U.S. Surgeon to Conduct Six Sex-reassignment Operations in Israel

Private insurance companies will pay for six female-to-male operations at Sheba Hospital, because it is cheaper than surgery overseas.

An operating room at an Israeli hospital (illustrative photo), 2016.
Moti Milrod

Six Israelis are due to undergo female-to-male sexual reassignment surgery this week at Sheba Medical Center, Tel Hashomer, starting Tuesday. This complex operation is not usually done in Israel – the last one was conducted in 2012 – and it will be performed by a surgeon who has been flown in expressly for this purpose from the United States: Dr. Curtis Crane, of the California Pacific Medical Center in San Francisco, a urologic and plastic surgeon, who is one of the world’s leading experts in female-to-male gender reassignment.

Bringing Crane to Israel was a joint initiative of the private insurance companies covering the patients, the country's transgender community and the plastic surgery department at Sheba Medical Center, located outside Tel Aviv. The insurance companies were persuaded that bringing a foreign surgeon in would be cheaper than flying the patients to the United States.

The patients range in age from 20 to 50; the surgery will take between seven to 10 hours for each patient.

Female-to-male gender reassignment surgery is often accompanied by complications. All together it includes a series of procedures spread out over a long period, sometimes more than two years. These may include treatments involving the sexual organs – such as a hysterectomy – as well as mastectomies and chest contouring, among others.

Dr. Haim Kaplan, a senior surgeon at Sheba and the only Israeli trained and licensed to perform these operations, no longer does them. In his place, Dr. Alon Liran, a plastic surgeon trained in doing male-to-female reassignment surgery, will assist Crane this week.

About 20 Israelis are thought to be waiting for female-to-male sex reassignment surgery, after receiving approval from the Health Ministry’s Committee for Sex Reassignment, based at Sheba Medical Center.

Such procedures are considered to be a form of medical treatment in Israel, not just cosmetic or alternative health care. As such, they meet the Health Ministry’s criteria for medical treatments that are included in the state-subsidized health care "basket," and they are funded by local health maintenance organizations – on condition approval was given by the ministerial committee.

This panel, established in 1986, includes a senior psychiatrist, clinical psychologist, senior plastic surgeon, urologist and endocrinologist. Its members only approve the surgical procedure two years after patients have embarked on the process of gender reassignment, which includes living with the new gender identity and hormonal treatments, and assessment of the individuals' physical and psychological responses to their new gender.

The process also requires examinations by an outside psychiatrist and psychologist, who determine whether the person is mentally prepared to undergo the operation.

Representatives of the local LGBT community say the approval process is “hell,” and add that even after getting the ministry's green light, the HMOs raise all sorts of obstacles – especially relating to funding of female-to-male operations overseas. The time has come, say these sources, to train an Israeli surgeon to regularly perform the operation in Israel.