I guess you can say I kind of stumbled on the topic of gender reassignment surgery (GRS). I was researching the growing popularity of medical tourism in Thailand. That's when I found out how popular GRS was. It seems as if Thai surgeons have made this their unofficial specialty; perhaps because there are thousands now seeking this surgery.

GRS or sexual reassignment surgery, as it is sometimes called, is a term used to describe all the hormonal and surgical procedures that would encompass changing ones sexual organs to one specific gender. The term refers to the reconstruction of a man to a woman or the reconstruction of a woman to a man. Medical experts use GRS as part of the treatment for gender identity disorder (GID), condition in which a person has been born one gender, but identifies as belonging to another gender. The surgery is primarily done among (but is not limited to) hermaphrodite (people born with both male and female sexual organs) or transgender people (people born as one sex but identify with the opposite sex).

Some American insurances (i.e. CIGNA and Aetna) offer full or partial coverage for GRS. However, they have very strict guidelines that must be met before coverage is provided for surgery. As a result, most insurance companies follow the Standard of Care for Gender Identity Disorders (SOC) outlined by the Harry Benjamin International Gender Dysphoria Association. Under these guidelines, patients must first have a clean bill of health and must therefore undergo a physical examination, including, but not limited to check of cardiovascular, weight, HIV and liver health status. Then the patient must have an extensive psychiatric evaluation, at which time they must be diagnosed with GID. Thirdly, the patient must live in the desired gender role for at least one to two years. When one lives as the desired gender, they are expected to continue employment, examine their support system, engage in the community and make those in their lives aware of the role reversal.

In addition, patients must also take hormone replacement medication for a full year prior to surgery. During that time, says CIGNA, men take estrogens and anti-androgens to increase breast size, redistribute body fat, soften skin, decrease body hair, as well as decrease muscle and bone mass. Women, says the insurance carrier, take testosterone to achieve the opposite results, including increasing clitoris size and decreasing breast size.

These guidelines, insurances say, are imperative because most GRS procedures can not be reversed. While there are many getting the surgery that do not have insurance, experts in the GRS field agree that patients should still follow these guidelines. Some insurances such as CIGNA have additional requirements. For example, the disorder can not be due to another mental disorder (such as schizophrenia) or chromosome abnormality.

As indicated earlier, some insurances offer coverage for GRS. However, many restrict coverage to the following surgeries: a mastectomy, breast reduction, hysterectomy, salpingo-oophorectomy, colpectomy, metoidioplasty, angioplasty, colovaginoplasty, orchiectomy, penectomy, clitoroplasty and labiaplasty. Insurances consider these surgeries to be the basic, medically necessary procedures to treat the disorder. Anything extra is considered cosmetic and therefore must be paid out of pocket.

These procedures are considered cosmetic: breast augmentation/silicone implants, blepharoplasty, facial feminization surgery, rhinoplasty, lip reduction, face/forehead lift, chin/nose implants, trachea shave, laryngoplasty, liposuction, electrolysis, jaw shortening/sculpturing, collagen injections, and removal of redundant skin. If you have never heard of some of these surgeries, consider this your basic GRS guide.

Below is a brief description of the surgeries. Please note, these surgeries are not all inclusive of every GRS procedures.


FEMALE-TO-MALE PROCEDURES:
Mastectomy: Surgical removal of the breast.

Breast reduction: Surgical reduction of breast tissue and reduction of nipple size.

Hysterectomy: Surgical removal of the uterus.

Salpingo-oophorectomy: Removal of the fallopian tubes and ovaries.

Vaginectomy/Colpectomy: Surgical removal of the vagina.

Metoidioplasty: Clitoris is slightly enlarged with hormone replacement drugs, which allows the surgeon to create a penis out of the enlarged clitoris. Skin around clitoris is removed and sewed tightly together so that it can further extend out to resemble a penis. However, to urinate standing up, the vagina must be removed and the vaginal opening closed. The uretha is then extended down into the penis so that the patient can urinate standing up. Skin of the vaginal lips is used to create a scrotum.

Phalloplasty: Constructing a penis from the inner forearm and vaginal tissue and attaching it to the vaginal area.

Penile Implant: An internal device placed in the erectile chambers that is permanent and makes the penis hard enough for sexual penetration.

Angioplasty: Surgical reconstruction of a blood vessel.


MALE-TO-FEMALE PROCEDURES:
Vaginoplasty: Surgical construction or reconstruction of a vagina.

Colovaginoplasty: Is a type of vaginoplasty operation where a vagina is created by cutting away a section of the sigmoid colon and using it to form a vaginal lining.

Orchiectomy: The removal of the testicles, a man's main source of testosterone.

Penectomy: Surgical removal of the penis.

Clitoroplasty: surgical construction of a clitoris from a small section of the glans penis. Blood supply and nerves are intact to achieve sexual sensation in the clitoris.

Breast augmentation: prosthesis (such as silicone) used to enlarge the size of the breasts.

Blepharoplasty: A surgical procedure that reshapes the upper eyelid or lower eyelid by the removal and/or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons.

Facial Feminization Surgery: surgical procedures (hairline correction, forehead recontouring, brow lift, rhinoplasty, cheek implants, lip lift, lip filling, chin recontouring, jaw recontouring, tracheal shave) that alter the human face to increase its femininity.

Potential patients should thoroughly research GRS and GRS surgeons before proceeding with surgeries, and make sure that the doctor and facility are properly accredited. It should also be noted that GRS risks/concerns can include: post-operative infection, loss of sexual sensation, life-long hormone medication(s), bowel/urination problems, and large out-of-pocket expenses. GRS is generally more expensive in the United States (almost double) than overseas in places like Thailand.