When the decision is made to go through with surgical options, a great deal of consideration must be used. After all, even though surgeons were able to do wonders for John Bobbitt (of Lorena Bobbitt fame), that was a matter of mere reattachment; when a man becomes a woman, doctors will completely reform the penis into a vaginal cavity. That's pretty tough to undo.

The first step in getting surgery is for you to have your case reviewed by both psychologists and medical doctors, who will in conjunction decide if you meet the desired criteria for the operation. These doctors will not only make the judgment about your psychological and emotional stability to go into the procedure, but if they clear you, they will also help you through your transition.

As defined by the now familiar Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, there are several criteria that every individual must satisfy in order to be eligible for the transitional surgery. These include:

  1. Legal age of majority in the patient's nation (18 in the United States).

  2. Twelve months of continuous hormonal therapy for those without a medical contraindication.

  3. Twelve months of successful continuous full-time real life experience. Periods of returning to the original gender may indicate ambivalence about proceeding and should not be used to fulfill this criterion.

  4. If required by the mental health professional, regular responsible participation in psychotherapy throughout the real life experience at a frequency determined by the mental health professional. Psychotherapy is not always required; only if the doctor feels that it is.

  5. Demonstrable knowledge of the cost, required lengths of hospitalizations, likely complications, and post surgical rehabilitation requirements of various surgical approaches.

  6. Awareness of several different competent surgeons. Hey, this is a time when you shouldn't hesitate in getting a second opinion.

As you can tell, you will have to rely quite a bit on your doctors. That's because the medical industry wants to make sure that you are as knowledgeable and mentally healthy as possible before you make any final decisions. The Association also includes what they refer to as "Readiness Criteria." These are much mushier and subjective evaluations by doctors, which include:

  1. Demonstrable progress in consolidating the evolving gender identity.

  2. Demonstrable progress in dealing with work, family, ad interpersonal issues resulting in a significantly better state of mental health (this implies an absence of problems such as sociopathy, substance abuse, psychosis, and suicidality, for instance).

If you jump through all these hoops, you'll finally be ready to face your potential surgery. Sexual reassignment surgery (SRS) is an expensive procedure that, for male to female transsexuals, is relatively successful. It can cost anywhere from $3,000 to $100,000 to get a sex change, none of which is covered under medical insurance. There are several parts to the surgery, which may any or all of the following: orchiectomy, penectomy, vaginoplasty, and augmentation mammoplasty.

A vaginoplasty involves the removal of the testes to create labia. It also involves the inversion of the penis to create a vagina -- this requires extensive surgery and many follow-up visits. The good news is that these newly constructed vaginas look amazingly like the real thing.

As for augmentation mammoplasty (that is, a boob job), it may be performed if the physician prescribing hormones, the surgeon, and the patient have all documented that after undergoing hormone treatment for two years, the patient is still not comfortable in his/her gender role.

Many male to female transsexuals also have cosmetic surgery to feminize their facial features and reduce the size of their Adam's apple. Other surgeries can include: suction-assisted lipoplasty of the waist, rhinoplasty, facial bone reduction, face-lift, and blephroplasty. It is important to remember, however, that most of these procedures are irreversible.

Some individuals choose to get some part but not all of the surgery, for financial or personal reasons. Hey, whatever floats your boat.