Herr Spindler, was haben die Patientinnen, die zu Ihnen kommen, schon hinter sich?
Often a long period of suffering. At the beginning they are in doubt about their identity. Then, usually during puberty, they find themselves in a different gender, but at the beginning they cannot communicate this to the outside world. Most patients have already come out and are already alive have been in their new gender for some time and have undergone psychotherapy. This is also what the legislature provides for in its regulations for the approval of such an operation.
In this case, does approval mean that it will be taken over by the health insurance company?
Yes. The patients have already gone through all of these steps. They have come out to their surroundings, they live in their perceived gender and are undergoing hormonal treatment. The psychotherapist makes the indication and checks whether an operation makes sense. As a plastic surgeon, I am only called in at the very end.
How old are your patients usually?
Most patients are rather young, i.e. in their early 20s. And then there is a second peak in those in their late 40s or early 50s, who may have had a family life and then come out. But most people already live in the opposite sex during puberty, communicate this to the outside world and receive hormone therapy. You can often tell that it is a woman who comes in here and no longer a man.
How do patients feel when they prepare for surgery?
Many come to the preliminary meeting with family or partners. Some have already read up on the internet and know exactly what to expect. Others come for the initial consultation. I explain to them what to expect, how the operation will proceed, how long it will take and how long the inpatient stay will be. And what dangers such an intervention can entail. You will receive an information sheet that also contains sketches. For some, that’s a bit much at first. Then we’ll make another appointment to talk again.
What exactly do these interventions include?
The first thing most patients want is removal of the penis and creation of a neoclitoris and neovagina. This first step of the operation usually involves removing the testicles and erectile tissue. Then the skin of the penis – and sometimes with a little skin from the leg – is used to form the lining for the neovagina. The new clitoris is formed from the former glans, which is dissected with all nerves and vessels. As soon as the patient wakes up from the anesthesia, she already has feeling there.
Anyone who still says after this description, I want that, really wants it.
I attach great importance to a very detailed explanation. The patients then go into the three-and-a-half to four-hour operation more confidently.
What does the aftercare look like?
We use a placeholder during the operation so that the neovagina remains open for the time being. During the inpatient stay, we regularly change bandages with patients, including in the gynecological chair. The patients then come to my consultation for follow-up care. After three months we carry out a second operation, then the labia are padded with some fatty tissue and minor corrections can be carried out. This is to complete the picture. This will look completely normal once it has healed.
How risky is this surgery?
There are the normal, general risks, such as wound healing problems or secondary bleeding. The main risk is to prepare the new canal along neighboring organs without injuring anything. There are structures on the left and right that you have to respect, there are muscle groups and vessels. Here in our hospital, however, with our intensive care unit we have a good opportunity to adequately care for patients in the event of complications.
Does this also include breast reconstruction?
This is very different because patients react differently to hormone therapy. Some already have well-developed breasts, while for others the hormone has not yet increased the development as one would imagine. Here we can enlarge the breast with implants. Some people also have facial feminization, a reduction in the size of the Adam’s apple, or an adjustment to the forehead or nose. And this is not aesthetic surgery, this is reconstructive surgery.
How do the patients feel after the operation? Relieved?
Yes. They feel relieved because the step has been taken and what doesn’t belong to them and doesn’t fit is no longer there. This is often the end of a story of suffering and the last step towards being able to say that I now feel really at home in my body.
How long have you been offering this operation?
I started doing it in Bad Soden last year. I took over the management of the clinic three years ago. In the first few years, the focus was on getting used to the structures and organizing the clinic. Before that, I worked at the Leipzig University Hospital and worked with my boss to set up the range of gender reassignment surgeries there. I enjoyed doing that and would like to offer it here too.
Transsexuality is currently very much politicized, for example on the American right, or dismissed as a fashionable diagnosis.
We are seeing a significant increase in the number of patients because we are dealing with the situation more openly and the patients are able to admit their gender. Unlike in America, society here is much more open to someone saying I was born in the wrong body. And there are not just trans men and trans women, but also many intermediate forms to which you can feel like you belong. But most of the patients I see say very clearly: I am a woman. Most live in a relationship and are supported in it.
Have you ever experienced someone regretting the operation?
Not me personally yet. There was one case who wanted to have another operation, but that is probably an isolated case. Gender reassignment is not a fad, the patients go a long way and live it, most of them since puberty.
First of all, we would like to make it clear that we offer this range of services, as there are only a few specialized clinics in this area in Germany. Many patients also seek second opinions.
So far you only offer operations for trans women. Why not for trans men too?
I also learned that during my time in Leipzig. However, my strength lies in male to female transformation, which is why I focused on that. I now also offer special consultation hours for women so that they are in a protected environment. My colleagues assist me, learn the steps and receive appropriate training if they want. The procedure is not part of the usual training of a doctor.
Have you already received hostility?
No, never. On the contrary, we put the offer on the homepage and the first inquiries came immediately.
date: 2026-02-07 09:29:00