High Body Mass Index is A Significant Barrier to Gender-Confirmation Surgery for Transgender and Gender-Nonbinary Individuals

Martinson, Tyler; Ramachandran, Shruti; Lindner, Rebecca; Reisman, Tamar; Safer, Joshua D.

doi:10.4158/ep-2019-0345

Cited by 37 publications

(35 citation statements)

References 18 publications

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“…To our knowledge, while there has been work investigating how ED might affect gender affirmation more generally (Martinson, Ramachandran, Lindner, Reisman, & Safer, 2020) and exploring ED as a function of perceptions of gender affirmation (Testa, Rider, Haug, & Balsam, 2017), there have been no studies evaluating ED symptomatology as a function of GAI. In the present study, ED symptomatology was examined within a population of transgender patients receiving outpatient care.…”

Section: Introductionmentioning

confidence: 99%

Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation

Nowaskie

Filipowicz

Choi

et al. 2021

Intl J Eating Disorders

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Objective: Past studies have reported high rates of eating disorder (ED) symptomatology among transgender people, yet without consideration of gender affirmation. The primary objective of this study was to evaluate the relationship between gender identity, gender affirming interventions such as gender affirming hormones (GAH) and gender affirming surgeries (GAS), and ED symptomatology. Method: Transgender patients at a primary care outpatient gender health program in the United States completed a survey consisting of demographics, medical history, and clinical variables, including the Eating Disorder Examination Questionnaire (EDE-Q). Multivariate analyses of covariance were conducted to compare EDE-Q scores across gender identity and gender affirmation.Results: Compared to transgender men (n = 79), transgender women (n = 87) reported higher EDE-Q scores and significantly higher Eating Concern. Compared to hormone/surgery-naïve and hormone-experienced/surgery-naïve patients, hormone/ surgery-experienced patients had lower EDE-Q scores. Hormone/surgeryexperienced patients reported significantly lower Shape Concern and marginally lower Global Score and Weight Concern than hormone-experienced/surgery-naïve patients. There were no differences in EDE-Q scores between hormone/surgerynaïve and hormone-experienced/surgery-naïve patients.Discussion: Transgender patients report high levels of ED symptomatology. There are subtle, yet important, differences in ED between gender identities and gender affirmations. High ED prevalence may result from the dual pathways of sociocultural pressures as well as gender dysphoria. Both GAH and GAS may be effective interventions to support gender affirmation and thereby alleviate ED symptomatology. While the potential positive benefits of GAS on ED are more apparent, the effects of GAH are less clear.

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Section: Introductionmentioning

confidence: 99%

Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation

Nowaskie

Filipowicz

Choi

et al. 2021

Intl J Eating Disorders

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“…Consistent with other studies, our cohort had a high prevalence of traditional risk factors for cardiovascular disease such as obesity, hypertension, hyperlipidemia, and tobacco use. [ 7 , 17 , 18 ] Likewise, high rates of anxiety and depression were noted, both of which also have strong associations with CVD. [ [19] , [20] , [21] ] Mental illness may be related to risk factors that are more difficult to collect by chart review but nevertheless impact cardiovascular health, such as minority stress, health illiteracy, transportation barriers, and under-employment.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Transgender Women Referred to Women's Heart Clinic

Mahowald

Maheshwari

Lara-Breitinger

et al. 2021

American Journal of Preventive Cardiology

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Introduction Transgender women have been reported to have a high burden of cardiovascular disease (CVD) and risk factors based largely on surveys. Our aim was to describe the prevalence of CVD and associated comorbidities among a cohort of older transgender women referred to cardiology as part of their gender-affirming care. Methods This was a retrospective, cross-sectional study of transgender women at a single institution from 2017 to 2019. Results Fifty-two consecutive patients were included. The most common reasons for referral were cardiac risk factor management (45%) and pre-operative cardiac risk stratification prior to gender-affirming surgery (35%). The mean age was 57 ± 10 years, 87% were white, and 92% had insurance coverage. Forty-eight patients (92%) were taking gender-affirming hormone therapy; 5 had undergone breast augmentation, 4 had undergone orchiectomy, and 2 had undergone vaginoplasty. The most common comorbidities were depression and/or anxiety (63%), obesity (58%), and hyperlipidemia (54%). Excluding aldosterone antagonists, 46% were on cardiac medications; changes were recommended for 25% of patients: new prescriptions in 9, dose adjustments in 5, and discontinuations in 4. According to the pooled cohort equation, the 10-year risk of atherosclerotic CVD was 9.4 ± 7.7% when the study population was calculated as male and 5.2 ± 5.1% when calculated as female ( p <0.001). For patients who completed exercise testing, the functional aerobic capacity was fair (77.6 ± 21.4%) when calculated as male and average (99.5 ± 27.5%) as female ( p < .0001); there was inconsistency in sex used for calculating the result on the formal report. Conclusions Older transgender women may have an underestimated prevalence of CVD and its risk factors. More research is needed to identify cardiovascular health profiles, improve practice consistency, and establish normative values for transgender patients.

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“…To date, there are no studies of microvascular free flap phalloplasty or vaginoplasty in which the median BMI was greater than 30 kg/m 2 [Tables 2 and 3] [38][39][40][41][42][43][44][45][46][47][48][49][50] . An analysis of 1457 patients seeking consults for any gender-affirming surgery at a single high-volume institution from 2015-2019 demonstrated that 382 (26%) patients had a BMI ≥ 30 kg/m 2 at initial consult, and that 369 (27%) patients had a BMI ≥ 30 kg/m 2 at their subsequent consult [51] .…”

Section: Published Literature Does Not Provide Robust Evidence For Fa...mentioning

confidence: 99%

“…Gaither et al [50] 2018 Perineal Penile inversion vaginoplasty 25 (22-29) Not reported BMI: Body mass index.…”

Section: Evidence Applicable To Vaginoplasty and Colpectomymentioning

confidence: 99%

Weight stigma mitigating approaches to gender-affirming genital surgery

Castle¹,

Blasdel²,

Shakir³

et al. 2022

Plast Aesthet Res

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The use of body mass index (BMI) to determine eligibility for gender-affirming surgery in transgender and nonbinary individuals has been contested. While BMI thresholds are often meant to be protective, restricting patients from access to surgery can also cause harm. There is a rationale for the continued use of BMI, but the inherent problems with it must also be recognized, including how weight stigma impacts patients’ access to gender-affirming surgery and influences clinical care. This article uses a narrative review of current literature to discuss how high BMI affects surgical outcomes in gender-affirming genital surgeries, as well as analogous procedures, existing de facto BMI thresholds, and how to both minimize the harms of proceeding with surgery in patients with a high BMI or the harms of delaying for weight loss. BMI factors into surgical decision-making based on the existing literature, which demonstrates that high BMI is associated with increased surgical risk, including higher incidences of surgical site infections and poor wound healing, as well as the possibility of free flap complications, which are a component of certain genital procedures. This patient population is at higher risk for eating disorders, and it is prudent to find alternatives to requiring patient self-monitored weight management. The impacts of weight stigma should be considered when treating gender-affirming surgery patients, and further data and research are needed to augment shared decision-making and lead to practice change.

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High Body Mass Index is A Significant Barrier to Gender-Confirmation Surgery for Transgender and Gender-Nonbinary Individuals

Cited by 37 publications

References 18 publications

Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation

Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation

Characteristics of Transgender Women Referred to Women's Heart Clinic

Weight stigma mitigating approaches to gender-affirming genital surgery

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