Transgender Services

Transgender Services

Services & Education

Kaiser Permanente is a nationally recognized leader in LGBTQ health care equality, providing a wide range of services including psychological support, hormone treatment, and surgical procedures to help transgender and nonbinary individuals achieve their transition goals in a safe and healthy environment.

 

View the You are Not Alone video about our member’s facial feminization journey at Kaiser Permanente.

 

 

Gender-Affirming Surgery Overview

Our gender-affirming surgery evaluation process follows a multidisciplinary approach aligned with the World Professional Association for Transgender Health (WPATH) Standards of Care. Kaiser Permanente members should contact their gender therapist for a referral or call the Transgender Careline at 323-823-3818 for more information.

Common reasons people seek genital surgeries are to:

  • Increase physical and emotional comfort
  • Reduce distress related to the body
  • Feel more affirmed in their gender
  • Feel a greater sense of ease and safety in public spaces
  • Increase sexual function or fulfillment

A physician will explain what to consider before proceeding with surgery, including:

  • Which surgery option will help achieve the patient’s goals
  • Timing for surgery based on the patient’s life priorities
  • Recovery time
  • Physical and emotional health before, during, and after the healing process
  • Fertility plans or hopes about starting a family

Feminizing Genital Surgery Options

This information is for people thinking about or preparing for feminizing surgery, as well as caregivers who plan to support someone before and after the surgical process.

All feminizing genital surgeries have the following limitations:

  • Creation of internal reproductive anatomy, including a uterus, ovaries, or fallopian tubes
  • Menstruation, pregnancy, and childbirth
  • Surgeries include the removal of the testes and the ability to make genetic material (sperm). Unless sperm is banked in advance, a future pregnancy with genetic material will not be possible
  • Surgeries do not include the removal of the prostate, so patients will need prostate evaluations

 

Surgery Type Involves Why choose this procedure? Risks/Considerations
Full-Depth Vaginoplasty; lasts 4 to 6 hours under general anesthesia · Removing the phallus (penis) and testicles, if still present.

· Creating a vagina, labia, and clitoris from existing genital tissue (penile and scrotal tissue) using the penile inversion technique.

· Shortening and repositioning of the urethra to allow urinating while seated.

 

For some patients, it is possible to create a clitoral hood and labia minora at this stage. For others, this requires a second surgery called a labiaplasty. There can be 1 or 2 surgical stages about 3 to 6 months apart depending on the recovery process.

· If the patient is willing and physically able to undergo a more complex surgery with a longer recovery time than other genital surgery options.

· If the patient is prepared to perform lifetime vaginal dilation.

· If the patient has a desire for vaginal penetration.

 

· Visible scarring along the outer labia.

· Patches of permanent numbness in some areas of the genitals. Clitoral sensation is typically preserved.

· Vagina is not self-lubricating. Although some people do report some internal lubrication, a lubricant is typically required for vaginal penetration.

· Lifetime vaginal dilation is required to maintain vaginal depth and width. Decrease in vaginal depth and opening if dilation instructions are not followed. If loss of depth occurs, it is difficult to increase the size of the vagina even with additional surgery.

 

Risks

· Fistula (an unplanned opening that can cause leakage of stool or urine).

· Granulation tissue (part of a wound that does not heal, usually inside the vagina or around the urethra or clitoris).

· Loss of vaginal depth and width if dilation instructions are not followed.

Surgery Type Involves Why choose this procedure? Risks/Considerations
Vulvoplasty (Zero-depth Vaginoplasty); lasts 3 to 4 hours and is done under general anesthesia. · Removing the phalllus (penis) and testicles, if still present.

· Constructing external genitals, including clitoris, labia, and no vaginal canal.

 

As with full depth vaginoplasty, the goal is to preserve erotic and tactile genital sensation and urinary function, however penetrative sex with the vagina is not possible.

· Surgery is less complex than full-depth vaginoplasty, so risks are lower, and surgical and recovery times are shorter.

· Lifetime vaginal dilation is not required, since there is no vaginal canal.

· Vaginal penetration is not the desired outcome.

 

· Visible scarring along the outer labia.

· Patches of permanent numbness in some areas of the genitals. Clitoral sensation is typically preserved.

 

Surgery Type Involves Why choose this procedure? Risks/Considerations
Orchiectomy; typically lasts 2 hours and is done under general anesthesia. · Removing the testicles.

 

· Reduces the production of testosterone, which may allow patients to discontinue anti-androgen medications and reduce estrogen dose.

· Less complex than vaginoplasty or vulvoplasty, so risks are lower and recovery times are shorter.

· Difficulty maintaining an erection (if desired).

 

 

Surgery Risks

Understanding the benefits, risks, and possible complications will improve surgery outcomes. Risks for all surgeries include:

  • Infection
  • Side effects from anesthesia
  • Opening of the wound along incision lines
  • Abnormal swelling or bleeding

Post-surgery complications can be minimized by:

  • Following all the hospital discharge and aftercare instructions
  • Keeping the surgical area clean and dry
  • Responding to cues from one’s own body
  • Dilating on a regular schedule as advised by your surgeon

Even healthy people who follow all instructions may develop complications. Some complications heal on their own, but others may require multiple surgeries to address. The surgical team will provide appropriate care and follow-up if a complication develops.

Masculinizing Genital Surgery Options

This information is for people thinking about or preparing for masculinizing surgery, as well as caregivers who plan to support someone before and after the surgical process.

Surgery Type Involves Why choose this procedure: Considerations
Metoidioplasty; typically lasts about 4 to 6 hours under general anesthesia ·Creation of a neophallus (penis) from existing tissue through a procedure called suspensory ligament release.

· Vaginectomy, which is the removal or closure of the vagina.

· May include urethral lengthening using labial tissue to extend the urethra to the tip of the neophallus (penis).

· Use of a suprapubic catheter for at least 4 weeks until urethra heals.

· May include scrotoplasty or the creation of a scrotum with the option of testicular implants later.

· Lower rate of complications.

· Shorter recovery time.

· May be converted to a phalloplasty later.

· Can be done in combination with hysterectomy with or without salpingo-oophorectomy.

 

· Standing to urinate may not be possible.

· Generally, not suitable to achieve penetrative intercourse.

 

Surgery Type Involves Why choose this procedure: Considerations
Phalloplasty; performed in two stages. Stage 1 is similar to the procedures in metoidioplasty. Stage 2 phalloplasty is performed at least 6 months later to allow for healing. Stage 2 typically lasts about 8 hours and is done under general anesthesia. · Creation of a neophallus (penis) from a tube of skin from a donor site from the forearm or upper thigh.

· Skin graft usually taken from the thigh to cover the donor site.

· Use of a suprapubic catheter for at least 4 weeks until urethra heals.

· Ability to stand up and urinate.

· Ability for penetrative intercourse.

· Satisfying aesthetics.

· Maintenance of erogenous sensation/sexual function.

 

Surgery Risks

Understanding the benefits, risks, and possible complications will improve surgery outcomes. Risks for all surgeries include:

  • Infection
  • Side effects from anesthesia
  • Opening of the wound along incision lines
  • Abnormal swelling or bleeding
  • Urinary problems like retention or development of a stricture of narrowing of the urethra
  • Fistula, an unplanned opening that can cause leakage of urine

Additional stage 2 phalloplasty risks include:

  • Loss of phallus due to poor blood flow

Post-surgery complications can be minimized by:

  • Following all the hospital discharge instructions provided by your surgeon
  • Keeping the surgical area clean and dry
  • Responding to cues from your body

Even healthy people who follow all instructions may develop complications. Some complications heal on their own, but others may require multiple surgeries to address. The surgical team will provide appropriate care instructions if a complication develops.

Penile/Testicular Implants

Some patients will choose to have penile and/or testicular implants which can be done 6 months after phalloplasty. Reasons people choose this procedure:

  • The ability to have penetrative intercourse
  • Satisfying aesthetics

Hysterectomy with or without salpingo-oophorectomy

Hysterectomy with or without salingo-oophorectomy is the removal of the uterus, fallopian tubes, and ovaries. It typically takes 1 to 2 hours under general anesthesia and can be done non-invasively in some patients. This procedure can be performed at the same time as a metoidioplasty or phalloplasty, or in a separate surgery beforehand.

If ovaries are removed, biological children will not be possible unless eggs or embryos are banked prior to surgery. If a patient is interested in fertility preservation they should discuss with their physician.

How to Prepare for Gender-Affirming Surgery

Each treatment plan is tailored to the patient’s specific needs. Typically, the patient will:

  • Take hormone therapy for at least one year before surgery
  • Meet with a mental health gender therapist
  • Have a nurse case coordinator to guide the patient through the process
  • Have tests to check baseline health and hormone levels to make sure the patient is healthy enough for surgery
  • Work with their primary care physician to manage any chronic conditions so surgery may be performed safely
  • Attend a pre-surgery class
  • Have a consultation appointment with the multidisciplinary team to discuss surgery preparation and recovery
  • Have body hair removed professionally for several months to prepare for surgery
  • Remain in the hospital after surgery
  • Have follow-up appointments to make sure you’re healing well

Kaiser Permanente members may contact their gender therapist for a referral or contact the Transgender Careline at 323-857-3818 for more information.

Transition Pathways Clinic

For adult patients interested in attending a clinic specializing in gender health at KP West Los Angeles, referrals can be made for:

  • Gender-affirming hormone therapy
  • Injection teaching
  • Pap smears for transmasculine and nonbinary patients
  • STI screening and treatment
  • HIV Pre-exposure prophylaxis
  • Preventive care

Kaiser Permanente members may contact their gender therapist for referrals or contact the Transgender Careline at 323-857-3818 for more information.

Resources, FAQs, and Instructions

Click the links below for more information.

General Surgery FAQs and Instructions for Patients and Caregivers (PDF)

Facial Feminization Surgery (VIDEO)

Facial Feminization Surgery FAQs (PDF)

Chest Masculinizing Surgery Risks and Patient Instructions (PDF)

Chest Feminizing Breast Augmentation Surgery (PDF)

Tracheal Shave (Thyroid Cartilage Reduction) Surgery Patient Instructions (PDF)

Gender-Affirming Care and Hormone Therapy

Gender-affirming hormone therapy is offered by our endocrinology specialists and specially trained providers at every medical center. Kaiser Permanente members will need a referral from their gender therapist.

Click the links below for more information.

Frequently Asked Questions: Adult Feminizing Hormone Therapy (PDF)

Frequently Asked Questions: Adult Masculinizing Hormone Therapy (PDF)

Frequently Asked Questions: Adolescent Femininizing Hormone Therapy (PDF)

Frequently Asked Questions: Adolescent Masculinizing Hormone Therapy (PDF)

How to Inject Hormones Intramuscularly (PDF)

How to Inject Testosterone Subcutaneously (PDF)

Gynecologic Services

Our gynecologists are experienced and trained to serve transgender and gender nonbinary members.

Gynecologic Services may include:

  • Routine gynecologic care for transgender men and nonbinary patients.
  • Postoperative care for transgender patients
  • Hysterectomy/Oophorectomy, including minimally invasive surgery for select patients

Please contact a local Kaiser Permanente Medical Center to make an appointment for routine gynecological care. For gender-affirming surgery, please discuss with your gender therapist. For a detailed explanation of benefit coverages, contact Member Services at 800-464-4000.

Fertility Preservation

Gender-affirming hormone therapy with testosterone or estrogen can cause infertility. Surgery to remove the testicles and ovaries will also result in infertility. If a patient is interested in learning more about options for egg and sperm banking, they can ask their endocrinologist or hormone prescriber for a referral to a Fertility Preservation specialist. Kaiser Permanente benefits may cover some of the costs depending on the patient’s plan.

Click the links below for more information.

Transfeminine patients before starting hormone therapy (PDF)

Transfeminine patients already on hormone therapy (PDF)

Transmasculine patients before starting hormone therapy (PDF)

Transmasculine patients already on hormone therapy (PDF)

Mental Health Services (Adult and Youth)

We have specially trained gender therapists, psychologists and psychiatrists with experience and expertise in providing mental health services for gender diverse patients including:

  • Individual therapy
  • Therapy groups for patients, parents, spouses, and allies
  • Assessments for gender-affirming procedures and surgeries

Kaiser Permanente members contact their local Behavioral Health department to schedule an appointment.

Medical Center Contact number
Antelope Valley 661-951-0070
Baldwin Park 626-960-4844
Downey 562-807-6100
Kern County 855-323-2700
Los Angeles 323-783-2600
Orange County 714-644-6480
Panorama City 800-700-8705
Riverside 951-248-4000
San Bernardino County 866-205-3595
San Diego 877-496-0450
South Bay 310-325-6542
West Los Angeles 323-298-3100
Woodland Hills 855-701-7955

Gender Care Youth Services

We provide high-quality, gender-affirming:

  • Sexual and reproductive health care
  • Chest masculinizing mastectomy (top surgery) evaluations and procedures

Multidisciplinary Youth Gender Clinics

  • San Bernardino County Gender Care at KP Fontana at Medical Center.
  • Los Angeles Gender Care at KP Los Angeles Medical Center

Kaiser Permanente members should ask their gender therapist for a referral.

Primary Care

We have family practice, internal medicine, and pediatric physicians with experience and training in providing medical services to transgender and gender nonbinary patients.

To make an appointment, members can call their local Kaiser Permanente Medical Center. For a detailed explanation of services and benefit coverages, contact Member Services at 800-464-4000.

 

Care Management

Our dedicated nurse coordinators help our transgender and gender nonbinary members navigate and optimize the patient care experience. Nurse coordinator support includes:

  • Providing information about Southern California’s Kaiser Permanente Transgender Care Program
  • Coordinating care and assisting members through surgical process

Transgender program care nurse coordinators can be reached through the Patient Contact Line at 323-857-3818. Hours are Monday – Friday 7:30am – 5:00pm. For a detailed explanation of benefit coverage, contact Member Services at 800-464-4000.