Gender Affirmation Surgery, Transmasculine

Lee, Wai Gin; Christopher, Andrew N.; Ralph, David

doi:10.1016/j.ucl.2022.04.007

Cited by 5 publications

(4 citation statements)

References 63 publications

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“…This shared decision-making framework should also be incorporated into RT consent discussions. The chest, genitals, and face are the most common sites of gender-affirming surgery ( 5 , 21 – 23 ). For RT to a site of prior gender-affirming surgery, consent should include discussion of possible effects on the appearance or function of reconstructed tissues.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer

Mansur,

Kempf,

Bitterman

et al. 2023

Front. Oncol.

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IntroductionApproximately 1.6 million people in the US identify as transgender, many of whom undergo gender-affirming medical or surgical therapies. While transgender individuals are diagnosed with cancer at similar rates as those who are cisgender, the impacts of radiation therapy on outcomes of gender-affirming care in transgender, nonbinary, and gender-expansive people with cancer are understudied. We report on the experiences and outcomes of transgender and gender-expansive patients receiving radiation therapy for cancer treatment.MethodsThis study is a multi-institutional retrospective review of patients evaluated from 2005-2019 identified as transgender or gender-expansive in the medical record and treated with radiation therapy.ResultsWe identified 23 patients who received radiation to 32 sites, including 12 (38%) to the brain, head, or neck, 8 (25%) to the thorax, and 7 (22%) to the pelvis. Seventeen patients (74%) received gender-affirming hormone therapy and 13 patients (57%) underwent gender-affirming surgery. Four patients had pelvic radiation before or after gender-affirming pelvic surgery, including two trans women who had pelvic radiation after vaginoplasty. Four patients had radiation to the chest or thorax and gender-affirming chest or breast surgery, including two trans men with breast cancer. Two pediatric patients developed hypopituitarism and hypogonadism secondary to radiation therapy and, as adults, changed their hormone replacement therapy to affirm their transgender identities.DiscussionTransgender people with cancer undergo radiation therapy for a wide range of cancers. Understanding their prior gender-affirming medical or surgical treatments and future gender affirmation goals may identify important considerations for their oncologic care.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer

Mansur,

Kempf,

Bitterman

et al. 2023

Front. Oncol.

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“…Historical data suggest that the majority of transmasculine individuals feel this is a priority to their surgical affirmation (1)(2)(3)(4). Changes in urologic function and urologic complications (i.e., urethrocutaneous fistulae and urethral stricture) are unfortunately common and may present as urinary leakage (1,(5)(6)(7)(8).…”

Section: Review Articlementioning

confidence: 99%

“…Post-operative phallic length and visibility are difficult to estimate at time of consultation and often are limited by body fat distribution. When accompanied by urethral lengthening, patients may be able to void while standing; several series report 87-100% success with standing to void, though this is difficult to predict preoperatively (5,6,15). Patients may elect to undergo metoidioplasty without urethral lengthening, scrotoplasty or vaginectomy ("simple metoidioplasty").…”

Section: Metoidioplastymentioning

confidence: 99%

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy

Fascelli¹,

Sajadi²,

Dugi³

et al. 2023

Transl Androl Urol

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Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications-i.e., urethrocutaneous fistulae and urinary stricture-are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15-70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment.

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“…Transmasculine genitourinary surgical interventions, including phalloplasty and metoidioplasty, alter the appearance and function of preexisting pelvic anatomy with the goal of achieving transmasculine gender identity congruence. Metoidioplasty involves urethral extension by tubularization of labial and vaginal flaps, whereas phalloplasty requires both local and distal free flap transfer—often from the forearm or anterolateral thigh—in one or multiple stages [31 ▪ ]. Phalloplasty is favored in patients who aim to both perform penetrative sexual intercourse and stand while voiding since conventional metoidioplasty precludes the former.…”

Section: Introductionmentioning

confidence: 99%

Anesthesia for gender-affirming surgery: a practical review

Sanchez,

Tollinche,

Reece-Nguyen

2024

Current Opinion in Anaesthesiology

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Purpose of review Gender-affirming surgery (GAS) is an effective, well studied, and often necessary component of gender-affirming care and mitigation of gender dysphoria for transgender and gender-diverse (TGD) individuals. GAS is categorized as chest surgeries, genitourinary surgeries, facial feminization/masculinization, and vocal phonosurgery. Despite increased incidence of GAS during recent years, there is a gap in knowledge and training on perioperative care for TGD patients. Recent findings Our review discusses the relevant anesthetic considerations for the most common GAS, which often involve highly specialized surgical techniques that have unique implications for the anesthesia professional. Summary Anesthesiology professionals must attend to the surgical and anesthetic nuances of various GAS procedures. However, as many considerations are based on common practice, research is warranted on anesthetic implications and outcomes of GAS.

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Gender Affirmation Surgery, Transmasculine

Cited by 5 publications

References 63 publications

Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer

Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy

Anesthesia for gender-affirming surgery: a practical review

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