How Does Gender-Affirming Surgery Impact Someone’s Urologic Health?

Gender-affirming surgery is very complex and the procedures one person may need to reach their preferred result can be very different from what someone else may need. This is why a personalized approach is so vital. Aside from the many things a person may go through during this process, people undergoing gender-affirming surgery may also face a range of urologic issues.

Male to Female

Before surgery, people most often take hormonal therapy. For transgender women, the feminizing hormone therapy may be the pill spironolactone (Aldactone), which has the effect of increasing urination.
Women undergoing feminizing surgery may choose to start their surgical transition with removal of the testicles (orchiectomy).

She may have a surgery called a vaginoplasty (creation of the vagina). A vaginoplasty may cause such urologic conditions as an overactive bladder, stress urinary incontinence or a urethral stricture.

Female to Male

Transgender men may choose surgery to remove their uterus and vagina. There are also two procedures performed to allow transgender men to stand to urinate. They are called a Metoidioplasty and a Phalloplasty.
After these surgeries, possible urologic issues may include urethral stricture, leading to a problem with emptying the bladder, and urethral fistula, which is an abnormal communication between the urethra and the skin.

Other issues that could happen include recurrent urinary tract infections, overactive bladder and urine left over in the urethra that slowly leaks out after completion of urination.

While gender-affirming surgery may result in urologic issues, all of these conditions can be successfully treated after a proper discussion with your doctor.

Lee Zhao, MD, practices urology at NYU Langone Health System in New York. He is also Co-Director, Transgender Reconstructive Surgery Program at NYU.