Rethinking readiness for gender affirming surgery
This oral presentation explores how psychological readiness for gender-affirming surgery can be understood beyond the narrower question of diagnostic eligibility. As demand for gender-affirming surgical care continues to increase, clinicians are increasingly encountering complex presentations involving trauma, neurodivergence, co-occurring mental health difficulties, body image concerns, minority stress and significant psychosocial adversity. Although established guidance supports informed consent, autonomy and affirming care, less attention has been given to how psychological risk and protective factors may influence surgical decision-making, recovery and longer-term postoperative adjustment.
Drawing on extensive clinical experience in gender-affirming assessments, trauma-focused practice, and psychological assessment within surgical, cosmetic and aesthetic healthcare settings, the presentation will introduce a psychologically informed, formulation-based approach to readiness. It will consider how clinicians can explore an individual’s understanding of surgery, expectations, motivations, emotional preparedness, coping resources, support systems and capacity to manage possible complications or outcomes that may differ from those anticipated.
The presentation will also examine the relevance of trauma history, neurodivergence, mental health symptoms and body image concerns without automatically positioning these experiences as contraindications to surgery. Particular attention will be given to distinguishing genuine areas of psychological vulnerability from difference, distress arising from minority stress, or understandable anxiety about a major surgical intervention.
Through anonymised case examples, reflective discussion and comparison with psychological assessment approaches used in other surgical specialties, participants will be encouraged to consider how formulation can enhance—not obstruct—affirming care. The session will offer a practical framework for identifying strengths, vulnerabilities and individual support needs.
Ultimately, the presentation argues that psychological assessment should move beyond determining whether someone is “eligible.” At its best, it can strengthen informed consent, support collaborative decision-making, optimise surgical outcomes and promote compassionate, ethical and genuinely patient-centred care without creating unnecessary barriers to treatment.
Speaker
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Zoe Chouliara
Professor Dr Zoë Chouliara is a Consultant Counselling and Clinical Health Psychologist, psychotherapist, clinical supervisor and former Professor of Mental Health, with 17 years of clinical experience and 14 years of clinical supervision experience across psychological, surgical and healthcare settings.
She has expertise in gender incongruence and the psychological assessment of individuals seeking gender-affirming surgery. Her work includes assessments for chest masculinisation, breast surgery and other gender-affirming procedures, informed by ICD-11 and the World Professional Association for Transgender Health Standards of Care Version 8. Her approach is affirming, person-centred and grounded in autonomy, informed consent and respect for each individual’s lived experience.
Professor Chouliara also has expertise in psychological assessment relating to cosmetic, reconstructive and elective surgical procedures. She works collaboratively with surgeons, multidisciplinary teams and specialist healthcare providers to assess psychological readiness, clarify expectations, identify vulnerabilities and protective factors, and support informed surgical decision-making. Her experience across gender-affirming and aesthetic surgical pathways provides a distinctive perspective on the psychological factors influencing surgical outcomes, recovery, satisfaction and longer-term adjustment.
As a recognised specialist in complex trauma, she brings a trauma-informed, formulation-based perspective to surgical assessment, considering trauma history, neurodivergence, co-occurring mental health difficulties, body image, minority stress, resilience and psychosocial context. She is committed to ensuring that psychological assessment strengthens care without pathologising gender diversity or creating unnecessary barriers to treatment.
Professor Chouliara is widely published and has contributed extensively to research, academia, and professional practice. Her awards and recognition include the British Journal of Nursing Dermatology Award, inclusion among the Top 100 Nation’s Lifesavers for her contribution to childhood sexual abuse recovery, recognition among Edinburgh’s Top Five Psychologists, and selection as a finalist for the CeeD Resilience Award.
She is Director of Zoë Chouliara Psychology, an award-winning boutique psychology clinic in Scotland, where she combines clinical rigour with compassionate, individualised and ethically grounded care.
