Like many vocabulary words, medical terminologies go through an evolution. When there was a time the process of shifting to another gender was conveniently referred to as ‘sex change,’ which eventually led to ‘gender reassignment surgery,’ today’s more accurate term is ‘gender affirmation surgery’ (GAS) because it’s precisely that—a set of surgeries done to affirm one’s gender.

This is according to Filipino surgeon Dr. Alvin Jorge who, together with his wife Dra. Guia Favor-Jorge, a dermatologist, runs Cosmedics Dermaster Aesthetic Center at Dusit D2 Residences in Taguig.

Among the procedures done under GAS are facial reconstructive surgery, chest or top surgery, and genital or bottom surgery. In gender affirming vaginoplasty for a trans woman, the penis and testes (or testicles) are removed and the remaining tissues are reconstructed to become a female external genitalia with vaginal canal. With top surgery for a trans man, a double mastectomy (removal of breasts) is done and the chest is made to look like that of a male. Breast augmentation could also be done with a trans woman.

Even now there are not too many surgeons around the world performing the transmasculine bottom procedure (reconstructing the female genitalia to become a male genitalia). Jorge says it’s because the surgery is more complicated to accomplish and the genitalia doesn’t turn out to be fully functional after the procedure. There are also possible complications that may arise from the operation, he adds.

Meanwhile, to achieve either a feminine or masculine appearance, patients can undergo a facial masculinization or facial feminization surgery.

Benefits and risks

GAS is one way for transgenders to deal with gender dysphoria, says Jorge who is trained in general surgery, cosmetic surgery, and GAS. Gender dysphoria is a term used to describe a patient’s sense of discomfort or distress because his or her biological sex and gender identity don’t match.

“There are patients who feel extremely bothered seeing [their genitalia], such that they would like to get rid of it,” he says. The predicament could lead to psychological problems like stress, anxiety, or depression that could impact their lives.

Going thru GAS is also a way for transgenders to live their lives the way they want without being stigmatized. “There are still cases when [a trans woman] is not allowed or is shy to use the female restroom. Somehow this surgery affirms that she is a real woman and therefore she should not feel embarrassed and should be allowed to use the female restroom.” For some, undergoing GAS helps to make them feel complete as a man or woman.

As a general rule, Jorge requires his patients to have themselves evaluated by two board certified psychiatrists if they would like to undergo a GAS. “I ask my patients to get clearance from a psychiatrist to make sure that they are in their right frame of mind. Because once I have done the procedure, it’s irreversible. I cannot put back what I have removed,” he explains simply.

Are there reasons he deems invalid for getting a GAS? “I actually ask my patients, baka naman ang partner mo lang ang may gusto? Pag sinabing oo, that’s a no-no for me,” he says.

Aside from psychological preparedness, a patient has to be physically healthy to undergo the procedure. Jorge requires his patients to undergo a set of laboratory and diagnostic tests, apart from seeking clearance from a cardiologist to make sure he or she is fit to go thru a surgery. Jorge also has to be aware of any medical conditions the patient may have so that these are managed and addressed beforehand.

A GAS procedure takes about 6 to 8 hours, excluding preparation. Recovery period is between three to six months. “Before this period, I prohibit the patient from doing sexual intercourse para maalagaan ang sugat,” he says.

GAS surgeries are done in many parts of the world. Filipinos mostly go to Thailand to have it performed. Across the world, cost of procedure can go as low as P150,000 to as high as P700,000, says Jorge.

The only one

As far as he knows, Jorge says he is the only surgeon in the country who does gender affirming vaginoplasty. Which is likely why not many Filipinos know about it.

He is first and foremost a board-certified general surgeon. He got exposed to GAS thru his uncle Dr. Jaime S. Jorge, who started this type of surgery in the country. Doc Jaime was quite popular in the transgender community during his time. He passed away in 2012.

Doc Alvin underwent further training in cosmetic surgery and gender affirmation surgery in Phuket, Thailand. “I had since been able to improve on the techniques that we were performing back then,” he offers. “Before, we would only create a vaginal canal. But now, we’re able to create the labia majora, labia manora, and clitoris. The appearance is a lot closer now to the external female genitalia. This is a very big advancement.”

The genitalia also functions as it should, says Jorge. “In fact, it’s sometimes even more sensitive than the real female genitalia, so my patients are quite happy with the result of their surgeries.”

The advantage for Filipino transgenders to have the procedure done in the country, says Jorge, is that follow-up checkups are much easier. “With gender affirmation vaginoplasty, the doctor has to watch the healing process. It’s not like other cosmetic surgery procedures na after tanggalin ang stitches, okey na. This is quite different,” he says.

Compared to countries like Thailand, the Philippines is still in its infancy stage when it comes to transgender health. But Jorge says “we are making the right moves.”

He is seeing real acceptance of transgender relationships, and seeing real loving relationships between partners. He is also seeing Filipino-to-Filipino transgender relationships. “A lot of transwomen in the country have foreign partners. But now, some of them have Filipino partners,” Jorge notes. There is still a prevailing stigma when it comes to the transgender community but Jorge is happy to see “the walls are coming down.” He says: “Hopefully, [the Filipino transgenders] just continue to be themselves. I would like them know that I’m here to support them.”