Male to Female Gender Transition Surgery in Ankara, Turkey

There are many techniques in these surgeries, and compared to female-to-male transition surgeries, they can be considered surgically easier if micro-surgery–based procedures are not preferred. During the operation, the testes are removed (a procedure called castration), and after tissue is taken from inside the penis, vaginal tissue is created using the scrotum and penile skin. In these surgeries, in my opinion and based on what I have heard from my patients, there are some disadvantages. These include, in particular, narrowing (stenosis) in the newly created vagina and difficulties during sexual intercourse due to dryness.

What Is Male-to-Female Transition Surgery?

Male-to-female transition surgery is the surgical stage of the gender affirmation process performed in individuals who were assigned male at birth but have a female gender identity. These surgeries may include removal of the penis and testes, creation of a vagina (vaginoplasty), breast augmentation, and facial feminization surgeries. The aim is to align the person’s physical appearance with their gender identity, thereby improving psychological well-being and quality of life. The process is planned and carried out by a specialist team.

Why Are Legal Permission and a Court Decision Necessary in the Gender Affirmation Process?

In Turkey, gender affirmation surgeries have a very different procedure and legal basis compared to any cosmetic surgery procedure. These operations are bound by strict rules under Article 40 of the Turkish Civil Code. This legal framework has been established both to protect the patient and to ensure that this irreversible process is grounded on solid legal and medical foundations. In order for a surgeon to begin the operation, there must be a permission decision issued by the court. The process begins not in the hospital but, in fact, in the courthouse.

It is mandatory for the individual to apply to the court in person in order to undergo this surgery. When granting this permission, the court meticulously examines whether certain criteria are met. First, the person’s legal adulthood and marital status are checked. If the person is married, the effects of the process on family law are taken into account and the divorce case is expected to have been finalized. However, the most important step is proving through medical reports that the person has a transsexual structure and that gender transition is a necessity in terms of mental health.

The basic conditions sought in the court process are as follows:

• To have reached the age of 18
• Not to be married
• To have a transsexual structure
• Gender transition being a necessity in terms of mental health
• A medical board report obtained from a training and research hospital

Previously, the condition of being “permanently deprived of reproductive ability” was also required for this permission. However, within the framework of constitutional rights, this condition was removed as a preoperative prerequisite. Still, in order to change the civil registry and obtain a new ID, reports proving that a court-authorized surgery that ensures gender affirmation has been performed are required. Without these reports, the legal identity change cannot be completed.

Why Should Hormone Therapy Be Discontinued Before Surgery?

After the legal process is completed, the surgical preparation phase begins. At this stage, there are some rules that our patients struggle with the most, yet they are of vital importance. Our patients have usually been receiving hormone replacement therapy for a long time to feminize their bodies. However, these medications must be paused before going to the operating table.

The estrogen hormone has an effect that increases the tendency of blood to clot. In major surgeries such as gender affirmation surgery, which last a long time and require the patient to remain immobile for a period, this clotting tendency can create serious risks. Clots that may form inside the vessels can travel through circulation to the lungs or other vital organs and cause blockages. To minimize this risk, we request that hormone therapy be stopped approximately one month before the surgical intervention.

In addition, smoking is a factor that directly affects surgical success. Smoking constricts blood vessels and reduces the amount of blood reaching the tissues. In these surgeries, we reposition tissues and shape them into a new form. For healing, these tissues need ample oxygen and blood. In smokers, wound healing is delayed and tissue losses may occur. For this reason, it is mandatory to completely stop smoking at least one month before the operation.

Substances that should be discontinued before surgery are as follows:

• Estrogen-containing hormone medications
• Blood-thinning aspirin derivatives
• Vitamin E supplements
• Herbal teas
• Cigarettes and tobacco products
• Some painkillers

What Is the Gold Standard Method in Vaginoplasty Surgery?

Vaginoplasty lies at the surgical center of the male-to-female transition process. The goal of this operation is not only to create an anatomical cavity; it is to create a genital organ that looks aesthetically natural, has sexual function, preserves sensation, and maintains healthy urination function. Today, the method that provides the most reliable results worldwide and in our practice is the “Penile Inversion Vaginoplasty” technique.

This technique is based on preserving the existing penile skin, inverting it, and using it to create the vaginal canal. Over time, however, the classic method has been developed and has become much more functional under the name “Modified Penile Inversion.” When only skin is used in the classical method, the inside of the vagina may remain dry because skin does not produce fluid on its own. In the modified technique, the mucosal tissue surrounding the urethra is also included in the process.

The advantages of this method are as follows:

• Providing natural lubrication
• Increasing vaginal depth
• Lower risk of narrowing
• A more natural tissue feel

During the operation, a tunnel is created in the safe space between the prostate and the rectum. The penile skin is prepared to line the inside of this tunnel while preserving blood vessels and nerves. If the penile skin is not long enough, additional skin grafts from the scrotum or groin area can be used to achieve the desired depth (generally 12–16 cm). In this way, a functional structure with sufficient depth for sexual intercourse is created.

Is There a Loss of Sexual Sensation and Pleasure After Surgery?

One of the biggest concerns for patients is experiencing loss of sensation after surgery. One of the most important features of the modified penile inversion technique is the preservation of sensory nerves. The head of the penis (glans) is the area where sexual pleasure is most intense. During surgery, the vascular and nerve bundle that nourishes this area is preserved with microscopic precision.

By reducing the glans tissue, it is positioned as a clitoris at the upper part of the newly created vulva in a way that matches female anatomy. This “neoclitoris” preserves sexual arousal and the ability to orgasm thanks to its dense nerve endings. In some cases, sensitivity may even be observed to increase because the nerve endings become more superficial after excess tissue is removed.

Temporary numbness due to postoperative swelling is completely normal. Nerve healing is a slow process, and it may take months for full sensory function to settle. However, with the correct surgical technique, the risk of permanent loss of sensation is quite low.

How Are Vulva Aesthetics and External Appearance Created?

Vaginoplasty is not only about creating a canal; achieving an aesthetic and natural-looking female genital appearance from the outside is at least as important as functionality. We call this stage “Vulvoplasty.” Here, the surgeon’s aesthetic perspective comes into play.

Using the skin of the scrotum, full outer lips (labia majora) are created around the vaginal opening. Thinner tissues such as the foreskin or remaining penile skin are used to simulate the delicate inner folds, namely the inner lips (labia minora). The urethral opening is also shortened and positioned just below the clitoris, in its anatomically appropriate female location. In this way, the patient becomes able to urinate while sitting without splashing.

The anatomical structures targeted in vulva aesthetics are as follows:

• Labia majora
• Labia minora
• Clitoral glans
• Clitoral hood
• Vaginal opening
• Urethral opening

How Does Facial Feminization Surgery Change the Face?

The first and most important reference point that ensures an individual is perceived as a woman in society is the face. Body contours can be shaped with clothing, but the face is always at the forefront. For this reason, Facial Feminization Surgery (FFS) is critical for the patient’s social adaptation and self-confidence. There are fundamental structural differences between male and female facial skeletons, and FFS aims to change not only the skin but also the underlying bone structure.

The forehead region is one of the most distinctive areas for sex characteristics. While men have a prominent bony protrusion just above the eyebrows, women have a more vertical and smooth forehead. This area is flattened by shaving or reshaping the bone. In addition, the hairline is advanced to close male-pattern recession and achieve a more oval facial outline. The eyebrows are also lifted to give the gaze a more open and feminine expression.

The nose and jaw structure also play a major role in gender perception. The male nose is usually wider and has a dorsal hump. In feminization rhinoplasty, the nose is narrowed, the hump is removed, and the nasal tip is slightly lifted to create a delicate profile. The jaw angles are contoured to ovalize the face, and the chin tip is narrowed to achieve a more pointed structure.

Procedures performed within this scope include:

• Forehead bone shaving
• Hairline advancement
• Brow lift
• Rhinoplasty
• Lip lift
• Chin shaving
• Jaw angle reduction
• Cheek implants or fat injection

Does Adam’s Apple Reduction Damage the Vocal Cords?

The protrusion of the thyroid cartilage in the neck area, commonly known as the Adam’s apple, is one of the most prominent signs of biological male anatomy and creates a masculine appearance. With the procedure called “Tracheal Shave,” or medically chondrolaryngoplasty, this cartilage prominence is reduced and the neck line is smoothed.

The biggest fear regarding this procedure is voice damage. However, when performed with the correct technique, the vocal cords are not harmed. The surgical procedure is carried out with great precision just above the point where the vocal cords attach. The aim is not to raise the pitch of the voice but only to eliminate the external protrusion. To raise the pitch, different surgical procedures targeting the vocal cords or voice therapies are applied. Adam’s apple reduction is performed through a small incision made along a natural neck crease, and the scar is almost unnoticeable.

Which Implants Are Preferred in Breast Augmentation Surgery?

Hormone therapy provides a certain amount of breast tissue development in trans women. However, this development often does not create aesthetically sufficient fullness due to the width of the chest cage. The anatomy of trans women differs from biological women in some ways; the rib cage is wider, the pectoral muscles are stronger, and the nipples may be positioned farther apart laterally.

Because of these anatomical features, we apply specific strategies in implant selection. To fill the wide chest cage and reduce the gap between the breasts, we generally prefer implants with a wider base or high-profile round silicone implants. Since trans women often have limited breast tissue and tighter skin, we more frequently prefer placing the implant under the muscle to prevent the implant edges from being visible and to provide a more natural transition.

Factors considered in breast augmentation include:

• Chest cage width
• Amount of existing breast tissue
• Skin elasticity
• Nipple position
• Desired fullness level

Why Are the Postoperative Recovery Process and Dilation Vitally Important?

Surgery is only half of the transition process; the other half is the healing period, which requires patience and discipline. After vaginoplasty, our patients are usually hosted in the hospital for about a week. Although movement is limited in the first days, walking is started early to regulate blood circulation.

The most critical part of this process, where our patients must be most attentive, is “Vaginal Dilation.” The body perceives this surgically created new cavity as a wound and, through its healing mechanisms, tries to close and narrow it. To prevent this, the patient must regularly use medical devices called dilators to keep the vaginal canal open. This is like physical therapy, and neglecting it can lead to problems that are difficult to reverse.

The dilation schedule is generally as follows:

• Application 3–4 times a day
• Waiting 15–20 minutes in each session
• Progressing with dilators of different sizes
• Continuing for life or until regular sexual activity begins

Neglecting dilation can cause narrowing (stenosis) of the vaginal canal and loss of depth. This can make sexual intercourse impossible and may require reoperation. Therefore, dilation is the patient’s greatest responsibility in the success of the surgery.

What Should Be Considered Regarding Hygiene and Care?

Hygiene of the newly created genital area is very important to prevent infection risk and accelerate healing. In the postoperative period, the area should be kept dry and clean. After each toilet need, the area should be gently cleaned with lukewarm water and dried without irritation.

Especially in the first weeks, vaginal douching or directing water inside is not recommended. Instead, antiseptic solutions recommended by the doctor should be used. To prevent bacteria from the intestinal flora from contaminating the vaginal area, it is essential that cleaning is always done from front to back. In addition, cotton and loose underwear should be preferred, and non-breathable synthetic clothing should be avoided.

Hygiene rules to pay attention to include:

• Cleaning from front to back
• Using lukewarm water
• Gentle drying
• Preferring cotton underwear
• Changing daily pads
• Regular use of prescribed creams

What Are the Possible Complications of Gender Affirmation Surgery?

As with any surgical intervention, gender affirmation surgeries also carry risks and the possibility of complications. Discussing these openly is important to set realistic expectations. One of the most common issues is bleeding and hematoma. Blood may accumulate in the surgical field; this is usually controlled with drains, but sometimes re-intervention may be required.

The risk of infection should not be overlooked either. Since work is performed in a sensitive area with a high bacterial load, infection can develop, but it can be managed with appropriate antibiotic treatment and good hygiene. In patients who smoke, tissue perfusion is impaired, so delays in wound healing or partial tissue losses may occur.

A rarer but serious complication is fistula formation. Small unwanted channels may form between the vagina and rectum or between the vagina and bladder. This can cause stool or urine to pass through the vagina and requires surgical repair. However, in experienced hands and with the correct technique, these risks are minimal.

Possible risks include:

• Bleeding
• Infection
• Wound dehiscence
• Vaginal narrowing
• Difficulty urinating
• Fistula formation
• Tissue necrosis