Gender services: Caring gender services for every aspect of your health

UW Health’s Gender Services program provides the affirming care and support you deserve. We help transgender, gender expansive and non-binary adults and children get quality health care.
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Programs and research

Managing your health

At UW Health, our priority is your well-being. We work with you to understand your goals for gender-affirming care and managing your health.

Our gender services navigator program coordinates your care and paperwork. Navigators help you access quality health care and community resources as you need them.

We focus on your mental health as well as your physical health. If you feel depressed, anxious, or need advice on handling difficult relationships at work or home, we can help. We surround you with the care and support you need so you can be you.

We are proud to be named a Leader in LGBTQ Healthcare Equality by The Human Rights Campaign Foundation.

Conditions and treatments

Gender-affirming treatments

Treatments we offer

Your care plan depends on your specific needs and goals. The UW Health Gender Services team follows the standards of care from the World Professional Association for Transgender Health.

We provide psychological services to help you explore your gender identity in a safe and non-judgmental way. We also help you obtain letters of readiness for some surgeries.

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Our team of fertility specialists meets with you to discuss options for starting a family. We answer your questions and provide support and guidance.

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Our specialty doctors work with you to coordinate and manage treatments that meet your gender-affirming goals.

The providers in our HIV Care & Prevention Program provide compassionate and confidential care to those with HIV or are at risk for HIV.

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We provide permanent hair removal before and after surgery and on an as-needed basis.

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Our Pediatric and Adolescent Transgender Health Clinic provides care to help your child feel comfortable with themselves and understand their part in the community.

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Our doctors and nurses provide gender-affirming primary care. We partner with you from childhood to adulthood to help you manage hormonal therapy and other needs.

Our social workers help you access community services and manage questions and concerns, including health insurance, financial issues and home health needs.

At UW Health, our surgeons provide several gender-affirming procedures, including: 

  • Breast augmentation to increase breast size 

  • Facial feminization to make a face appear more feminine

  • Hysterectomy, oophorectomy and vaginectomy, to remove the uterus, ovaries and vagina

  • Orchiectomy to remove the testicles

  • Phalloplasty and scrotoplasty to create a penis and scrotum

  • Peritoneal pulldown vaginoplasty to create a clitoris and labia, and a vagina using the lining of the abdomen

  • Trach shave (thyroid cartilage reduction) to reduce the size of the Adam's apple 

  • Top surgery to remove breasts and create a more masculine-looking chest

  • Vaginoplasty to create a vagina, labia and clitoris

  • Voice and pitch surgery to change the sound of the voice 

  • Zero depth vaginoplasty to create a clitoris and labia, without a vagina

Our care for you continues after your surgery. We make sure you feel well physically and mentally and recover fully.

When you want your voice to match your gender identity, our speech-language pathologists can help.

Evaluation
First, you’ll see a speech-language pathologist (SLP) and otolaryngologist, or ear, nose and throat doctor (ENT). These specialists look at your current voice patterns and overall vocal health.

Evaluation may include:

  • Acoustic measurements of your current voice function

  • Impact of voice on your quality of life

  • Goal setting

  • Trial therapy to find the best and easiest ways to modify your voice

  • Talk about voice treatment options including surgery

Videostroboscopy / laryngoscopy is a minimally invasive clinic procedure to assess the details of vocal function. It’s needed when you have a hoarse voice or there is any concern about your ability to modify your voice safely and effectively. The SLP and ENT will determine if this procedure is needed.

Therapy
Voice change is a process of discovery. It can take several months of therapy, with independent exploration often lasting well beyond the initial treatment period. An individual plan will be tailored to meet your specific goals.

Authentic voice and communication
Treatment goals may include changes in:

  • Speaking pitch

  • Resonance - the "color" of your voice

  • Prosody - the "melody" of sentences

  • Articulation - how words are pronounced

  • Voice quality - loudness, breathiness, etc.

  • Non-verbal communication - gestures, posture, etc.

Trans men and gender non-conforming individuals
Hormone replacement therapy (testosterone) often provides satisfactory voice change for trans men, but this is not always the case. Voice masculinization therapy is available for those who are unsatisfied with their voice change with hormones alone, or for those who are not taking testosterone. Gender non-conforming individuals may find voice therapy helpful to achieve a communication style anywhere along the gender spectrum.

Some insurance companies may offer coverage for gender-related voice services, depending on the policy. Please check with your insurance provider for coverage information. A private pay option is also available.

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Locations

Easy access to care

We provide every service you may need in one location and we are the only comprehensive gender services program in the region.

You can access gender services at clinics in Madison and Middleton, Wisconsin. Our compassionate team provides care and helps you access resources throughout your life.

  • University Hospital - Gender Surgery Clinic
    • 600 Highland Ave. / Madison, WI
    • (608) 263-7502
    • Closed now
    •  
      View hours, services and more
  • Transformations
    • 2349 Deming Way, Suite 100 / Middleton, WI
    • (608) 836-9990
    • Closed now
    • At UW Health Transformations, we offer a full complement of cosmetic, plastic and reconstructive surgery, as well as aesthetic and laser treatment options in a caring, discreet environment.

    •  
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Meet our team

Experts in cross-specialty care

The gender services team at UW Health creates a safe and comfortable experience for you.

You get access to specialists in:

  • Behavioral health

  • Endocrinology

  • Family medicine

  • Internal medicine

  • Obstetrics and gynecology

  • Pediatrics

  • Plastic surgery

  • Social work

  • Urology

  • Voice

Learn more about what you can expect.

Primary care
Gender affirming hormones
Pediatric and adolescent gender care
Facial feminization/trach shave
Facial feminization/eyelid surgery
Top surgery/gender mastectomy
Bottom surgery/vaginoplasty, phalloplasty
Orchiectomy
Fertility
Hysterectomy
Speech therapy
Laryngology
Endocrinology
HIV care and prevention

Patient and support services

Get the services an support you need

The gender services teams at UW Health work to maximize your health and psychological well-being while connecting you to the resources, support and information you need.

Frequently asked questions

What standards of care does UW Health follow for transgender healthcare?

UW Health follows the World Professional Association for Transgender Health (WPATH) standards of care.  

Do I have to be a UW Health patient to receive gender services?

No. UW Health accepts external clients. Please contact us at (800) 323-8942 for additional information.

How much does surgery cost?

UW Health fees are comparable to other surgery centers in the United States. Actual surgery prices will be given following the initial consultation.

Will my insurance cover any of the gender reassignment surgeries?

Clients interested in using insurance to pay for gender surgery should thoroughly investigate their options prior to making a commitment for surgery. We have pricing available for self-pay patients without insurance coverage.

Are gender surgery consultations free?

These consultations are deemed medically necessary and will be billed to your insurer. As required by law, you will be responsible for any balance due after insurance pays.

Who is a good candidate for breast augmentation or breast implants? 

Good candidates for breast augmentation are physically healthy women who are looking for improvement, not perfection, in the size and shape of their breasts.

 Many women seek breast augmentation to restore the youthful contour of their breasts after pregnancy, breastfeeding or aging. Others want to balance a difference in breast size or simply improve body contour with fuller breasts. Breast augmentation is also performed as post-surgery reconstruction technique for women who have lost a breast to cancer.

What does breast augmentation/breast implants involve?

During this surgical procedure, breast size is enhanced using inflatable implants filled with saline (salt water) solution. Your surgeon will make incisions in an area that is as inconspicuous as possible, given your particular body shape. This may be near the armpit, around the areola or nipple, or under the breast itself.

The breast implants are then inserted and centered directly under the breast tissue or beneath the chest wall muscle. Surgery usually lasts between 30 minutes to an hour. Patients are typically given general anesthesia and do not need to be hospitalized. 

What should I do in the time leading up to my breast augmentation surgery?

Your doctor will give you instructions before your breast augmentation surgery, including guidelines on eating, drinking and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure.

Your surgeon may require you to have a mammogram before surgery, depending upon your age and family history.

You will also want to arrange for someone to drive you home after surgery and stay with you for a day or two because some activities may be uncomfortable. 

What should I expect following a breast augmentation/breast implant procedure?

Immediately following breast augmentation surgery, you may experience temporary soreness, swelling, bruising, sickness upon waking up from anesthesia, and changes in nipple sensation. These symptoms can be managed by medication prescribed by your doctor. Your surgeon may also discharge you with gauze dressings and a surgical or soft bra. Dressings are typically removed after several days and stitches, if any, are removed between a week and 10 days. If your doctor gives you a surgical or soft bra, it should be worn as directed.

You may feel tired and sore a few days after your breast augmentation surgery, but will be able to resume light activities between one and two days. Usually, women go back to work in a week or two and resume strenuous activities after a month. It may take three to five weeks for the swelling to completely subside and several months for scars to fade.

Risks associated with breast augmentation surgery include deflation of your breast implant, bleeding or infection. The most common complication experienced after breast augmentation is capsular contracture. After surgery, fibrous tissue forms around your implants to form a natural "capsule." Sometimes the capsule contracts and causes the implant to feel hard and the breasts to appear distorted. There is no sure way to prevent contracture. Your surgeon may treat your contracture manually, by applying pressure to the breasts. In some cases an additional surgery is required to relieve the effects of contracture on the breasts.

Who is a good candidate for facial feminization surgery?

The UW Health team follows the World Professional Association for Transgender Health (WPATH) standards of care. Letters of readiness from mental health providers are not necessary for facial feminization surgery. Gender expansive patients and patients with gender dysphoria are candidates for facial feminization surgery. Facial feminization surgery has been shown to improve quality of life in transgender women who are experiencing gender dysphoria.

What is the difference between a Type 1 and Type 3 forehead cranioplasty?

Changes to the upper third of the face has been recognized as an important marker of femininity. Surgery can remove and shape the ridge of bone across the forehead (called brow bossing) along with the bone overhanging the eyebrows. Underneath the frontal (forehead) bone is an air-filled cavity called the frontal sinus. Some patients have very little bossing, or a very thick bone covering the sinus, and can have a Type 1 forehead cranioplasty to shave down the heavy bone. More often, patients will have a thin layer of bone covering the frontal sinus and require Type 3 forehead cranioplasty to remove the thin layer of bone, sculpt the brow, and set back the forehead bone in a feminized place. This procedure is often combined with a brow lift and hairline surgery. Your doctor may order an x-ray of your skull or review any prior imaging you had in the past to recommend a Type 1 or Type 3.

Who is a good candidate for hairline surgery and hair transplants?

Surgery can be performed to address the hairline shape and height, often at the same time as surgery to the forehead and brow position. For some patients, hairline advancement can be used to lower a high hairline and round the recessed corners often found in the male scalp. For those with a very high hairline, high “M” shaped corners, or in those whose scalp is not as mobile, your surgeon may recommend a hair transplant. Hair transplants are not currently performed at UW Health.

What are options to increase the fullness of the cheeks?

Feminine cheeks are round and full. For many patients, hormone therapy with estrogen will naturally increase the size of their cheeks after 1-2 years. Filler injections can be used to augment the size of the cheeks during this time, or to add additional volume. The procedure is done quickly in the clinic and may last 12 to 24 months, depending on the type of filler used. More permanent options include surgery using cheek implants or fat grafting, which are surgeries performed in the operating room. Fat grafting is a procedure where fat is harvested from the belly or leg and “transferred” to the face.

Does insurance cover facial gender confirmation surgery?

Many insurance carriers now cover these operations in the treatment of gender dysphoria. Your doctor will submit a prior authorization to determine coverage. You may also directly check with your insurance to determine if these are covered procedures.

What should I do in the time leading up to my facial feminization surgery?

Your doctor will give you instructions before your facial feminization surgery, including guidelines on eating, drinking and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure. Hormonal therapy (estrogens) must be stopped prior to surgery to prevent blood clots. Your doctor will instruct you on when to start and stop these medications.

What should I expect following a facial feminization procedure?

Immediately following facial feminization surgery, you may experience temporary soreness, swelling, bruising, sickness upon waking from anesthesia and changes in sensation. Your head may be wrapped with gauze or you may have small surgical drains in place for several days. Swelling make take several months to resolve after surgery. The anticipated recovery is dependent on the specific operations performed for an individual patient.

Who is a good candidate for phalloplasty surgery?

The UW Health team follows the World Professional Association for Transgender Health (WPATH) standards of care and requires that patients are 18 years of age and have two letters of readiness for surgery by mental health providers. Patients must be on hormonal therapy and live in an identity-congruent gender role for at least one year.

Phalloplasty surgery has been shown to have lasting benefit in mental and physical functioning in transmen who desire reconstructive surgery. Patients with prior history of metoidioplasty are candidates for phalloplasty surgery.

What should I do in the time leading up to my phalloplasty surgery?

Your doctor will give you instructions before your surgery, including guidelines on eating, drinking and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure.

Permanent hair removal with laser or electrolysis on the donor site skin is necessary to prevent urinary strictures and fistulas. This may require several sessions.

What should I expect following a phalloplasty procedure?

Immediately following phalloplasty surgery, you may experience temporary soreness, swelling, bruising, sickness upon waking from anesthesia and changes in sensation. You will have a suprapubic catheter in place for urine drainage and a transurethral drain through the new urethra. Your donor site, either the forearm or leg, will have a special dressing over a skin graft for five days. You will remain in the hospital for 10-14 days. Patients will be discharged from the hospital after they are able to void through the new urethra and suprapubic tube is removed.

What are scrotal implants?

Scrotal implants, used to create the look and feel of testicles, are implanted in a separate procedure approximately a year after the scrotoplasty, and are made of silicone filled with silicone gel or saline.

Who is a good candidate for thyroid cartilage reduction surgery?

Transgender women or gender-expansive patients with prominent Adam’s apple are candidates for chondrolaryngoplasty. The UW Health team follows the World Professional Association for Transgender Health (WPATH) standards of care. Specific letters of readiness for thyroid cartilage reduction are not required as with chest or genital gender-affirmation surgery.

How are the vocal cords protected during surgery?

During the operation, a needle is placed through the neck to mark how much cartilage will be removed. A camera called a fiberoptic laryngoscope is placed through the breathing tube and used to confirm the needle is safely above vocal cord attachment. This reduces the risk of injury to the voice.

Does insurance cover thyroid cartilage reduction surgery?

Many insurance carriers now cover this operation in the treatment of gender dysphoria. Your doctor will submit a prior authorization to determine coverage. You may also directly check with your insurance to determine if this is a covered procedure.

What should I do in the time leading up to my thyroid cartilage reduction surgery?

Your doctor will give you instructions before your surgery, including guidelines on eating, drinking and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure. Hormonal therapy (estrogens) must be stopped prior to surgery to prevent blood clots. Your doctor will instruct you on when to start and stop these medications.

What should I expect following a thyroid cartilage reduction procedure?

Immediately following thyroid cartilage reduction surgery, you may experience temporary soreness, swelling, bruising, sickness upon waking from anesthesia and changes in sensation. Swelling in the neck may take several weeks to resolve after surgery. You will have a scar on your neck hidden under your chin that will fade over the course of a year.

Who is a good candidate for gender mastectomy surgery?

The UW Health team follows the World Professional Association for Transgender Health (WPATH) standards of care and requires that patients are 18 years of age and have one letter of readiness for surgery by a mental health provider. Patients younger than 18 may be surgical candidates if the patient, legal guardians and mental health professional are in agreement that delaying surgery would induce patient harm.

What should I do in the time leading up to my gender mastectomy surgery?

Your doctor will give you instructions before your surgery, including guidelines on eating, drinking and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure.

Your surgeon may require you to have a mammogram before surgery, depending upon your age and family history.

You will also want to arrange for someone to drive you home after surgery and stay with you for a day or two because some activities may be uncomfortable.

What should I expect following a gender mastectomy procedure?

Immediately following gender mastectomy surgery, you may experience bruising, swelling, temporary soreness, sickness upon waking from anesthesia and changes in nipple sensation. You may be advised to wear a surgical chest binder to help alleviate swelling for several weeks after surgery. If you undergo free nipple grafting as part of your procedure, you will have special bolster dressings on your nipples for five days after surgery, which will be removed in clinic. You may be discharged home with surgical drains in your breasts, which will be removed when output decreases in the first one to two weeks after surgery.

You will be able to resume light activities one to two days after surgery. Usually, patients return to work within three to four weeks after surgery. Risks associated with gender mastectomy surgery include hematoma (limited bleeding under the skin), seroma (fluid collection), unfavorable scarring and chest asymmetry.

Who is a good candidate for vaginoplasty surgery?

The UW Health team follows the World Professional Association for Transgender Health (WPATH) standards of care and requires that patients are 18 years of age and have two letters of readiness for surgery by mental health providers. Patients must be on hormonal therapy and live in an identity-congruent gender role for at least one year.

Vaginoplasty surgery has been shown to have lasting benefit in mental and physical functioning in transwomen who desire reconstructive surgery. Patients with prior history of orchiectomy are candidates for penile inversion vaginoplasty surgery.

What should I do in the time leading up to my vaginoplasty surgery?

Your doctor will give you instructions before your surgery, including guidelines on eating, drinking and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure.

Permanent hair removal with laser or electrolysis is required in several areas in the perineum prior to surgery. This may require several sessions.

Hormonal therapy (estrogens) must be stopped three weeks prior to surgery to prevent blood clots. Hormonal therapy will be restarted one to two weeks after surgery. A bowel prep is administered the day before surgery to clear the colon of any stool.

What should I expect following a vaginoplasty procedure?

Immediately following vaginoplasty surgery, you may experience temporary soreness, swelling, bruising, sickness upon waking from anesthesia and changes in sensation. You will have a temporary urinary catheter in place for five days along with vaginal packing. You will remain in the hospital with modified activity restrictions during that time. You may have surgical drains in place which will be removed prior to discharge from the hospital. Upon removal of the vaginal packing five days after surgery, you will be performing vaginal rinses three times a day along with vaginal dilation. You must dilate your neovagina every day to prevent stenosis, or narrowing of the vagina. Recovery time following this operation is six to eight weeks. Most patients return to work six to eight weeks after surgery.

What happens if I don’t like the result after surgery?

The operations can be revised to better tune the voice, however, returning to the patient’s previous pitch and voice quality is difficult.

How long is the scar in the front of my neck?

This surgery produces a scar that measures 4 cm or just over 1.5 inches.

Do I really have to do voice therapy before surgery?

Definitely. Voice therapy alone is enough for most patients to achieve their desired pitch and voice characteristics.

Will my insurance cover this surgery?

The best way to learn about coverage of gender-affirming care is to speak with your insurance provider to understand your benefits, if any, and exactly what your coverage will be.

Beyond changing the pitch, are there other voice effects after an operation?

Yes. Sometimes the voice will sound rougher and may require more effort to produce.

Who is a good candidate for zero depth vaginoplasty surgery?

The UW Health team follows the World Professional Association for Transgender Health (WPATH) standards of care and requires that patients are 18 years of age and have two letters of readiness for surgery by mental health providers. Patients must be on hormonal therapy and live in an identity-congruent gender role for at least one year.

Gender affirming surgery has been shown to have lasting benefit in mental and physical functioning in transwomen who desire reconstructive surgery. Patients with prior history of orchiectomy are candidates for zero depth vaginoplasty surgery.

What should I do in the time leading up to my zero depth vaginoplasty surgery?

Your doctor will give you instructions before your surgery, including guidelines on eating, drinking and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure.

Permanent hair removal with laser or electrolysis is not required for a zero depth procedure.

Hormonal therapy (estrogens) must be stopped three weeks prior to surgery to prevent blood clots. Hormonal therapy will be restarted one to two weeks after surgery.

What should I expect following a zero depth vaginoplasty procedure?

Immediately following zero depth vaginoplasty surgery, you may experience temporary soreness, swelling, bruising, sickness upon waking from anesthesia and changes in sensation. You will have a temporary urinary catheter in place for two to three days. You will remain in the hospital with modified activity restrictions during that time. You will have one surgical drain in place will which removed following discharge from the hospital. Recovery time (time off work and strenuous activities) following a zero depth vaginoplasty is 3-4 weeks total, shorter than a full depth vaginoplasty.

UW Health resources

Transgender community resources

This group works toward health equity and the improved safety and well-being of LGBTQ people and communities in Wisconsin.

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Supports the Latinx LGBTQ+ community in Dane County by cultivating an equitable and safe environment.

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A magazine for Madison’s LGBTQ and allied community.

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  • A group committed to equity and quality of life for all LGBTQ+ people. Groups part of OutReach include:

    • Madison Area Transgender Association: Open to folks who identify as transgender or gender nonconforming.

    • FTM/GQ: Peer-led social and support group for people who identify as FTM, genderqueer, drag kings, butch, intersex men and anyone else assigned female at birth who identifies as masculine.

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This group works to provide fair access to health care for people who identify as transgender, intersex, nonbinary and gender nonconforming.

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This group’s mission is to promote evidence-based care, education, research, advocacy, public policy and respect in transgender health.

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