So you want to be a gender surgeon.
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.
I’ve been able to grow my hair out, have tattoos, and be true to myself, even though
this isn’t what you’d normally expect from a surgeon.
What is perhaps even more surprising is that my patients seem to respect me even more for
doing so.
They’ve inspired me to live my life in a way that’s true to myself, even if other
people consider it to be “against the grain.”
Because you’re working with such a unique population as a gender surgeon, no two days
are ever the same either.
Each patient has their own unique goals and needs so you constantly have to adapt your
treatment plan accordingly.
In addition, being such a new specialty, you are always on the cutting edge of medicine.
Although some may see this as a negative, you have the opportunity to constantly learn
and grow as a surgeon.
As procedures such as vaginoplasty and phalloplasty become more common, I have no doubt that the
techniques and surgeries will evolve as well.
As a gender surgeon, you have the unique opportunity to be a part of something new, help advance
the field of medicine, and offer services to people that they thought they’d never
have access to.
I learn something new almost every day and am constantly stimulated intellectually.
If you enjoy a challenge, gender surgery will not disappoint.
While gender surgery is an awesome specialty, it’s not for everyone.
To start, the training to become a gender surgeon is longer, more competitive, and less
standardized than most other specialties.
Although there will undoubtedly be more gender surgery fellowships opening in the future,
we are still at least 10 to 20 years away from where it’ll be as common as even some
of the more niche specialties like microsurgery.
The lifestyle of a gender surgeon is also incredibly demanding – even by most surgeons’
standards.
Only a handful of physicians in the country are currently performing genital gender surgery,
so it is highly unlikely that there will be more than one in any given practice.
As such, there’s often nobody else to take care of your patients when issues arise.
Most gender surgeons have to be available for their patients 24 hours a day, 7 days
a week, 365 days a year.
Taking a personal day, traveling out of town, or getting a drink with friends can often
be a luxury to a gender surgeon.
Starting a gender surgery practice also requires much more work up front than most other specialties.
Gender surgery is a team effort.
You need urologists and gynecologists to assist with hysterectomies and genital surgeries.
You need craniofacial-trained plastic surgeons or ENT surgeons to help with facial masculinization
or feminization and voice modification procedures.
You need mental health providers to write clearance letters.
And you need endocrinologists and primary care physicians to help manage patients’
hormone regimens.
Due to the stigma associated with gender surgery, it can be difficult to find physicians to
work with given their social and religious beliefs.
In addition to clinical staff, you also need a team of lawyers and advocates to fight insurance
companies and get these procedures covered as there are many people who believe that
they should be considered “cosmetic” and therefore be paid out of pocket.
This is further complicated by the fact that these procedures are relatively new and there
is not much historical data regarding reimbursement or whether patients tend to be litigious,
or sue, after receiving surgery.
For these reasons, obtaining malpractice insurance or even just finding hospitals that will allow
you to perform these surgeries can be a monumental challenge.
As a result of these difficulties, compensation for gender surgeons is often lower than their
colleagues in reconstructive or cosmetic plastic surgery.
Although compensation varies widely, you can expect to make somewhere between $300,000
to $350,000/year as a gender surgeon.
This is on par with the low end of what reconstructive surgeons make but significantly less than
what cosmetic surgeons make.
In addition, it is not uncommon for gender surgeons to lose money on their gender surgeries
and have to do reconstructive or cosmetic procedures on the side in order to keep their
practice afloat.
Although this will likely change in the future as more insurance companies start to cover
these procedures, as it stands right now, gender surgery is not the best fit if you’re
optimizing for money.
How can you decide if gender surgery is right for you?
If you are passionate about surgery and have a desire to help one of the most marginalized
patient populations in society, gender surgery may be a good fit.
You should be open-minded and flexible, and willing to learn and adapt as the specialty
grows and techniques evolve.
You should also be highly motivated and willing to put in the time and effort it takes to
match into plastics, urology, ENT, or OB/GYN residency and then gender surgery fellowship.
Lastly, you should be willing to sacrifice a cushy lifestyle and high compensation for
the satisfaction of knowing that you’re saving lives and helping people find happiness
in the body they’re in.
Huge shout out to Gender Surgeon Dr. John Brosious for helping me with this video.
See a Day in his Life on my other channel, Kevin Jubbal, M.D.
- link in the description.
And check him out on Instagram and at the Vegas Plastic Surgery Institute here in Las
Vegas - links in the description.
Are you hoping to become a gender surgeon?
To get into medical school and match into plastics, you’ll need to be at the top of
your class.
As you look for experts to work with, seek out those who are actual MD physicians who
crushed their MCAT and USMLE, gained multiple top medical school acceptances, matched into
competitive residencies, and even had medical schools fighting over them by throwing merit-based
scholarships to sway their decision.
Only the top performers can best show you how to most effectively improve your own performance.
At Med School Insiders, we’ve been empowering a generation of happier, healthier, and more
effective future doctors since 2016.
By recruiting the top talent and pioneering a systems-focused approach to our services,
we’ve become the fastest growing company in the space with industry-leading customer
satisfaction.
Learn more at MedSchoolInsiders.com.
Thank you all so much for watching!
If you enjoyed this video, be sure to check out Day in the Life of a Gender Surgeon or
So You Want to Be a Plastic Surgeon.
Much love, and I’ll see you guys there.