Choosing a Surgeon
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The surgeon matters more to your outcome than the technique, the clinic or the country. I have watched the same operation done well and done carelessly in hospitals a mile apart.
Where the names come from
Most people end up choosing from a list someone else drew up. If you are going through the NHS, a Canadian provincial plan or a US insurer's network, your options may come down to two or three surgeons, sometimes one. Every question below still applies.
If you are paying privately, the useful sources are the people already in the system. Your gender clinic, prescriber or letter writer will know which surgeons their patients go to and which ones they stop referring to. Peer groups and forums tell you who people are using this year. Surgeons who publish their own outcome data, or present at WPATH and national gender health meetings, are at least prepared to have their numbers looked at.
A personal recommendation tells you how one person's surgery went, not how yours will. I will not rank surgeons here, and I would be wary of anyone who does, because outcomes depend on your body, your goals and which operation you are having.
Check the basics first
Before you look at a single photo, confirm the surgeon is qualified in the right field and allowed to operate where they say they do. In the US that means board certification in plastic surgery, urology or gynaecology, depending on the operation. A title like "cosmetic surgeon" doesn't tell you which specialist training sits behind it, so look the name up rather than relying on the website. In the UK the GMC's specialist register is public; elsewhere, the national medical council usually has a searchable licence list.
Then check where the operation happens. A hospital or an accredited surgical centre, with an anaesthetist rather than sedation run by the surgeon's own team, is the norm for anything under general anaesthetic. And ask who does which part. At teaching hospitals a trainee may close, which is normal and fine if you are told.
How often they do your operation
Ask how many of your specific procedure they did last year. Not "gender surgery" in general, but the exact operation you want. I would not put a number on what counts as enough; any threshold I gave you would be made up. You want to hear that it is routine, and you want the answer to come easily.
- Top surgery. Plenty of surgeons do this weekly. If they do keyhole or peri-areolar, ask how many of those against double incisions; a surgeon who rarely does keyhole may be slow to say you do not qualify.
- Metoidioplasty and phalloplasty. Far fewer surgeons do these anywhere, so the numbers are small and a low figure is not automatically a warning. What matters more is their fistula and stricture rates for the version you want, and whether they manage their own urethral complications.
- Hysterectomy. Gynaecologists do these all the time. Ask whether they have operated on trans men, and whether they will coordinate with the surgeon doing any later vaginectomy or phalloplasty.
- Face and body. Look for masculinizing work specifically. Many facial surgeons mostly feminize, and the same skills do not always come with the same eye.
What to look for in the photos
Ask for results on bodies like yours, meaning your chest size, build, skin tone and age. The best results on lean 22-year-olds tell you very little if that is not you. And ask for healed results: a year for top surgery and phalloplasty, six months or more for metoidioplasty, liposuction and facial work. The six-week photos every website leads with show swelling and fresh scars, not the result.
What to look at, by procedure:
- Top surgery. Scar placement, the outer ends of the scars and nipple symmetry, across several healed chests rather than the best one. The double incision page lists what to check in each, and top surgery results and scars show what varies.
- Phalloplasty. Healed donor sites as well as phalluses. If the surgeon can't show you forearms or thighs a year on, ask why.
- Metoidioplasty. Cases with growth similar to yours, since length depends on what you start with.
- Facial work. Front-on as well as profile, and the temples and jaw angles, where implant edges show if they show anywhere.
- Body contouring. The waistline from behind, which is where a curve either went or did not.
Before and after should share the lighting, angle and distance. A crop that stops just short of the armpit, or a change of pose between shots, can hide exactly the thing you wanted to see.
Complications, revisions and who pays
Every surgeon has complications. You want one who is straight about them and fixes their own. A revision rate means nothing until you know what it counts, whether a dog ear trimmed under local anaesthetic goes in the number or only a return to theatre. A surgeon who explains the definition unprompted is telling you something good.
Then ask who pays. Some surgeons include minor revisions within a year, some charge the full fee, and it is rarely on the website. Get it in writing before you pay a deposit. Read revisions and complications first, so you can tell a candid answer from a comfortable one. The full question list for the room itself is on the consultation page.
Aftercare
Most of your contact with this team happens after the operation, when something looks wrong and you want an answer the same day. Find out who answers post-op questions, whether there is an out-of-hours number and who picks it up, and what happens if something needs looking at in person at week three. If you live far away, ask how remote follow-ups work. If you are going abroad, aftercare is the weak point; read surgery abroad and travelling for surgery.
Red flags
None of these on its own proves a surgeon is bad. Each is a reason to stop and ask before you pay anything.
- No numbers, or "very low" in place of a figure, for volume, revisions or complications
- Only one technique on offer, with no explanation of why the others do not suit you
- Photos that are all early, all lean bodies, or inconsistent in lighting and angle
- Promises of no visible scars, guaranteed sensation or a guaranteed length
- A discount that expires, or a large non-refundable deposit before you have an itemised quote
- All contact through a coordinator or social media account, with no consultation with the surgeon until the day
- No clear answer on who handles a complication once you have gone home
The last one matters most for people travelling. In the Bangkok hospitals I have worked with, the patients who had a hard time were rarely the ones with a complication. They were the ones who had flown home and could not get anyone to look at a photo of it.
Making the decision
At some point the comparing has to stop. The surgeon to pick is one who does your operation often, who described your case in terms you recognised, who was straight about what could go wrong, and who you believe will pick up the phone at week three. If one of those four is missing, that is the question to take back before you pay a deposit.
This is information from someone who has sat in on a lot of consultations, not medical advice, and I am not a surgeon.
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