Yes. We offer video consultations. Although we love to meet our patients face-to-face, we recognize that travel may be difficult. Many of our patients have busy schedules or live outside of the Dallas/Fort Worth area.

We use a video conference system that does not require you to install software on your computer for your peace of mind.

Yes, there are several things you will need to do prior to having surgery. Requirements vary depending on the type of case:

Top Surgery

• ONE referral letter from mental health professional
• It is recommended but NOT REQUIRED to be on hormones for a period of 12 months.

Breast Augmentation

• ONE referral letter from mental health professional
• Hormones for minimum 12 months, unless contraindicated medically or personally unwilling to take (please note that this will need to be well documented for insurance purposes). In addition to reducing dysphoric episodes, hormone therapy can cause a natural increase in size of natural breast tissue, and potentially improve operative outcomes.
• Must be 22 years old or older

Bottom Surgery (Genital Surgery)

• TWO referral letters from separate mental health professionals. Some insurance companies require one of these letter from a PhD level provider, and the other from a masters level provider
• Hormones for a minimum 12 months, as is appropriate to your gender goals. If you have a medical contraindication or are otherwise unable or unwilling to take hormones, then it is OK to not be on hormones. Again, this will usually need to be well documented.
• 12 continuous months of living in a gender role that is congruent with their gender identity

ALL PROCEDURES

• Mental health/medical health concerns must be reasonably well controlled
• Persistent, well documented dysphoria
• Age: 18 years or older

Prior to surgery, we will have you obtain routine blood and urine tests. Depending on your age and health, we will sometimes order an EKG and/or chest x-ray. You will need to obtain a physical exam by your primary care physician no more than 30 days before surgery.

1) Tobacco use is the enemy of great outcomes. If you are still smoking, you will need to stop using all tobacco products including marijuana and vaping at least (1) month prior to, and ideally lifelong after surgery. Certain byproducts of the combustion process involved in smoking, as well as nicotine in vaping may prevent you from having the best outcome possible.

2) Chronic medical conditions, including diabetes, AIDS, steroid use, and others will need to be addressed prior to surgery.

3) We know that you’ve come this far and you want to look perfect immediately after surgery. Understand that ideal aesthetics will take time and do not occur immediately after you leave the operating room. Your skin needs to heal, inflammation must resolve, and new tissue has to settle in place. We will work together to get you to your ideal outcome as fast as reasonably possible.

4) You should maintain routine hygiene practices, and adhere to post-operative guidelines for the best possible result.

Yes! We work with many different specialties to help you get to where you want to be. These specialties include microsurgery, ob/gyn, psychiatry, and endocrinology.

Generally no. We usually do not require you to undergo painful and expensive electrolysis or laser hair removal before surgery. Instead, during your procedure, your surgeon will remove the necessary hair while you are under anesthesia. Its

Yes, this can occur post vaginoplasty. However, it’s highly unlikely. If hair does regrow, the follicles are typically lighter in color, less abrasive, and fewer in number than previously.

If you experience hair regrowth, we are more than happy to ensure permanent removal using a fast and painless method in our office.

Yes, and yes! The clitoris is formed using existing genital tissue, so your erotic nerves are preserved. During penetrative intercourse, expect a pressure-like sensation. Orgasm will require sexual and physical stimulation, just as it did pre-surgery.

Yes. It’s your body, and you have control over your implants. Before your surgery, we will work closely with you to identify the most appropriately sized implants for your body and wishes.

While you are the authority, your surgeon will offer some guidance based on training and experience:

• For breast implants, Dr Hanna offers gummy bear breast implants. These are widely considered the best style implant, offer the most natural look and feel.
• For testicular and penile implants, you will decide and sign off on your preferred sizes preoperatively. You will select a range of options you’re comfortable with, and, depending on several factors, your surgeon will make the final discretion in the operating room.

We will never give you an implant size you did not approve before surgery.

If you choose to undergo fertility preservation before your gender affirming surgery, you will still have the option of having biological children (through a surrogate or other means) after your transition. If children are part of your long-term goals, you may want to discuss egg freezing or sperm banking with your doctor to ensure we create the best plan for any future family building.

A consultation with Dr. Hanna will allow you to discuss your end goals with your surgeon where he will provide guidance and present various options that may work for you.

You should expect moderate pain for up to a week following surgery, and you may be restricted to bed rest for up to five days, depending on your procedure. We recommend avoiding strenuous activities for six-twelve weeks after surgery and abstaining from sex for up to three months if necessary. More specific guidelines for your surgery will be available during your consultation and pre-op appointments.

If your question is not addressed on this page, please do not hesitate to reach out. Alternatively, we can discuss your specific concerns during your consultation.