The surgical pathway is not the same for all people and can vary based on the requests of each person.
Some (but not all) transgender people start a gender affirming path that proceeds in stages and may involve hormonal and/or surgical treatment. This is not a mandatory path and the process is not the same for all people but should be adapted according to the requests of each person.
There are recommendations (Standards of Care) proposed by the World Professional Association of Transgender Health (WPATH) and international guidelines to which health providers refer for surgical treatment. The person who intends to undergo medical gender affirming procedures must therefore contact specialized centers. Infotrans.it offers a list of structures, present on the national territory, able to provide this type of services in the section "Map of services".
It is important, before undergoing a gender affirming surgical procedure, that the person is aware that this step is not mandatory and that may not be a surgery able of fully obtaining the desired sexual characteristics. Indeed, gender affirming surgeries may involve the removal of the genital organs present (uterus and ovaries; testicles and penis), but do not allow the creation of genital organs of the experienced gender (for example the creation of a uterus in an assigned male at birth person). Surgical interventions can be reversible or irreversible. Those, for example, that prevent a person from reproducing are irreversible.
It is also important that the person is aware of what the realistic outcomes of surgery will be: in fact, while plastic surgery of the external genitalia in gender affirming surgery in male assigned people at birth is nowadays able to obtain adequate results, the outcomes can be disappointing in the in female assigned at birth people. The reconstructive methods of the neophallus are complex, are often burdened by complications, may require repeated interventions and may be unsatisfactory both from an aesthetic and functional point of view. The surgical team therefore has the task of describing to the user all the aspects related to the surgeries and its possibilities of realization, so that the person has realistic expectations and consequently obtains a good degree of satisfaction with the achieved results.
Within the website you will find a description of the main surgeries related to the gender affirmation surgical pathway.
It has to be underlined that what was written by the authors was agreed with the researchers of the Italian National Institute of Health and in any case represents a simplification of what is necessary for the surgical procedure of gender affirmation pathway and it has only the purpose of dissemination. The details of the pathway are fully explained to the patient by the health care professionals in the context of the first visit and at the time of acquiring informed consent for any surgery.
Coleman E, Bockting W, Botzer M, et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgend. 2012; 13(4): 165-232.
Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. Erratum in: J Clin Endocrinol Metab. 2018; 103(2): 699. J Clin Endocrinol Metab. 2018; 103(7): 2758-2759.