Your Consultation: What to Ask and Bring

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 12 October 2026· How this site is researched

A consultation runs both ways. The surgeon is assessing you, and you are assessing the surgeon. Most people prepare well for the first half and arrive with nothing for the second. I have sat in on hundreds of these in Bangkok over the last ten years. The regret I hear most afterwards is simple: the question that mattered never got asked before the time ran out.

Before you book it

• Fees. Some surgeons charge for the consultation. Others take the fee off the surgery if you go ahead. Ask when you book, so the invoice holds no surprises.
• Intake forms. Expect questions on your medical history, medications, height and weight, smoking, and how long you have been on oestrogen and an anti-androgen. Many clinics also ask for photos before a first video call. For facial feminization that means front, side and three-quarter views in good light. For breast augmentation it means your chest from the front and both sides.
• Paperwork they want first. Some surgeons need a letter of support before they will see you. Others take it later, or work on informed consent. Check which before you wait weeks for a slot.
• Video or in person. Video is the usual first step, especially if you are travelling for surgery. The examination then happens in person, often a day or two before the operation. The plan can still be refined on the day, so ask how they would handle that.

What happens in the room

Expect anything from twenty minutes to an hour. The order rarely changes.

1. History. Medical history, medications, past operations, any trouble with anaesthetic, smoking, mental health, and your hormones. Give the exact oestrogen preparation, dose and route, plus your anti-androgen, or whether you have had an orchiectomy. Be completely open. The surgeon is weighing your risk, and oestrogen matters for clotting.
2. Examination. This depends on the operation. See the list below.
3. Their recommendation. Which technique, and why it suits you rather than someone else.
4. Risks. Informed consent rests on this part, so it should not be rushed. Listen for the complication they call most common, not just the full list.
5. Logistics. Wait time, price, letters, blood tests, how long to stay nearby afterwards, and any rules on BMI or nicotine.
6. Your questions. Usually squeezed into the last five minutes. Have them written down, with the most important first.

What the examination looks like, by procedure

• Facial feminization. Photos from set angles and careful measurements of your forehead, brow, nose, jaw and chin. For bone work, most surgeons want a CT scan of the skull. It shows the thickness of the frontal sinus wall, which decides whether the brow can be reshaped by burring or needs the bone set back. Some clinics order the scan before you fly; others do it on arrival. See forehead and brow.
• Vaginoplasty. A genital exam, mainly to judge how much skin is available. That shapes the depth the surgeon expects to reach, and whether they suggest penile inversion, a peritoneal pull-through or zero depth. They will also check your hair removal. Bring your electrolysis records. If the area is not clear yet, this is where the date gets set around it.
• Breast augmentation. The surgeon measures chest width, the base width of the breast, the gap between the nipples and how much tissue oestrogen has already built. Trans women often have a broader chest, and that drives the implant width more than the volume you have in mind. Many clinics have sizers to try on. See implants.
• Voice surgery. Expect a laryngoscopy. A thin camera goes through the nose or mouth so the surgeon can see your vocal folds move. It takes a few minutes and is uncomfortable rather than painful. Many surgeons also want an assessment from a voice therapist first. See voice.

What to bring

• Photo ID, and any referral or insurance paperwork
• A list of every medication and supplement, with doses. Include your oestrogen preparation and route, your anti-androgen, and any progesterone
• Your letters of support, if the surgeon needs them
• Records of past operations, especially any problem with anaesthetic, nausea or blood clots
• Recent blood results, including hormone levels if you have them
• For vaginoplasty, your hair removal log, signed and dated by your electrologist
• For FFS, any existing CT scan, on disc or as a download link
• Your questions, printed or on your phone
• A notebook, or permission to record. Most surgeons agree if you ask first
• Someone with you, if possible. The person caring for you afterwards is ideal; see the caregiver guide

If you have ever had a blood clot, or one runs in your family, say so clearly. It changes how the team plans your hormones around the operation.

Questions to ask your surgeon

Choosing a surgeon covers what to weigh. These are the words to use in the room.

About them:

• How many of this exact operation do you do a year?
• What is your revision rate, and what counts as a revision in that figure?
• What is your most common complication, and how do you manage it?
• Can I see healed results on people with a build like mine, at a year?

About the procedure:

• Which technique do you recommend for me, and what would change your mind?
• For vaginoplasty: what depth do you expect for me, and what decides it?
• For breasts: what implant size, shape and placement, and why?
• For FFS: which procedures, done together or in stages?
• Where will the scars sit, and what will they look like at a year?

About recovery:

• How long should I stay nearby before flying home?
• For vaginoplasty: what is the dilation schedule, and are dilators included?
• Who do I contact out of hours, and how quickly do they reply?
• How do follow-ups work once I am home?

About money and paperwork:

• What does the quote include? Surgeon, anaesthetist, hospital nights, garments, medication and follow-ups.
• What is the deposit, and what is refundable if either of us postpones?
• If I need a revision, who pays, and within what time limit?

What a good answer sounds like

How easily the answer comes matters as much as the answer itself. A surgeon who gives a revision figure and says what it counts has done that sum before. The same goes for technique. A good surgeon will explain why the other options suit you less. In the best consultations I have sat in on, the patient walked out understanding her own body better than when she arrived.

Warning signs

The consultations that go badly share a pattern. Pressure to pay a deposit on the day. No figures for volume or complications. Questions about depth, sensation or revisions treated as nerves. Nobody able to say who answers the phone after surgery. One of these alone does not rule a surgeon out. Two or three are a reason for a second opinion. The full list is under red flags on choosing a surgeon.

Afterwards

Write up your notes the same day, while they are fresh. Ask for the quote and the plan in writing. If you see more than one surgeon, put their answers side by side. Where two surgeons disagree is usually where the real decision sits, so take that question back to both.

If you are planning more than one operation, raise it now rather than later. Most surgeons have firm views on what can be combined and what should be staged. Once you have a date, work through the pre-op checklist.

This is information, not medical advice. Your surgeon has your history and your body in front of them, and their judgement comes first.