Applying concurrent multidisciplinary care to gender affirmation in transgender women: A case series

Abstract

This case series presents three transgender women who underwent gender-affirming treatment with concurrent feminizing glottoplasty and penile inversion vaginoplasty. In our series, combining these into one procedure minimized anesthesia exposure and did not increase operative time, hospitalization, or complications, suggesting that they can safely combined. Gender dysphoria and vocal dysphonia are common among transgender women (TGW). 1 Gender-affirming surgical procedures can improve quality of life of transgender persons. 2 Specifically, voice training and therapy may be effective methods for improving voice perception in transgender women. 3 However, some may require pitch elevation surgeries to achieve desired pitch. Transgender women also frequently seek genital surgery to construct a neovagina. Despite their benefits, each surgical procedure portends the risks of anesthesia, hospitalization, and complications. As an academic hospital center specializing in comprehensive surgical and therapeutic management of transgender patients, we are often able to combine surgical procedures to minimize these risks. Most recently, we have combined feminizing glottoplasty (FG) and penile inversion vaginoplasty (PIV). This has served to prevent two anesthetics, minimize travel, improve patient care, and decrease cost. We are unaware of previous reports combining these two important gender-affirming feminizing procedures. 2 | CASE SERIES Three patients, age range 45-51 years old, underwent combined FG and PIV at our center between 2017 and 2018. Each

Meta-Analysis of Validated Quality of Life Outcomes Following Voice Feminization in Transwomen

“…All 5 studies reported preintervention and postintervention outcomes on a scale of 30-120 points. Lloyd et al 33 and Casado-Morente et al 34 found that EGL improved QoL scores as measured by the TWVQ, but did not report P values. Yilmaz et al 36 and Chang et al 35 found a significant improvement in TWVQ scores postintervention.…”

“…1). 9,12,[26][27][28][29][30][31][32][33][34][35][36][39][40][41] Of these, 2 studies assessed QoL improvements following VT without surgical intervention, 12 following EGL, 3 following LRGL, and 1 following CTA (Supplemental Table 2, Supplemental Digital Content 1, http:// links.lww.com/SCS/F497).…”

“…Of the reported data, there is a great deal of heterogeneity in surgical technique and clinical management, which limits the conclusions of reanalysis. In particular, technical approach (ie, extent of de-epithelialization 9,30,35,40 and number of sutures 26,27,[29][30][31][32]35,40 following glottoplasty), concomitant interventions (ie, chondrolaryngoplasty, 9,27,29,40 corticosteroids, 40 or antibiotics 40 ) and variable postoperative voice rest protocols (ranging from no intervention, 36 7-to 15-day voice rest 9,[26][27][28]32,33,35,40,41 or botulinum toxin-induced paralysis 29,31 ). Furthermore, the length of follow-up was variable among analyzed studies, which introduces potential bias as complete vocal fold healing may take up to 6 months.…”

“…However, psychometrically validated questionnaires do exist to assess voice-related QoL. These include the Voice Handicap Index (VHI), and more recently, the Trans Women Voice Questionnaire (TWVQ), among others 9,12,26–36 . However, although these instruments are validated to assess voice-related QoL, none are specifically validated in the setting of transwomen undergoing voice feminization interventions.…”

“…These include the Voice Handicap Index (VHI), and more recently, the Trans Women Voice Questionnaire (TWVQ), among others. 9,12,[26][27][28][29][30][31][32][33][34][35][36] However, although these instruments are validated to assess voice-related QoL, none are specifically validated in the setting of transwomen undergoing voice feminization interventions. As a result, at present there is no consensus on the most appropriate instrument for measuring QoL in this patient population.…”