Bottom Surgery

Genital reconstruction surgery for transgender and non-binary people. For transfeminine people, bottom surgery includes vaginoplasty (construction of a vagina) and orchiectomy (removal of the testicles). For transmasculine people, it includes metoidioplasty and phalloplasty (construction of a penis).

Bottom surgery is major surgery with significant recovery times and real risks, and it is deeply personal. Some trans people want it, many do not, and many cannot access it due to cost, healthcare barriers, or personal circumstances. None of this makes a person less trans.

Access is harder than top surgery: longer waitlists, stricter requirements in some systems, and higher costs ($15,000–$100,000+ without coverage). Many countries and insurers require documentation of gender dysphoria and years of hormone therapy before approval.