Surgical Options for Patients Seeking Gender-Affirming Surgery

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CARE FOR THE TRANSGENDER PATIENTS (C FERRANDO, SECTION EDITOR)

Surgical Options for Patients Seeking Gender-Affirming Surgery Kavita Mishra 1 & Shannon L. Wallace 2

# Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract Purpose of Review To describe the surgical treatments available to transgender women and men desiring gender-affirming surgery (GAS). Recent Findings Transgender patients who undergo GAS have high satisfaction and improved quality of life. Masculinizing procedures include chest reconstruction, facial masculinization surgeries, hysterectomy with bilateral salpingo-oophorectomy, metoidioplasty, and phalloplasty. Feminizing procedures include facial feminization surgeries, chondroplasty and voice surgeries, breast augmentation, orchiectomy, and genital surgeries, such as vaginoplasty and vulvoplasty. Vaginoplasty can be performed with inversion of penile skin, sigmoid colon, or peritoneal flaps. The most common GAS surgery in the United States is chest masculinization surgery. Major complications after penile-inversion vaginoplasty are infrequent. Summary A wide range of surgical options exist for the treatment of gender dysphoria. In recent years, systematic reviews and meta-analysis data have shown high satisfaction and more consistent complication rates for GAS. Limited, multicenter data exist regarding surgical techniques, outcomes, and complications. Keywords Gender-affirming surgery . Transgender surgery . Male-to-female . Female-to-male

Introduction Gender dysphoria describes an internal conflict caused by a discrepancy between one’s gender identity and birth-assigned gender [1]. Gender-affirming surgery (GAS) can play a critical role in achieving mind-to-body congruity and alleviate extreme psychological discomfort [2]. In a U.S. population-based survey, roughly 1.4 million adults, or 0.6% of the population, identified as transgender or gender nonbinary (TG/NB) [3]. An estimated 10% to 30% of the transgender population have undergone or are interested in GAS [4••]. With increased insurance coverage for GAS and several states banning exclusions for gender-affirming treatment, there is a high demand for surgical services [5–9].

* Kavita Mishra [email protected] 1

Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University, Palo Alto, CA, USA

2

Cleveland Clinic Women’s Health Institute, Cleveland, OH, USA

The World Professional Association for Transgender Health (WPATH) has developed guidelines for standards of care (SOC) in GAS [10]. Criteria include persistent, well-documented gender dysphoria, capacity to make a fully informed decision, age of majority, and control of any medical or mental health concerns. Other criteria, depending on the surgery, may include mental health referral letters, 12 continuous months of hormone therapy (unless unable or unwilling), and 12 continuous months of living in a gender role congruent with one’s identity. During surgical consultation, the patient’s goals and