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Table 16. Criteria for Gender-Affirming Surgery that Affects
Fertility
1. Persistent, well-documented gender dysphoria
2. Legal age of majority in the given country
3. Having continuously and responsibly used gender-affirming hormones for 12 mo (if
there is no medical contraindication to receiving such therapy)
4. Successful continuous full-time living in the new gender role for 12 mo
5. If significant medical or mental health concerns are present, they must be well
controlled
6. Demonstrable knowledge of all practical aspects of surgery (e.g., cost, required
lengths of hospitalizations, likely complications, postsurgical rehabilitation).
