Phalloplasty is a type of surgery that takes existing skin, tissue, and nerves from surrounding areas on a patient’s body to repair or form a neophallus, or a new penis structure. In 1946, Harold Gillies, a plastic surgeon who practiced in England, performed one of the first modern phalloplasties that entailed creating an entire neophallus for a transsexual, called transgender as of 2022, man in London, England. The reconstructive need for phalloplasties started as a result of treating blast wounds during World War I and World War II. The techniques from that time allowed Gillies to perform a phalloplasty with urethral lengthening. Lengthening the urethra allows the patient to use the neophallus to urinate, for a transgender person as a means of affirming their gender identity. Phalloplasty procedures improve the quality of life for people who have congenital conditions, physical trauma, or are seeking gender affirmation surgery.

In the United States, most people are assigned both a biological sex and gender at birth based on their chromosomes and reproductive organs. However, there is an important distinction between biological sex and gender. Biological sex, such as male or female, commonly refers to physical characteristics. Gender refers to the socially constructed roles, behaviors, and actions people take on, usually in relation to expectations of masculinity or femininity. As of 2022, there is disagreement over the relation between sex and gender. People’s biological sex and gender greatly influence the way they understand themselves, as well as how others treat them and how they interact with society. Moreover, some people’s gender differs from what they were assigned at birth, and they face discrimination, harassment, and violence. Evolving understandings of gender and sex in the US have created more ways for people to live and express their gender identities.

Harold Delf Gillies performed one of the first sexual reassignment surgeries, termed gender affirmation surgeries as of 2022, on record in 1946 in London, England. He also practiced modern plastic surgery and helped distinguish it as a new branch of medicine in London, England, starting in the early 1900s. Gillies’s work focused initially on facial reconstructive surgery, particularly during both World War I and World War II. Gillies created newer and more efficient techniques that later became standard procedures for reconstructive and cosmetic surgeries. Gillies, along with two members in his practice, standardized over 11,000 techniques, and beginning in 1946, he performed one of the first successful phalloplasties on a transgender man, where he formed a new penis from the patient’s existing skin and tissue.

Gender-affirming mastectomy is a type of surgery that removes breast tissue, tightens the skin, and can adjust nipple placement to provide the desired results of a more masculine-looking chest. Mastectomies started as a way for surgeons to remove breast cancer and tumors from the breast tissue. However, as of 2022, surgeons also use the procedure as a means of gender-affirming surgery for transgender and non-binary, hereafter TNB, individuals. If a person identifies as transgender, their gender identity differs from the sex they were assigned at birth and the gender they were most likely raised as, which can produce gender dysphoria, a condition that can last a lifetime. Non-binary individuals may have a similar experience, but they identify outside of or between the identifiers of man and woman. Gender-affirming mastectomy, sometimes called top surgery, improves the quality of life for people who seek the appearance of a masculine chest to both better integrate themselves into society and lessen the mental and emotional burden of gender dysphoria.

In the mid-1960s, psychologist John Money encouraged the gender reassignment of David Reimer, who was born a biological male but suffered irreparable damage to his penis as an infant. Born in 1965 as Bruce Reimer, his penis was irreparably damaged during infancy due to a failed circumcision. After encouragement from Money, Reimer’s parents decided to raise Reimer as a girl. Reimer underwent surgery as an infant to construct rudimentary female genitals, and was given female hormones during puberty. During childhood, Reimer was never told he was biologically male and regularly visited Money, who tracked the progress of his gender reassignment. Reimer unknowingly acted as an experimental subject in Money’s controversial investigation, which he called the John/Joan case. The case provided results that were used to justify thousands of sex reassignment surgeries for cases of children with reproductive abnormalities. Despite his upbringing, Reimer rejected the female identity as a young teenager and began living as a male. He suffered severe depression throughout his life, which culminated in his suicide at thirty-eight years old. Reimer, and his public statements about the trauma of his transition, brought attention to gender identity and called into question the sex reassignment of infants and children.

Metoidioplasty is a type of gender-affirming surgery that creates a small-sized neophallus, or new penis, from an enlarged clitoris. Gender-affirmation surgeries are procedures that alter a person’s body, typically sexual characteristics like the genitals, to align a person’s sex with their gender identity so that they can move through society more comfortably. Such procedures treat gender dysphoria, which is the distress or discomfort that may be felt by transgender people. Transgender people’s gender identities differ from the genders they were assigned at birth, usually conflated with the sex they were assigned at birth. As opposed to a phalloplasty, a procedure where a neophallus is created using tissue from other areas of the body and not just the existing genital tissues, metoidioplasty allows transgender individuals to have a penis with less noticeable scarring, preservation of erogenous sensation, and, if the patient desires, the ability to urinate while standing. The technique was first suggested in 1973, then performed in 1974, however, doctors and researchers did not refer to it as metoidioplasty until 1989. Since its implementation, several modifications have ensured lower risks and better results for patients. Metoidioplasty improves the quality of life for people seeking gender-affirmation surgery by treating gender dysphoria.

Christine Jorgensen was a transgender woman and activist in the United States who lived during the twentieth century. She was one of the first US citizens to publicly disclose her gender transition from male to female through gender-affirming surgery and hormone replacement therapy. By 1949, when Jorgensen began her transition, few individuals had undergone gender transition. Various popular media outlets reported on Jorgensen’s gender transition and surgery, which allowed Jorgensen to educate the American public on topics such as gender identity and sexual orientation. Jorgensen authored an autobiography in 1967, which detailed the journey of her life from early childhood to the end of her forties. Although many transgender people continue to fight for acceptance and equality in the US as of 2024, Jorgensen’s advocacy and activism increased transgender awareness for the general public at a time when existing and living openly as a transgender person received little recognition and support.