the voice is determined by the frequency of vibrations, higher frequencies will give you a higher voice. The procedure is done through a scope, which means that there is no visible scar. We join the front part of the vocal cords together with stitches and when this heals, it makes the part of the vocal cords that vibrate shorter. This is done under general anesthesia (fully asleep with a breathing tube), but it can usually be done as an outpatient surgery. It may take 6-8 months for your voice to feel “natural,” during which time you will continue voice therapy.
Thyroid Chondroplasty – The thyroid cartilage, known commonly as the Adam's Apple, can be surgically reduced for a more feminine or less masculine curvature of the neck. This procedure may be performed in combination with other procedures. If performed as a solo procedure, patients typically stay overnight in the hospital for observation and go home the next day.
Fertility Preservation – Prior to removal of the testicles or ovaries, you and your surgeon will discuss whether you would like to preserve sperm or eggs for potential biological reproduction. Should you wish to consider that option, your surgeon will refer you to our fertility preservation specialist for further discussion.
Masculinizing/Defeminizing Procedures
Mastectomy/Chest or Top Surgery – A bilateral mastectomy is the removal of the breasts. Whether your goal is to masculinize or de-feminize your chest contour, you and your surgeon will discuss options for the type of incision based on your body and your goals. This surgery can be done with or without preservation of the nipple. This is usually an outpatient surgery, and you will go home the same day.
Hysterectomy/Oophorectomy – A Hysterectomy is the removal of the uterus, and a salpingo-oophorectomy is the removal of the bilateral fallopian tubes and ovaries. The ovaries not only make estrogen, they are also the storage for ova (eggs), so removing them prevents future harvest of ova. If you are considering Fertility preservation, ova may be harvested before surgery. This is an irreversible procedure.
Metoidioplasty – A Metoidioplasty is the creation of a small penis and possible urethral extension using the existing genital tissue. The post-operative length of the penis ranges from 4 to 6cm on average. Typical goals achieved by this surgery include the ability to stand while urinating, closure of the vaginal canal, and the potential creation of a scrotum. Due to the limited length of the penis, it does not allow for penetrative intercourse. If your goals include the closure of the vaginal canal, you must first have a total hysterectomy to remove the cervix due to the related risk of future cervical cancer.
Body Contouring – Though bodies come in all shapes and sizes, there are some curves typically ascribed as feminine curves such as wider hips, rounder buttocks, smaller waist, or “hourglass” shape. Likewise, an “A-frame” shape or less curvature in the hips and thighs is generally perceived as more masculine. Though hormones affect where fat is distributed on the body, body contouring may help you achieve the body shape that feels natural to you. You and your surgeon will discuss your personal goals as well as areas of your body that increase your dysphoria. This is usually an outpatient surgery, and you will go home the same day.
Fertility preservation – Prior to removal of the testicles or ovaries, you and your surgeon will discuss whether you would like to preserve sperm or eggs for potential biological reproduction. Should you wish to consider that option, your surgeon will refer you to our fertility preservation specialist for further discussion.
