Where does SRS/GRS fit into the treatment plan for Gender Incongruity(GI)/Gender Identity Disorder(GID)? The terms GRS (Genital Reassignment Surgery) and GI (Gender Incongruity) will be used from here on to make this flow easier. The diagnosis has been made and you are now in therapy, so what next?
The answer to this question is really up to you and your therapist or physician. There are no rules here so I recommend doing your research and getting to know the options as well as getting to know yourself a little better. Your therapist should be helpful in guiding you in the decision of whether you need GRS and where to place it in your treatment plan. It is not their decision to make though, it is yours. Please understand that you are responsible for finding your way to relief. The professionals are there to help and provide guidance.
The next step is to decide if you have enough funding to get the surgery soon or will it be years before you can afford it? If you have money or the resources to get it, then you have several options. Even if you don’t have the money now, you have options. Here they are. Get an orchiectomy right at the beginning (if you are FtoM – hysterectomy) so you do not have to take hormone blockers. For FtoM it just makes the testosterone that much more effective. Any cosmetic surgeries desired can be done later in the transition as is convenient. After fully transitioning and living in the chosen gender and knowing you are happy, get the full GRS. This option makes the most sense to me, however most doctors are uneasy with this choice, probably because they are not the ones with discomfort. (Reproduction desires need to be addressed also, since this option sterilizes)
The next option is to get hormone treatment and electrolysis done and after going full time as your chosen gender, have GRS done and leave cosmetic surgery to last. The reasoning here is financial and basically goes in order of importance and cost. This seems to be the most popular option chosen, for obvious reasons. Start where you are and take a new step each day toward your ideal.
Those with lots of money sometimes get carried away with the surgeries and do all kinds of physical alteration without fully embracing the changes emotionally. From my experience this is a difficult path and somewhat backwards. Gender transition is an emotional process and the surgery is meant to assist in the assimilation into society. Where the surgery is very important, so is taking the time to learn what it means to be a woman when you were raised as a man, or vice versa. Jumping in with the surgery can lead to disaster when you have changed your appearance and not your self concept.
When I first started my journey one of the questions I asked my therapist is where does GRS fit into my treatment? (I already knew I wanted it, and most of us do) He told me it does not matter if you get it early or later, the important part is to break down the false persona you created to fit into society and allow your natural self to emerge. The surgery will re-enforce your feelings and make it easier for you, but does not really matter to a person who will never see between your legs! GRS is for your own satisfaction in knowing your body reflects your self image.