The comprehensive services offered through the Center for Transgender and Gender Diverse Health include connecting transgender patients with primary care providers across Johns Hopkins Medicine who are trans affirming. These providers can manage a patient’s general health care needs as well as specific transgender-health-related needs such as initiating and managing hormone therapy in most cases. Our primary care team members are vital partners in providing holistic care that leverages the resources of our academic medical health care system.
Services and Appointments for Adults
The Johns Hopkins Center for Transgender and Gender Expansive Health offers comprehensive, evidence-based and affirming care for transgender and gender diverse youth and adults that is in line with the standards of care set by the World Professional Association for Transgender Health (WPATH).
Creating an environment in which our patients and their families feel safe and confident in the care they receive is central to the mission of Johns Hopkins Medicine. The multidisciplinary care team takes careful consideration of best practices and the appropriate provision of care for transgender and nonbinary individuals.
Services for Adults
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Dermatologists at the Center for Transgender and Gender Expansive Health perform laser hair removal for both aesthetic reasons and as preparation for some surgeries.
During laser hair removal, a dermatologist uses a low-energy beam laser, which results in long-term or permanent hair reduction and removal. Usually, a series of laser hair removal appointments are recommended for best results. Discuss an individualized plan with your dermatologist.
Patient Resources
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In cases where hormone therapy is not enough to achieve desired gender affirming changes to the face, surgery can help. Feminizing facial surgery includes a variety of procedures, such as reshaping the nose; brow lift (or forehead lift); chin, cheek and jaw reshaping; Adam’s apple reduction; lip augmentation; hairline restoration; and earlobe reduction. Masculinizing facial surgical options including hairline reshaping, jaw augmentation, and thyroid cartilage enhancement are also available. Watch to learn more. See eligibility requirements. See surgical timeline.
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Our specialists at the Fertility Center coordinate with the Center for Transgender and Gender Expansive Health to provide services for gender affirming fertility preservation, reproduction assistance and contraception. It is recommended that you consider speaking to a specialist before undergoing hormone treatment to review how gender-affirming hormone therapy may affect your fertility options.
Patient Resources
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Our specialists in Geriatric Care coordinate with the Center for Transgender and Gender Expansive Health to provide the highest quality clinical care to improve the health of older adults and society.
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Gyn/Ob specialists provide preventive, gender- affirming gynecologic care throughout your life. This may include routine annual exams/cervical screening for transgender and gender diverse individuals, sexuality and sexual health care, the management of benign gynecologic disorders, transitioning and gender affirmation including menstrual suppression, trauma informed pap smears, local anesthetics for IUD placement and counseling when appropriate. The department also specializes in shared decision making for family planning, care during pregnancy, childbirth and the postpartum period for transgender and gender diverse individuals.
Patient Resources
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The Center for Transgender and Gender Expansive Health partners with endocrinologists and primary care providers. Both endocrinologists and primary care providers work with each patient to prescribe either gender-affirming hormone treatments. Hormone treatments can be part of a pre-surgical plan, or be a stand-alone service, depending on your desired outcomes. Talk to your doctor about the process and any side effects that you can expect.
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Hysterectomy includes the removal of the uterus and ovaries (oophorectomy). Many gender patients are seeking gender affirming hysterectomy as part of their gender journey. Other patients have preexisting conditions such as fibroids, or endometriosis.
Options for oocyte storage and fertility preservation are also available if desired. See eligibility requirements. See surgical timeline
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The Department of Psychiatry and Behavioral Sciences partners with the Center for Transgender and Gender Expansive Health (CTH) to provide mental health services through the expertise of the Sex and Gender Clinic. Assessments for surgical readiness are available. These involve the completion of a comprehensive mental health evaluation, following WPATH guidelines. Other services include recommendations for ongoing care such as support and guidance preoperatively and postoperatively as well as treatment for co-existing mental health conditions. Support and education for families and significant others are further aspects of the team’s services. The aim of the collaboration between CTH and Psychiatry is to maximize the health, well-being and quality of life of transgender and gender diverse individuals.
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Metoidioplasty is a surgical procedure for gender affirmation that is sometimes called a meta procedure or bottom surgery. It is an alternative to phalloplasty.
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Our pelvic health physical therapists are specially trained to evaluate and treat different types of pelvic floor dysfunction and treat a variety of pelvic floor symptoms after performing a complete assessment to best suit your needs. They can also assist with pre and post-operative exercises for genital surgery, and assist with dilation teaching.
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Phalloplasty can include removal of the vagina (vaginoplasty), reconstruction of the urethra, scrotoplasty, penile and testicular implants, and penile construction. Surgeons will use tissue from another part of the body to construct the penis. See eligibility requirements. See surgical timeline.
Patient Resources
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Top surgery is surgery that removes or augments breast tissue and reshapes the chest to create a more masculine or feminine appearance for transgender and nonbinary people. See eligibility requirements. See surgical timeline.
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At the Center for Transgender and Gender Expansive Health, you will receive care from doctors in the Johns Hopkins Department of Urology who have experience in the range of gender-affirming surgeries.
The urology team works closely with the Department of Plastic and Reconstructive Surgery and other members of our integrated team to provide the most up-to-date gender affirmation procedures and ongoing care. Services provided include robot assisted vaginoplasty, orchiectomy, and insertion of penile prostheses. Follow-up visits with urology are available for prostate screening or urological issues. See eligibility requirements. See surgical timeline.
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This surgical procedure is a single stage procedure during which our skilled surgeons may remove the penis (penectomy) and the testes (orchiectomy), if still present, and use tissues from the penis to construct the vagina (vaginoplasty), the clitoris (clitoroplasty) and the labia (labiaplasty). See eligibility requirements. See surgical timeline.
Patient Resources
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The Center for Transgender and Gender Expansive Health works with otolaryngologists who specialize in voice therapy, which some transgender individuals find beneficial. Intervention is designed to meet the individual needs of the person who is transitioning and may include diagnostic evaluation, treatment or surgical intervention. Our team works together to assist in the voice transition. Specifically, we provide a supportive and guided environment to maximize total communication, including aspects of voice such as conversational pitch and inflection, as well as nonverbal communication.
The initial evaluation will include a case history and assessment of voice and speech prosody. All clients are initially screened for any laryngeal pathology to ensure optimal vocal fold health. An individualized treatment plan is created with the client based on the assessment findings and the client’s perceived needs. Some aspects the voice pathologist may choose to address include:
- Habitual speaking pitch
- Resonance
- Inflection (the melodic ups and downs of the voice)
- Rate of speech (how fast or slow the person speaks)
- Non-verbal communication
- Volume/intensity
- Articulation
- Prosody
- Pragmatics (social rules of communication)
Sometimes, voice therapy alone is not enough to achieve your desired outcome. In cases like this, vocal cord surgery is an option and is usually done as an outpatient procedure. Talk to your doctor about surgical options to achieve the vocal identity that is right for you.
Insurance coverage for voice therapy often differs among providers. It is important for the patient to be familiar with their specific contract coverage for this service.
Center Collaborators
You are being redirected to websites outside of Johns Hopkins for informational purposes only. Johns Hopkins is not responsible for any aspect of the external websites.
- Chase Brexton
- Whitman Walker
- Johns Hopkins Community Physicians
- East Baltimore Medical Campus
- Johns Hopkins University Student Clinics
Eligibility Criteria
Our team is committed to providing high-quality, compassionate care that is in line with the standards of care outlined by the World Professional Association for Transgender Health (WPATH), including mental health criteria for surgical services.
Gender affirming surgery is only offered to patients aged 18+.
| Consult Requested | Documents Needed for Consult | Next Steps | Needed to Schedule Surgery |
|---|---|---|---|
| Chest Masculinzation | One Mental Health letter Possible insurance requirement: Referral from PCP |
Schedule a consult appointment with Dr. Liang or Dr. Mundy through JHCTH |
Medical records, pre-operative physical, pre-operative lab work No BMI Limit Potential Insurance Requirements: 2nd MH letter and/or MH letter from a doctoral level MH provider |
| Breast Augmentation |
One Mental Health letter and twelve month HRT (estrogen) record. Possible insurance requirement: Referral from PCP |
Schedule a consult appointment with Dr. Liang or Dr. Mundy through JHCTH |
Medical records, pre-operative physical, pre-operative lab work No BMI Limit Potential Insurance Requirements: 2ndMH letter and/or MH letter from a doctoral level MH provider |
| Facial Feminization (FFS) |
One Mental Health letter and a head CT scan. Possible insurance requirement: Referral from PCP |
Schedule a consult appointment with Dr. Liang through JHCTH |
Medical records, pre-operative physical, pre-operative lab work No BMI Limit Potential Insurance Requirements: 2nd MH letter and/or MH letter from a doctoral level MH provider |
| Hysterectomy, Ovariectomy, Salpingectomy | No Mental Health letter or HRT records required to schedule a consult | Schedule an appointment with Dr. Martin |
Medical records, pre-operative physical, pre-operative lab work If surgery is being done for primarily gender affirming reasons: Two Mental Health letters- one from a doctoral level MH provider- and HRT records (if indicated for patient). |
| Metoidioplasty | One Mental Health letter. Possible insurance requirement: Referral from PCP |
Schedule a consult appointment with Dr. Cohen through JHCTH |
Medical records, pre-operative physical, pre-operative lab work, possibly previous hysterectomy BMI <= 30 Potential Insurance Requirements: 2nd Mental Health letter and/or MH letter from a doctoral level MH provider |
| Orchiectomy |
Two mental health letters (one from a doctoral level MH provider) and twelve month HRT record. Possible insurance requirement: Referral from PCP |
Schedule an appointment with Dr. Cohen | Medical records, pre-operative physical, pre-operative lab work |
| Phalloplasty |
One Mental Health letter. Possible insurance requirement: Referral from PCP |
Begin hair removal Schedule a consult appointment with Dr. Liang through JHCTH |
Medical records, pre-operative physical, pre-operative lab work BMI <= 30 Potential Insurance Requirements: 2nd MH letter and/or MH letter from a doctoral level MH provider |
| Vaginoplasty |
One Mental Health letter. Possible insurance requirement: Referral from PCP |
Begin hair removal Schedule a consult appointment with Dr. Liang through JHCTH |
Medical records, pre-operative physical, pre-operative lab work BMI <= 35 Potential Insurance Requirements: 2nd MH letter and/or MH letter from a doctoral level MH provider |
Surgical Services Timeline
Intake
It all starts with a phone call.
First, call 844-546-5645 for an initial intake interview via phone with a clinical specialist. This is your first point of contact with the clinical team, where you will review your medical history, discuss which procedures you’d like to learn more about and what is required, and develop a plan for next steps.
After intake, you'll receive next steps to schedule a consult appointment. Depending on your specific surgery, you'll likely need to prepare the following documentation:
- Mental Health Evaluations and Surgical Readiness referral letters from mental health providers documenting their assessment and evaluation
- Pharmacy records and medical records documenting your hormone therapy
- Medical records from your primary physician (these will be requested by the clinical team)
- Information about which prescription and over-the-counter medications you are currently taking
- Insurance information
Consult
Meeting with your surgeon.
The consult will be your first appointment with your new healthcare provider. These appointments typically include:
- Assessment of your medical health status and readiness for major surgical procedures;
- Discussion of your long-term gender affirmation goals and assessment of which procedures may be most appropriate to help you in your journey;
- Specific details about the procedures you and your surgeon identify, including the risks, benefits and what to expect after surgery.
After the consult, you'll receive next steps for scheduling the surgery.
Next Steps
Getting ready for surgery.
After your consult with the surgical team, you will receive information regarding next steps. Next steps can include a variety of things, to include:
- Medical Clearance tests and/or notes from other providers
- Additional imaging
- Updated mental health evaluation letters
- Hair removal, or other pre-operative readiness
Once all these things have been completed, you will receive a surgery date.
Preoperative Appointment
A preoperative anesthesia and medical evaluation.
Your surgeon may need to meet with you before surgery to finalize your surgical plan and go over any questions you may have before the morning of your procedure. You may also be asked to complete these evaluations at the hospital, which ensure that you are healthy enough for surgery.
Surgery
Your surgery.
On the day of your procedure, you'll arrive at the hospital two hours prior to surgery. You will be brought back to the pre-op area where you'll change into a surgical gown and nursing staff will begin your check in. This involves asking questions, taking blood samples, starting an IV for fluids, and monitoring your vital signs with a blood pressure cuff and oxygen monitor.
In addition to the nurse that checks you in, you will see your surgeon, our PA, anesthesiologists, and possibly other surgical attending’s and surgical residents who assist in the operating room. Together everyone works as a team to ensure the best possible outcome.
Read FAQs for more information about what you can expect during your hospital experience at either the Levi Watkins, Jr., M.D., Outpatient Center or the Harry and Jeanette Weinberg Building.
Post-Operative Care
What can you expect after gender affirming surgery?
For specific questions, please refer to the post-operative instructions you received from your surgical team.
If you have any of the following signs and symptoms, please call us: temperature greater than 101.5˚F; redness or rapidly changing shape of the surgical area; pus and/or large quantities of drainage from your incision or drain site; continuing inability to urinate; severe and unremitting pain not relieved by maximum doses of pain medications.
If you have any questions or concerns during regular business hours between 8:00 am and 5:00 pm, please call 844-546-5645 to reach the Center for Transgender and Gender Expansive Health. If you have questions or concerns after regular business hours, please call 410-955-5000 and ask for the “Plastic Surgery Resident On Call” to be paged. A doctor is available and present in the hospital 24/7/365 in case of emergencies.
For life-threatening symptoms such as shortness or breath, difficulty breathing, dizziness or fainting, chest pain, or mental status changes, call 9-1-1 or go to your nearest emergency department immediately.
Long-Term Follow-Up
We're here for you.
When you’ve finished the surgical aspects of your gender affirmation, we encourage you to follow up with your primary care physician to make sure that they have the latest information about your health. Your doctor can create a custom plan for long-term care that best fits your needs.
Among other changes, you may consider updating your name and identification. This collection of resources for transgender and gender-nonconforming individuals can help you in this process.
