Gender-Affirming Surgery in Persons with Gender Dysphoria

Abstract

The landscape of gender dysphoria has changed dramatically in recent years secondary to increased societal acceptance, legislative changes, and medical providers' increased awareness of the associated psychosocial burden associated with the diagnosis. National and global advocacy efforts, in conjunction with expanded third-party insurance coverage, have resulted in new health care opportunities for patients suffering from gender dysphoria. Delivering quality, streamlined health care to these patients requires a complex multidisciplinary approach, involving multiple medical and mental health disciplines, including plastic surgeons. To accommodate the expanding demand for gender-affirmation surgery, academic medical centers specializing in these procedures are gradually emerging. Advancing surgical techniques in the setting of rising patient demand encourage plastic surgeons to increasingly provide high-quality health care to this diverse patient population in an effort to optimize psychosocial functioning and minimize the burden of gender dysphoria. Although the current literature is replete with the evolving surgical and technical approaches to gender-affirming surgery, there remain critical gaps in the plastic surgery literature describing the delivery of comprehensive care to these patients. To address these gaps, the authors establish a framework that plastic surgeons can use to guide their management of patients with gender dysphoria to optimize surgical and psychosocial outcomes. First, the authors describe a timeline of events that have shaped present-day transgender medicine and characterize the current role of the plastic surgeon in the management of gender dysphoria. Subsequently, the authors discuss psychosocial and ethical considerations surrounding gender dysphoria. Finally, the authors discuss the future scope of transgender medicine.

The Relationship Between Tobacco Use and Legal Document Gender-Marker Change, Hormone Use, and Gender-Affirming Surgery in a United States Sample of Trans-Feminine and Trans-Masculine Individuals: Implications for Cardiovascular Health

“…In our sample, enacted stigma was associated with higher odds of past 3-month tobacco use in both trans-feminine and trans-masculine individuals, which is consistent with other research. 5,53 The process of gender transition is intended to alleviate gender dysphoria and increase gender affirmation, 54 which may promote resilience and buffer the negative effects of minority stress. 55,56 Therefore, if tobacco use is in fact a coping mechanism for minority stress, 24 then the enhanced coping capacity derived from gender transition may explain the association between transition and lower rates of tobacco use.…”

Outcomes in chest feminization patients with a history of illicit hormone use and silicone injections

“…Addressing the underlying cause of disadvantaged transgender individuals seeking illicit feminization procedures is essential to reducing both the barriers to GCS and the adverse outcomes of illicit substance use. Though the number of patients seeking GCS increased three‐fold in 2014 after improved Medicaid and Medicare legislation and expanded coverage by commercial insurance companies, there are still many transfeminine patients at risk of barriers to surgery that may encourage illicit therapies 21,24 . One‐quarter of transgender patients still report issues with insurance coverage in the USTS; additionally, increased demand for surgery has increased the need for surgeons specialized in GCS 1,24 .…”

“…Though the number of patients seeking GCS increased three‐fold in 2014 after improved Medicaid and Medicare legislation and expanded coverage by commercial insurance companies, there are still many transfeminine patients at risk of barriers to surgery that may encourage illicit therapies 21,24 . One‐quarter of transgender patients still report issues with insurance coverage in the USTS; additionally, increased demand for surgery has increased the need for surgeons specialized in GCS 1,24 . Among our patients, insurance obstacles, financial issues, and difficulty accessing surgeons with experience treating patients with a history of illicit treatment contributed to their delays in achieving chest feminization surgery.…”

Evaluating Patient Benefit From Laryngochondroplasty

“…According to Weissler et al, “national and global advocacy efforts, in conjunction with expanded third‐party insurance coverage, have resulted in new health care opportunities for patients suffering from gender dysphoria. Delivering quality, streamlined health care to these patients requires a complex multidisciplinary approach, involving multiple medical and mental health disciplines, including plastic surgeons.” 9 The gender pathways clinic provides hormone therapy, mental health services, sexual and reproductive healthcare, and surgical evaluation and procedures. There are several criteria for patients to meet who are interested in reducing their laryngeal prominence prior to referral for laryngochondroplasty.…”