When a trans person seeks information to begin their transition, to learn about different treatments or gender-affirming surgeries, the most common resource is the internet. The large number of forums, social networks, websites, blogs, and shared personal experiences can become a great source of support. However, not all information is valid or truthful, and it can encourage false beliefs. These repeated ideas can create confusion, unrealistic expectations, or even fear of taking the step. For this reason, in this article we review some of the most frequent myths about gender-affirming surgeries, explaining what is true and what is not in each of them.

All vaginoplasties are the same

Reality: There are several vaginoplasty techniques, such as penile inversion vaginoplasty, colovaginoplasty, peritoneal vaginoplasty, skin grafts, vulvoplasty, or zero-depth vaginoplasty. The choice of one surgery or another depends on the needs of each trans person, their characteristics, and medical history. The medical team must be familiar with the different techniques in order to offer the trans woman or non-binary person the option that best suits their case.
Generalizing leads to the idea that all experiences are identical, when in reality the choice depends on each person’s characteristics and goals.

Phalloplasty is always better than metoidioplasty (or vice versa)

Reality: There is no universally “better” technique. Phalloplasty allows the creation of a larger phallus, with the option of implanting prosthetics for penetration, but it is a complex surgery. Metoidioplasty, on the other hand, uses the clitoris enlarged by testosterone, offering more discreet results and usually an easier recovery. The choice depends on what each person prioritizes: aesthetics, functionality, number of surgeries, or scarring—as well as the medical team’s advice.

Hormone therapy achieves the same as surgery

Reality: Hormones produce very significant changes: they redistribute body fat, alter the skin, the voice, and body hair. However, they do not replace surgery when the goal is to modify bone structures (such as the forehead or jaw), chest size, genital shape, or breast volume (at least not substantially). Hormone therapy and surgery are complementary processes, but not equivalent. This does not mean all trans people must undergo both. In fact, many choose neither, living their gender identity without feminizing hormones, masculinizing hormones, treatments, or surgery.

Facial feminization surgery completely changes your identity

Reality: Facial feminization surgery does not “transform” someone into a different person. Its goal is to harmonize features and soften traits more commonly associated with typically masculine faces (forehead, jaw, nose, Adam’s apple). Far from erasing identity, it seeks to allow the face to more faithfully reflect the person’s gender identity while respecting their unique features.

Recovery is quick and without complications

Reality: Each surgery has its own recovery time. A vaginoplasty, for example, requires several days of hospitalization and weeks of relative rest, as well as ongoing dilations. Phalloplasty may involve several surgical stages: the phalloplasty itself, the placement of testicular implants, or a penile prosthesis. Facial feminization surgery may require multiple procedures or treatments and swelling can last for weeks. Talking about “quick and perfect” recoveries is unrealistic. The most important thing is to prepare for a gradual process, have realistic expectations, and count on a supportive environment.

Any surgeon can perform gender-affirming surgery

Reality: Gender-affirming surgery is a highly specialized field. Being a plastic surgeon, gynecologist, or urologist is not enough. It requires specific training, continued experience, and a multidisciplinary team. Choosing a center without this specialization can increase risks and compromise results.

Breast augmentation in trans women is the same as in cis women

Reality: While the implant placement technique may seem similar, breast augmentation in trans women differs from that in cis women. This is because the starting anatomy is different: the rib cage is often wider, the distance between the nipple and clavicle greater, and the skin may be firmer. All these factors influence the choice of size, type of implant, and surgical approach. This is why it is essential to see a surgeon with specific experience in trans women, capable of achieving a natural and harmonious result.

All mastectomies are the same and leave the same scars

Reality: There is no single mastectomy technique for trans men. The type of incision depends on chest size and shape, as well as skin elasticity. Some patients benefit from minimal incisions around the areola, while others require horizontal incisions under the pectoral muscle. This means mastectomy scars vary in size and visibility, and should always be explained individually before surgery.

Vaginal depth depends only on the surgeon’s skill

Reality: Surgical skill is very important, but it is not the only factor. Vaginal depth also depends on each person’s anatomy, available tissue, and the technique chosen. For example, the amount of penile skin available can determine the vaginoplasty technique used, as well as the final results. Therefore, knowing all vaginoplasty techniques and when each is appropriate to achieve good vaginal depth is essential.

Vaginal aesthetics depend only on the technique used

Reality: In addition to the technique, vulvar aesthetics after vaginoplasty (that is, the design and construction of the labia minora, clitoris, and clitoral hood) depend on the amount and quality of available tissue, such as urethral or scrotal skin, which are used to create the labia majora and minora. This explains why results differ from person to person, even with the same surgical procedure.

Once you are discharged from the hospital, no further medical follow-up is needed

Reality: Hospital discharge is only the beginning of recovery. After gender-affirming surgery, continuous medical follow-up is necessary, including postoperative check-ups, scar management, functional evaluation, and, in the case of vaginoplasty, monitoring of dilations. Medium- and long-term medical support is key to ensuring good outcomes and addressing complications in time. For this reason, having surgery abroad without guaranteed follow-up care can be counterproductive.

Dilations are not necessary or only for the first few weeks

Vaginal dilations are a cornerstone of vaginoplasty aftercare. They are not limited to the first weeks: they must be maintained continuously for months, and even for life, depending on sexual activity and individual progress. Stopping dilations too soon can cause loss of depth or narrowing of the vaginal canal. This is why medical follow-up is so important after surgery.

These are some of the most common myths about trans surgeries, but there are many others. These false ideas can create unrealistic expectations or fear among people considering gender-affirming surgery. The only way to dismantle them is to seek truthful information from reliable sources and ask every question before making a decision.

Do you have questions about gender-affirming surgery?
At IM GENDER we work to provide clear, truthful, and evidence-based information, supporting each person in their process with professionalism, sensitivity, and responsibility.