Germaine de Larch: My Trans top surgery experience

Joanne Olivier Photography

My experience: Process for top surgery at Helen Joseph, Johannesburg, South Africa


I am only the second person (we know of in the trans community) that went to Helen Joseph for top surgery. A trans friend went a year ago, and the processes have changed completely from his experience.

I had to go through endless different processes to him and learn the new system. So I made a lot of ‘mistakes’, because I followed the same procedure he did.

I am writing down my experience, and trust that it will be the same general process for you.

This is the information I have, at my stage in my journey, for FTM/Nonbinary top surgery. I am a non-binary trans person on testosterone having top surgery, so my experience is different to what you might need. ALL the info I know is here.

Please don’t ask me anything else because I DON’T KNOW.

Go to the hospital with the referral letters from your own doctors, therapists, and psychiatrists and ask hospital what to do next. If you don’t have doctors, etc. get referral letter from TIA, GenderDynamiX or (go here for contact info for these resources and more), phone the hospital or go to hospital and ask them what to do.

BUT: this is the process I followed under my specific circumstances as a white trans person on testosterone for over a year, who has been with a therapist for two years, who has been with a psychiatrist and who brought referral letters from: Therapist, HRT-prescribing Dr and Plastic surgeon at Charlotte Maxeke (Jhb Gen) – public hospital in Parktown, Johannesburg. (I’d had my breast reduction there in 2010 and had a great experience. I chose not to do the surgery as they charge R30,000 as they see the surgery as cosmetic and not medically necessary – in other words, they don’t see this surgery as necessary for a transgender, queer or LGBQIA+ person). See this experience at Charlotte Maxeke here.

Your experience will be different depending on your circumstances.

But here is a general guideline to follow.

Important general info

Germaine de Larch (Facebook)

The clinic (Breast and Plastic Surgery) is THE best in South Africa, as confirmed by many cisgender women who use it for post-cancer reconstruction of breasts. When you speak to the women in the queue who have been going there for years, they will tell you only good things. These doctors train other doctors. They are therefore as good, if not better, as plastic surgeons in private practice.

Please note: The staff at Helen Joseph are amazing, from nurses, to security, to Doctors. They are super helpful and friendly if you remain calm and friendly. The system is what it is, but works very well if you just keep asking which queue you should be in and double-checking all the time. But:

These surgeries are called “sex change” surgeries at Helen Joseph, which is a completely incorrect and outdated term, but necessary for their processes, so best is just to nod and agree while it is extremely triggering. They also misgender you and use a lot of other problematic trans terminology. They do NOT know what nonbinary is, so for the purposes of getting the healthcare you need, play along with them and refer to yourself as the relevant FTM or MTF.

While this is problematic and causes dysphoria and justified anger, this is the process right now. We can choose to refuse service and get upset, and then go and pay 3-10x the prices at private hospitals. Or we can choose to make the very difficult decision to play along with these difficulties at a hospital where they DO understand that this is for your health, and they ARE VERY sympathetic and they UNDERSTAND that you are not sick, but need these surgeries to be healthy. So my advice is focus on their genuine care and concern, deal with the dysphoria and anger caused by the outdated language (this is NOT their fault, but the South African healthcare’s fault in general) and get the healthcare you need that you can ACTUALLY afford.

This blog post was originally published on Germaine de Larch’s blog. Check it out. 



About Author

Freelance Writer, Educator, Artist - Trans/Gender, LGBQIA, Mental Health & Living Life Large Advocate. Unapologetic idealist, recovering addict, neurodivergent, Spoonie living with Bipolar II; learning to live large, one day at a time by recreating myself and what that means for the world around me. Not a survivor, a warrior. Documenter in words and images of Life, Lived Large, as well as my transgender, testosterone-fuelled journey as a nonbinary feminist queer #BeingHumaninFearfullyBeautifulWorld | Johannesburg, South Africa For my work, interviews, conference appearances, exhibitions, etc. see and my website

Leave A Reply