Dr. Steve Merten

Whether hormone therapy is required prior to gender affirmation surgery is a commonly discussed consideration for patients exploring surgical options in Sydney. One of the questions often asked is whether surgery is accessible without prior hormonal treatment. The answer depends on individual factors, including the specific procedure being considered, the patient’s medical history, and the clinical pathway involved. This article outlines the key considerations and what may be discussed at consultation.

What Is Gender Affirmation Surgery?

Gender affirmation surgery is a collective term for surgical procedures that address the alignment of a patient’s physical anatomy with their gender identity. Procedures within this category include facial feminisation surgery (FFS), top surgery, breast augmentation, and other body and genital procedures. Each procedure has distinct clinical considerations, and the relevance of hormone therapy varies between them.

How Hormone Therapy Influences Surgical Planning

Facial Feminisation Surgery (FFS)

Facial feminisation surgery addresses structural features of the face, including the forehead, brow, nose, jaw, and chin. These are skeletal and soft tissue procedures. As FFS addresses anatomical structure rather than hormonal effects, the relevance of prior hormone therapy to surgical planning is assessed on a case-by-case basis. The clinical assessment focuses on the patient’s facial anatomy, medical history, and the procedures under consideration.

Top Surgery

Top surgery refers to chest procedures performed as part of either a transmasculine (FTM) or transfeminine (MTF) gender affirmation pathway. This may include chest masculinisation procedures or breast augmentation procedures, depending on the individual’s goals and clinical considerations.

Whether hormone therapy is relevant prior to surgery varies between individuals. Factors such as the patient’s anatomy, gender expression, medical history, and the procedures under consideration are assessed during consultation. Some patients, including some non-binary individuals, may not have undergone hormone therapy prior to surgical assessment.

Other Gender-Affirming Procedures

For other gender-affirming procedures, the assessment process takes into account any prior hormonal treatment where relevant, alongside the anatomical and clinical factors applicable to each individual. The extent to which hormone therapy influences the surgical plan varies between individuals and procedures.

What Is Assessed at Consultation

A gender affirmation surgical consultation at Pure Aesthetics includes evaluation of the following:

  • The specific procedures under consideration and the clinical indications relevant to the individual
  • Medical history, including any current or prior hormone therapy
  • Anatomical assessment relevant to the planned procedure
  • Engagement with a multidisciplinary team where clinically relevant
  • Timing considerations and any documentation relevant to the clinical pathway

No surgical recommendation is made without a thorough clinical assessment. Suitability is determined on a case-by-case basis.

The Multidisciplinary Care Pathway

Australian clinical guidance generally supports a multidisciplinary approach for patients accessing gender-affirming surgical care. This may involve a general practitioner, endocrinologist, and mental health clinician, depending on the procedures being considered and the patient’s circumstances. A surgical consultation is one component of this pathway and does not replace other elements of clinical care where relevant.

Patients who have already engaged with multidisciplinary support are encouraged to bring relevant documentation to their surgical consultation. Patients who are at an early stage of their clinical pathway are assessed on the basis of the information available at the time of consultation.

Timing Considerations

Timing of gender affirmation surgery in Sydney is assessed at consultation. For patients under 18, additional legal and clinical considerations apply under the relevant Australian framework. For adult patients, the timing of surgery is determined through clinical assessment and is discussed as part of the consultation process.

Risks and Considerations

All surgical procedures carry risks. The specific risks relevant to each gender-affirming procedure are discussed at consultation and depend on the individual’s anatomy, medical history, and the planned surgical approach. Outcomes vary between individuals and are not guaranteed.

What to Discuss at Consultation

  • Which specific procedures are being considered, and what is the clinical basis for assessing suitability?
  • Is prior hormone therapy a factor in the assessment for the planned procedure?
  • What multidisciplinary engagement, if any, is relevant to the planned pathway?
  • What are the risks specific to the procedures under consideration?
  • What does the post-operative recovery involve?

Further Reading

 

Written by Dr Steve Merten – Specialist Plastic Surgeon, Pure Aesthetics, Sydney NSW. FRACS (Plastic and Reconstructive Surgery). All content is reviewed for accuracy and AHPRA compliance. Last reviewed: March 2026.