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For trans men, these may include mastectomy removal of the breasts and chest reconstruction the shaping of a male-contoured chest , or hysterectomy and bilateral salpingo-oophorectomy removal of ovaries and Fallopian tubes. Some surgeons charge higher fees for HIV and hepatitis C-positive patients; other medical professionals assert that it is unethical to deny surgical or hormonal treatments to transgender people solely on the basis of their HIV or hepatitis status. Archived copy as title CS1 maint: Health care and medicine. Alternative local standards of care exist, such as in the Netherlands, Germany, and Italy.

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In , the United States Defense Health Agency for the first time approved payment for sex reassignment surgery for an active-duty U.

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Arch Pediatr Adolesc Med. For trans women, genital reconstruction usually involves the surgical construction of a vagina , by means of penile inversion or the sigmoid colon neovagina technique; or, more recently, non-penile inversion techniques that make use of scrotal tissue to construct the vaginal canal. Sex reassignment surgery or SRS also known as gender reassignment surgery , gender confirmation surgery , genital reconstruction surgery , gender-affirming surgery , or sex realignment surgery is the surgical procedure or procedures by which a transgender person's physical appearance and function of their existing sexual characteristics are altered to resemble that socially associated with their identified gender. The best known of these surgeries are those that reshape the genitals, which are also known as genital reassignment surgery or genital reconstruction surgery GRS - or bottom surgery the latter is named in contrast to top surgery , which is surgery to the breasts; bottom surgery does not refer to surgery on the buttocks in this context. Regret may be due to unresolved gender dysphoria, or a weak and fluctuating sense of identity, and may even lead to suicide. In , the United States Defense Health Agency for the first time approved payment for sex reassignment surgery for an active-duty U. Many medical professionals and numerous professional associations have stated that surgical interventions should not be required in order for transsexual individuals to change sex designation on identity documents.

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