Gender reassignment surgeries can be partially reversed in many cases, but full restoration to pre-surgical anatomy is rarely possible. The degree of reversibility depends heavily on which specific procedures were performed. Some surgeries, like breast augmentation with implants, are relatively straightforward to reverse. Others, like facial bone contouring or vaginoplasty, involve permanent structural changes that are extremely difficult or impossible to undo completely.
How Common Is Surgical Reversal?
Regret after gender-affirming surgery is uncommon by most measures. A large longitudinal study at the VU Medical Center in Amsterdam tracked 6,793 people who sought gender-affirming services between 1972 and 2015. Among those who ultimately had gonadectomy (removal of ovaries or testes), regret rates were 0.6% for trans women and 0.3% for trans men, with an average time to regret of about 11 years.
The 2015 U.S. Transgender Survey, which included over 27,000 transgender adults, found that 8% had detransitioned at some point, but the majority did so only temporarily. Detransition rates were higher among trans women (11%) than trans men (4%). It’s worth noting that detransition doesn’t always involve surgical reversal. Many people detransition socially or stop hormones without pursuing further surgery, and many cite external pressures like discrimination or family rejection rather than a change in gender identity.
Reversing Bottom Surgery
Bottom surgery reversal is the most complex category. For trans women who underwent vaginoplasty and later seek reversal, the process typically involves multiple staged surgeries: removing the surgically created vaginal canal, reconstructing a scrotum, lengthening the urethra, and building a phallus using tissue grafted from another part of the body. A study published in the Journal of Sexual Medicine documented this multistage approach, with follow-up periods ranging from 13 to 61 months. All patients in that study reported satisfaction with the cosmetic results and significant psychological improvement.
Still, the reconstructed anatomy won’t be identical to pre-surgical genitalia. Tissue that was removed or restructured during the original surgery cannot simply be put back. A reconstructed phallus requires tissue from a donor site on the body (often the forearm or back muscle), and achieving both urinary function and cosmetic appearance takes multiple procedures spaced months apart. Penile prostheses may be implanted to allow rigidity, but natural erectile function is not restored.
For trans men who underwent metoidioplasty (a procedure that uses hormonally enlarged clitoral tissue to create a small phallus), the situation is somewhat different. Because metoidioplasty preserves the original clitoral tissue and its nerve supply, patients retain full sensation, arousal, and the ability to orgasm. In a study of 813 cases, 79% reported being totally satisfied with the cosmetic result. However, reversing metoidioplasty to restore female genital appearance would still require additional surgery, and published data on that specific reversal is extremely limited.
For trans men who had a full phalloplasty using a large tissue flap, reversal would mean removing the constructed phallus and attempting to reconstruct female anatomy. This is technically possible but involves significant scarring and functional trade-offs.
Reversing Top Surgery
Top surgery reversal varies depending on the direction of the original procedure. For trans men who had double mastectomy and later want breast reconstruction, the options mirror those available to anyone who has had a mastectomy: implants, tissue expanders, fat grafting, or autologous tissue flaps (using tissue from elsewhere on the body). If the chest skin retained enough elasticity, an implant alone may suffice. If not, surgeons typically use a staged approach, first placing a tissue expander to gradually stretch the skin, then swapping it for an implant months later. Fat grafting and scar revision can refine the result afterward.
The reconstructed breasts won’t look exactly like the originals. Nipple sensation is often permanently reduced after mastectomy, and if the nipples were removed or grafted during the initial surgery, cosmetic tattooing may be needed to recreate the areolar appearance.
For trans women who received breast implants as part of feminization, removal is straightforward, similar to any implant removal surgery. The main concern is excess skin or changes in breast shape after the implant is taken out, which may require additional procedures to address.
Reversing Facial Surgery
Facial feminization surgery is considered permanent and may be impossible to reverse, according to the American Society of Plastic Surgeons. These procedures often involve reshaping bone, including reducing the brow ridge, contouring the jaw, or shaving down the tracheal cartilage (Adam’s apple reduction). Once bone has been cut away, it cannot be regrown. While reconstructive techniques exist to build up bone or add implants, the result would not replicate the original facial structure.
Soft tissue procedures like brow lifts or lip modifications are somewhat more amenable to revision, but even these involve scarring and tissue changes that can’t be fully undone.
What Hormonal Changes Can and Can’t Reverse
Stopping hormone therapy allows some changes to reverse naturally, but not all. For someone who took estrogen, breast tissue that developed will not disappear on its own (surgical removal would be needed). Reduced fertility may or may not recover, depending on age and duration of treatment. Softer skin and redistributed body fat will gradually shift back toward their previous patterns.
For someone who took testosterone, voice deepening is permanent because the vocal cords thicken irreversibly. Facial hair growth will slow but may not stop entirely. Clitoral enlargement from testosterone does not fully reverse. Menstrual cycles typically resume after stopping testosterone, though the timeline varies.
How Reversal Care Is Managed
The most recent WPATH Standards of Care (Version 8) recommend that anyone seeking surgical reversal be evaluated by a multidisciplinary team experienced in transgender health. This isn’t a gatekeeping mechanism so much as a practical necessity. The team works with the patient to understand what motivated the original transition, what’s driving the desire to reverse, and what outcomes are realistic. The goal is to ensure the reversal plan addresses the person’s actual concerns and avoids replicating the same dissatisfaction.
Finding surgeons who perform reversal procedures can be challenging. These are technically demanding operations that few surgeons specialize in, and insurance coverage is inconsistent. The multistage nature of many reversals means the process can take a year or longer from start to finish, with recovery periods between each surgical phase.
Realistic Expectations for Reversal
The central reality is that reversal surgery can meaningfully change anatomy back toward its original state, but it cannot achieve a perfect restoration. Every surgical procedure creates scar tissue, and tissue that has been removed or fundamentally restructured cannot be made identical to what existed before. Nerve damage from the original surgery may limit sensation permanently, and donor-site scars from tissue flaps add to the overall physical impact.
That said, published outcomes suggest that patients who do pursue reversal generally report improved psychological well-being and satisfaction with their results. The surgery is complex and the journey is long, but for those who need it, meaningful improvement is achievable.