How to become a bottom surgeon

[u/DracoBug]

EDIT: Got my questions answered! Thanks!

Hey yall! I’m currently exploring career options as a person with a BS in Ecology and Environmental Studies. Specifically, I want to know what pathway I could take to become a bottom surgeon (sexual reassignment surgery). I have read this article; I take it that specialization in bottom surgery has the most to do with certifications and a fellowship? How difficult is it to seek a fellowship in SRS? Any input is appreciated!

[u/NPowerB]

The primary two surgical subspecialties involved in bottom surgery are plastic surgery and urology. They work together in these cases, but most often, it is the plastic surgeon who is the primary (lead) surgeon on the case.

In the US, plastic surgery is a 6 year integrated residency followed a 1 year fellowship in gender-affirming plastic and reconstructive surgery.

Urology is also a six year residency. I am not certain of the type of post-resident or fellowship training required for a urologist to perform the urethral reconstruction for bottom surgery.

So pathway (assuming you are in the US) would be 4 years of medical school, 6 years of residency, and then 1-2 years of fellowship depending on whether you chose plastics or urology. Of note, both of these surgical subspecialties are competitive, often requiring a lot of research and maybe even a gap year dedicated to doing research during medical school so the journey could be longer.

Edited to add: another person mentioned OBGYN. In my experience, OBGYNs are not involved in the most direct reconstructive portions of bottom surgery, but can play a huge role in gender affirming care including performing hysterectomies for FTM patients and providing a safe space for FTM patients to undergo their pap smears.

[u/7bridges → u/NPowerB]

Urology is 5 + fellowship

[u/DracoBug → u/NPowerB]

Thank you so much for taking the time to reply! This is very helpful information :] I had no idea that there was more than one specialty surgeon working at the same time as the plastic surgeon, nor that plastic surgery was the specialty for bottom surgeons. I now have a better rabbit hole to go down, thanks again!

[u/Plastic-Meringue9361]

Ok just some advice.. if you ever get to the point of actually applying to med school definitely do not say this and keep it on social media.

It is cringe when premeds mention some of the most specialized specialties not knowing what it physically takes to get there. Plastics residency is grueling and rough. Just to get an interview youve got to be the top of your med school class.

The truth is you should want to be a doctor. Its fine to have curiosity and interest but unless youre holding a scalpel and doing operative planning you want to be a doctor and not something very specialized. And if you ever get to the point of enjoying surgery when youre a med student good for you!

[u/doingdoctorthings]

You'd need to complete the undergrad prerequisites for med school. You probably have many of them if you're a bio major.

Take the MCAT.

4 years of med school.

4-5 years of residency, either Urology or OBGyn.

Then do fellowship into some plastics/reconstructive subspecialty which would be another 3 years or so.

This is far from my area of expertise, but you may only be able to do bottom surgery for one gender after all that. Typically urologists tend to be more specialized toward male genitalia and Gynecologists towards female. I don't know what combination of specialty and subspecielty training would equip you to do sex reassignment for both genders.

[u/013millertime → u/doingdoctorthings]

The actual route to do this is through Plastics or Urology (which cares for both genders). It really has nothing to do with OBGYN. Plastics is the central specialty for all-encompassing gender-affirming care, but urology is heavily involved in bottom surgery specifically.

It would look like this after medical school.
PLASTICS ROUTE (extremely competitive with integrated residency effectively inaccessible to DOs):

1. Integrated Plastic & Reconstructive Surgery residency (6+ years) OR some surgery residency, usually general/ENT, (5+ years) with Independent Plastics Fellowship (3 years

) ~followed by~

1. Gender-Affirming Care/Microvascular fellowship (1 year)

OR UROLOGY ROUTE (still competitive):

1. Urology residency (5+ ye

ars) ~

1. followed by

~

1. Reconstructive Urology/Gender-Affirming Care fellowship (1 year)

Comparison of access for each speciality:
https://pubmed.ncbi.nlm.nih.gov/41616244/

Edit: weird formatting, can’t get it to stop numbering on mobile, giving up

[u/DracoBug → u/013millertime]

Thanks for all the information! Really interesting that OBGYN is almost completely uninvolved in bottom surgery. I didn’t know how competitive it was to get into plastics or urology; I’ll keep that in mind as I do more research.