Gender Health Services and Transgender Care

Gender Health Services and Transgender Care

Services & Education

Kaiser Permanente is a nationally recognized leader in LGBTQ+ health care equality, providing a wide range of services including mental health, hormone treatment, and surgical procedures to help transgender and nonbinary individuals achieve their gender-affirming goals.

 

View the You are Not Alone video about our members’ experiences with facial feminization.

 

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 323-857-3818 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 goals for starting a family

Feminizing Genital Surgery Options

This information is for people thinking about or preparing for feminizing genital surgery, as well as caregivers who plan to support someone before and after the surgical process. The surgery types below will not result in:

  • An internal reproductive anatomy, including a uterus, ovaries, or fallopian tubes
  • Menstruation, pregnancy, and childbirth
  • Removal of the prostate, so patients will need future prostate evaluations
Surgery Type
Full-Depth Vaginoplasty; performed under general anesthesia
Involves Why choose this procedure
· 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.

 

Surgery Type
Vulvoplasty (Zero-depth Vaginoplasty); performed under general anesthesia.
Involves Why choose this procedure
· 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.

 

Surgery Type
Orchiectomy; performed under general anesthesia.
Involves Why choose this procedure
· 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.

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. During the patient’s consultation, the surgical team will discuss additional risks associated with each procedure type and appropriate care and follow-up if a complication develops.

Masculinizing Genital Surgery Options

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

Surgery Type
Metoidioplasty; performed under general anesthesia
Involves Why choose this procedure
·Creation of a neophallus (penis) from existing tissue through a procedure called suspensory ligament release.

· Vaginectomy, which is the 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 (tube to drain urine) for at least 4-6 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 (removal of fallopian tubes and ovaries).

 

Surgery Type
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 is performed under general anesthesia
Involves Why choose this procedure
· 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 (tube to drain urine) for at least 4-6 weeks until urethra heals.

· Ability to stand up and urinate.

· Satisfying aesthetics.

· Maintenance of erogenous sensation/sexual function.

· Ability to receive penile implant later for penetrative intercourse.

 

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. During the patient’s consultation, the surgical team will discuss additional risks associated with each procedure type and 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 at least 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.

Gender-Affirming Facial Surgery Overview

This information is for people thinking about or preparing for facial feminization or masculinizing surgery. People seek gender-affirming facial surgery to:

  • Increase physical and emotional comfort.
  • Reduce distress related to their body (or other symptoms, such as social anxiety).
  • Feel more at ease and safer in public spaces.

Facial Feminization Surgery (FFS)

FFS is a series of procedures that modifies the craniofacial features to create a more feminine appearance. The surgeon will discuss and customize an FFS surgical plan based on the patient’s goals and physical exam findings. FFS procedures may involve:

  • Forehead contouring (frontal sinus setback)
  • Eyebrow elevation (brow lift)
  • Hairline lowering (scalp advancement)
  • Jawline contouring (mandibuloplasty)
  • Chin contouring (genioplasty)
  • Nose reshaping (rhinoplasty)
  • Tracheal shave (chondrolarynoplasty)

Click the links below for more information:

Facial Masculinization Surgery (FMS)

FMS is a series of procedures that modifies the craniofacial features to create a more masculine appearance. The surgeon will discuss and customize an FMS surgical plan based on the patient’s goals and physical exam findings. FMS procedures may involve:

  • Forehead contouring
  • Jawline contouring (mandibuloplasty)
  • Chin contouring (genioplasty)
  • Nose reshaping (rhinoplasty)

Click the link below for more information:

Facial Surgery Risks

Any surgery involves risks. Facial surgery has specific risks that are important to consider including:

  • Bleeding
  • Infection
  • Blood clots (hematoma)
  • Fluid collection (seroma)
  • Delayed wound healing
  • Scarring
  • Hair loss
  • Difficulty breathing through your nose
  • Loss of sensation in specific areas
  • Weakness of facial muscles
  • Future sinus infections or complications
  • Hardware infections or complications
  • Dental loss, infections, or complications
  • Possible need for surgical revisions

Even people who are in the best physical and mental health going into surgery and follow all instructions can unfortunately have complications. If you develop a postoperative complication or have any concerns about your healing, your surgical team will provide aftercare and follow-up.

How to Prepare for Gender-Affirming Surgery

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

  • 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 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, if recommended
  • Remain in the hospital after surgery, if needed
  • 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.

Click the links below for more information.

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.

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.

Click the links below for more information.

Gynecologic Services

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

Gynecologic Services may include:

  • Routine gynecologic care for transgender men and nonbinary patients.
  • Postoperative care for transgender women and nonbinary patients
  • Hysterectomy/Salpingo-ophorectomy (removal of uterus/fallopian tubes, ovaries), 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.

For more details on coverage and fertility care locations, visit kp.org/scal/fertilitycare.

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 care:

  • Sexual and reproductive health care
  • Hair removal
  • Voice therapy
  • 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 nonbinary patients.

To make an appointment, members can call their local Kaiser Permanente Medical Center. To meet our LGBTQ+ physician allies, click here.

 

Care Management

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

  • Providing information about Southern California’s Kaiser Permanente Gender Health program
  • Coordinating care and assisting members through gender-affirming medical and 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.