You love the idea of creating new body parts and want to be one of the first surgeons to

break into this up-and-coming field.

Let’s debunk the public perception myths of what it means to be a gender surgeon and

give it to you straight.

This is the reality of gender surgery.

Dr. Jubbal, MedSchoolInsiders.com.

Welcome to our next installment in So You Want to Be.

In this series, we highlight a specific specialty within medicine, such as gender surgery, and

help you decide if it’s a good fit for you.

You can find other specialties on our So You Want to Be playlist.

If you have a specific specialty you want covered, make sure you’re subscribed to

vote in upcoming polls.

Also, consider becoming a YouTube channel member to receive additional perks and priority

in helping us decide future specialties.

Click the JOIN button underneath this video for more information.

If you’d like to see what being a gender surgeon looks like, be sure to check out my

Day in the Life of a Gender Surgeon video with Dr. John Brosious on my second channel,

Kevin Jubbal, M.D., and subscribe for more Day in the Life videos covering other specialties

in the future.

Gender surgery is the field of medicine concerned with alleviating gender dysphoria through

surgical procedures.

Gender dysphoria is defined as the unhappiness that patients in the gender expansive community

feel due to the incongruence between their gender identity and their physical characteristics.

We often think of gender surgery as synonymous with genital surgery; however, the scope of

a gender surgeon is much broader.

Any surgical procedure that is done to help alleviate gender dysphoria can be considered

gender surgery.

This includes masculinization and feminization of the face and chest, tracheal shaves, voice

modification, body contouring, and even limb lengthening and shortening procedures.

Gender surgeons work with the full spectrum of gender patients including transgender,

non-binary, gender fluid, and intersex.

Transgender patients are individuals whose gender identity differs from their assigned

gender at birth.

Within the gender surgery community, the appropriate terminology is either “assigned male”

or “assigned female” at birth.

We use this terminology as opposed to “biologically male” or “biologically female” as the

latter terms do not take into account the mental and psychological aspects of biology.

Non-binary individuals do not identify as solely male or solely female but rather view

themselves as having features of both.

There are also gender-fluid individuals whose gender identity varies depending on the social

situation.

For example, these individuals may identify as one gender while at work and another while

outside of work.

This isn’t to be confused with cross-dressing which is typically done for sexual satisfaction

as opposed to being an integral part of that person’s identity.

Lastly, there are intersex individuals who are born with some variation of both male

and female sex organs.

Because gender surgeons work with a wide variety of gender patients, each with their own unique

goals and needs, the treatment plan often varies significantly from patient to patient.

When it comes to gender surgery, there is no one-size-fits-all solution.

This brings me to an important method of differentiating a gender surgeon’s practice: top surgery

vs bottom surgery vs other masculinization and feminization surgeries.

The majority of gender surgeons focus primarily on top surgeries.

This includes a variety of chest masculinization and feminization procedures including mastectomies

for trans-men and breast augmentations for trans-women.

This is the most common type of gender surgery as these procedures are very similar to routine

breast augmentation, reduction, and mastectomy procedures.

They are also less functional compared to genital surgeries so there is often less risk

of complications.

The combination of these two factors means that more surgeons are comfortable performing

these types of procedures.

Gender surgeons who perform bottom surgery, which includes vaginoplasty, phalloplasty,

and metoidioplasty, are much less common.

The reason being is that the surgical creation of a vagina or penis is still quite new and

these procedures are constantly evolving.

It has only been within the last few years that training to perform these procedures

has become more readily available.

In the past, physicians interested in performing genital surgery had to do much of the research

on their own and seek out mentors who were willing to train them.

That being said, bottom surgery does not always involve the creation of a new sex organ.

Sometimes the role of the gender surgeon is to simply remove the incongruent sex organ

to combat hormone production or to allow the patient to live more in accordance with their

gender identity.

For example, a trans-female that has an orchiectomy to remove one or both of the testicles may

be able to significantly reduce the amount of testosterone-blocking medications that

she has to take – thereby reducing the risks and side effects of the medications.

In addition, a trans-male may find having menstrual periods as a male to be very traumatic

psychologically.

In this scenario, having a hysterectomy to remove the uterus may allow him to live more

in accordance with his gender identity.

Lastly, there are other gender surgeons that don’t perform top or bottom surgeries, but

rather other procedures that help alleviate gender dysphoria.

This includes plastic surgeons that perform facial masculinization or feminization, body

contouring, or fat grafting procedures; ENT surgeons performing tracheal shave or voice

modification procedures; and even orthopedic surgeons performing limb-lengthening or shortening

procedures.

Let’s clear up some of the misconceptions about gender surgery.

But rather than telling you myself, I’m going to hand it over to my friend, Dr. John

Brosious.

He’s the only practicing gender surgeon in the state of Nevada that performs genital

surgery and just recently opened Nevada’s first gender surgery practice, Vegas Plastic

Surgery Institute.

Without further ado, here is Dr. Brosious.

To start, many people believe that you have to be a part of the LGBTQ+ community, or have

a family member that is, in order to do gender surgery.

As a heterosexual, cisgender, white male, who grew up in a religious household, I can

tell you that you do not.

If you are a kind, empathetic, and down-to-Earth individual that truly wants to help gender

patients, there will always be a place for you within the gender surgery community.

Gender surgery is currently such a niche specialty that we don’t need every gender surgeon

to fit some sort of perfect ideal.

We need more physicians to go into gender surgery, period.

As it stands right now, the gender expansive community is extremely underrepresented in

healthcare and we can’t gatekeep the specialty and wait for there to be more representation

before we start expanding our ability to offer services to these patients.

Doing so would only be a disservice to this already deeply marginalized population.

Many people also believe that gender surgery is purely cosmetic – it definitely is not.

When you look at the data, patients with gender dysphoria are at a significantly higher risk

of mental illness and substance abuse than the general population.

According to one study, approximately 82% of transgender youth experience suicidal ideation

and approximately 40% have attempted suicide.

I commonly see this in my own practice as well.

Many of my patients have long histories of self-harm as a result of the mental strain

that being transgender, non-binary, gender fluid or intersex has placed on them.

I’ve even had patients who have taken their own lives because of it.

As such, I don’t see gender surgery as cosmetic.

It truly is life-saving surgery.

I cannot tell you how many patients I have performed surgery on that have told me I saved

their lives.

It’s easy for people outside of the gender expansive community to say that one’s gender

identity is a choice and these procedures should be considered cosmetic; however, anyone

who works with these patients will tell you it’s far from the truth.

This isn’t a matter of novelty or sex life.

Gender surgery is about the patient’s identity and safety more than anything.

That being said, another misconception is that every transgender patient wants the full

spectrum of surgery.

Although many patients come to me specifically because I offer these services, this isn’t

the case for all people in the gender-expansive community.

What it means for someone to be “fully transitioned” varies from patient to patient.

It’s not for me, society, or anyone else to determine, but rather for the patient to

decide for themselves.

For some, fully transitioning might just mean that they’ve accepted their gender identity,

dress differently, and act more in accordance with their gender identity.

For others, their journey may include the full spectrum of surgery and hormones.

Most patients, however, fall somewhere in the middle.

As a gender surgeon, it’s important to remember that surgery is not always a part of the patient’s

personal journey.

Becoming a gender surgeon is a bit more complicated than most other specialties.

After medical school, there are a few different pathways to become a gender surgeon, and which

pathway you choose will be dependent on which area of gender surgery you wish to go into.

The most common pathway to becoming a gender surgeon is to complete plastic surgery residency

followed by either a one year gender surgery fellowship or a one year microvascular fellowship.

To learn more about how to become a plastic surgeon, check out our So You Want to Be a

Plastic Surgeon video.

The plastic surgery pathway allows you to perform the widest variety of gender surgeries

including chest masculinization and feminization procedures, vaginoplasty, phalloplasty, and

metoidioplasty, as well as facial masculinization and feminization surgery, body contouring,

and fat grafting.

If you want to be fully-trained in all aspects of gender surgery, then plastic surgery is

the route you should take.

That being said, plastic surgery is far and away the most competitive pathway to becoming

a gender surgeon.

For the past several years, it has been the number one most competitive specialty to match

into and requires you to be at the top of your class with great grades, Step scores,

and research.

In addition, gender surgery fellowships are incredibly new and only recently came about

within the last few years.

As such, there are only a handful of gender surgery fellowships available – most of

which only accept one fellow per year despite having many applicants per spot.

Getting into one of these fellowship programs is incredibly difficult - even among plastics

surgeons who have already “beaten the odds,” so to speak.

That being said, there are other, less competitive, pathways to becoming a gender surgeon as well.

Physicians interested in performing bottom surgery may also enter the field through completing

residency in either urology or OB/GYN and then seeking additional training afterwards.

Physicians that are interested in performing procedures such as tracheal shaves or voice

modification surgery are able to do so by completing ENT residency.

Although ENT, urology, and OB/GYN are competitive to match into in their own right, they are

still easier to match into than plastic surgery.

In terms of competitiveness, ENT and urology are considered tier 2 or highly competitive

and OB/GYN is considered tier 4 or less competitive.

To learn more about the competitiveness of each specialty, check out my video going over

Why Every Doctor Specialty Seems Competitive - link in the description.

Given the sheer competitiveness of gender surgery and the length of training relative

to other medical specialties, students best-suited for this specialty tend to be highly motivated

and are often at the top of their class.

Given the stigma associated with working with the gender-expansive community, these students

also tend to be very open-minded and down to earth as well.

There’s a lot to love about gender surgery, so I’ll hand it back to Dr. Brosious to

tell you all about it.

The thing I love most about gender surgery is that you get to work with one of the most

marginalized communities in the world and have the opportunity to truly change your

patients’ lives forever.

Many of my patients come to me feeling like they’ve lived their entire lives in someone

else’s body, and I have the privilege of helping them fix that.

And unlike hormone treatments and medications which can take months, if not years, to show

significant changes, gender surgery provides you with near-instant gratification.

Within hours, I can remove a body part that someone has lived their entire life being

too ashamed to look at and replace it with a new body part that finally makes them feel

whole.

In my opinion, there is no other specialty that gives you a more profound, yet instant,

gratification than gender surgery.

The patients that you get to work with as a gender surgeon are also some of the most

interesting and down-to-earth people you’ll ever meet.

Society has judged them their entire lives.

Many have lost friends and family members or been verbally and physically abused just

for being true to themselves.

And yet, through all of that, these patients still get out of bed each day and tell the

world, “I am who I am and I don’t care what you think of me.”

It’s truly inspiring.

Working with these patients day-in and day-out has allowed me to be my authentic self without

worrying about fitting into some sort of “cookie-cutter” doctor mold.