Surgery

Where does surgery happen?

Scroll slowly. For each operation we zoom in on where it happens, and you see what changes. Schematic, not to scale.

Reducing the Adam's apple

Through a small cut in a skin fold of your neck, the surgeon reduces the prominent part of the thyroid cartilage, staying clear of where your vocal folds are attached. Only covered for a passability problem, with prior authorisation, and if it clearly protrudes more than 5 mm.

Covered: only with authorisation

Breast augmentation

An implant is placed behind the breast gland or behind the chest muscle, usually through a cut in the fold under the breast. Covered if your breasts do not or barely grow on hormones: no fold under the breast and less than 1 cm of gland tissue on an ultrasound. How long you must take hormones first varies per insurer: from 6 months to 2 years.

Not covered? DUS-I subsidy up to €3,830, until 1 February 2028

Mastectomy

The surgeon removes gland tissue and fat and makes the chest flatter. With smaller breasts this can be done through a cut around the areola. With larger breasts there is a cut under the breast, and the nipples are often made smaller and moved. Covered, with prior authorisation.

Gender Clinic: 14 days to intake, then ±8 weeks

Uterus and ovaries

In a hysterectomy and oophorectomy the uterus and ovaries are removed, often by keyhole surgery through a few small cuts. Discuss fertility preservation first: the standard asks that you have done it or consciously declined it. Without ovaries you still need testosterone, among other things for your bones.

Covered

Orchiectomy

Through a small cut in the scrotum, the testicles are removed. Your body then makes much less testosterone, and testosterone blockers are usually no longer needed. Can be done on its own, or as part of a vaginoplasty.

1. Testicles→removed

Covered by basic insurance

Vaginoplasty

The surgeon creates a vagina, clitoris and labia from tissue you already have. Sometimes peritoneum or a piece of bowel is also used for depth. Afterwards you need to stretch the vagina regularly (dilation) for a long time. Conditions in the standard: 18+, 12 months of hormones, 12 months in your gender role, genital hair removal completed, BMI 18 to 30, not smoking.

1. Skin of the penis→vaginal wall
2. Skin of the scrotum→labia
3. Part of the glans→clitoris, with sensation
4. Urethra→shorter, sitting to pee
5. Testicles→removed

Amsterdam UMC, UMCG, Radboudumc and Gender Clinic

Metoidioplasty

Testosterone makes the clitoris grow. The surgeon releases it so it comes forward as a small penis. You keep sensation, and penetrative sex is usually not possible. Covered.

1. Clitoris (grown)→released, brought forward
2. Labia→scrotum, optionally with testicle implants
3. Urethra→can be lengthened: standing to pee

Phalloplasty

The surgeon builds a penis from skin, fat and blood vessels from your forearm or thigh. A nerve is connected for sensation. This usually takes several operations; an erection implant follows later and is also covered. Radboudumc does phalloplasty without urethral lengthening (1 year of hormones, not smoking, BMI 18 to 30) and refers to Amsterdam UMC for urethral lengthening.

1. Skin of the forearm or thigh→new penis
2. Nerve from the flap→connected for sensation
3. Urethra→can be lengthened

Gender Clinic: 9–12 months wait

What fits you?

Not everyone wants everything, and that is fine. If you are non-binary, coverage depends on the diagnosis and a justification per treatment; this differs per case and per insurer. Have your practitioner justify your care request well. Abroad, basic insurance covers planned care up to the Dutch rate, usually only with prior authorisation.