The sex change procedure varies for male to female patients and female to male patients. The most familiar surgery is genital reassignment surgery. For male to female patients genital reassignment surgery involves removing the penis and testicles and performing a vaginoplasty. For female to male patients this includes the shaping of a penis. In addition to the major genital reassignment surgery the patient must undergo other procedures and processes. To start the process of a sex change operation the patient must meet with a surgeon and undergo intensive therapy. The surgeon will normally ask the patient to live as the chosen sex for up to one year before the surgery is performed. Some surgeons begin hormone therapy prior to surgery while others wait until the process in close to completion. If the patient meets all of the surgeon's criteria he will perform the appropriate surgeries to accomplish sexual reassignment.