Legislation, Market Size, and Access to Gender-affirming Genital Surgery in the United States

Dagi, Alexander F.; Boskey, Elizabeth R.; Nuzzi, Laura C.; Kang, Christine O.; Ganor, Oren; Labow, Brian I.; Taghinia, Amir H.

doi:10.1097/gox.0000000000003422

Cited by 12 publications

(13 citation statements)

References 48 publications

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“…Waiting lists may serve as an index of demand and operational capacity but may also reflect the impact of other factors such as financial constraints in a practice or the coverage of procedures by insurance. Accordingly, it may be productive to compare waiting lists discovered in this study with those found in analyses of other types of specialized health care provision 29 …”

Section: Discussionmentioning

confidence: 99%

“…Recent studies show that most physicians offering GABS are geographically concentrated in metropolitan areas, with greater than 55% practicing in Northeastern and West Coast states 28 . In addition, 47% of American states did not have a physician practice offering GABS 29 . A future of accessible health care for transgender patients would ideally include greater national distribution of health care practices that serve their medical needs without financial barriers.…”

Section: Discussionmentioning

confidence: 99%

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A Critical Assessment of the Transgender Health Care Workforce in the United States and the Capacity to Deliver Gender-Affirming Bottom Surgery

et al. 2022

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Background: Gender-affirming surgery is a critical component of transgender health care, but access information is limited. The study aim was to assess workforce capacity to perform gender affirming bottom surgeries (GABSs) in the United States. Methods: A questionnaire was administered via email, phone call, or fax from February to May 2020 to 86 practices identified as performing GABS by searching 10 Web-based databases with standardized keywords. Questions assessed training capacity, surgical capacity, and surgeon experience. Results: Thirty-two of 86 practices responded, 20 met the inclusion criteria. Practices were identified in 15 states, with an average 2.4 (SD, 1.3) surgeons performing GABS per year. States with the greatest number of total providers offering GABS were Illinois (n = 21), Texas (n = 10), and Massachusetts (n = 13). No significant correlation between number of GABS types offered and geographic population density (r = −0.40, P = 0.08), or between number of providers and geographic population density (r = 0.19, P = 0.44). Vaginoplasty was most frequently performed, with the longest waitlists and highest number of waitlist additions per month. Phalloplasty was the second most common procedure, and waitlist additions per month exceeded provider capacity to perform the procedure. Most surgeons performing GABS were plastic surgeons and urologists, whereas obstetricians/gynecologists performed the majority of hysterectomies. Conclusions: This study demonstrated a shortage of providers with requisite training and experience to provide GABS. Although more robust studies are needed to better characterize the relationship between the number of patients seeking GABS and available providers, these findings indicate a need for improved training.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Critical Assessment of the Transgender Health Care Workforce in the United States and the Capacity to Deliver Gender-Affirming Bottom Surgery

et al. 2022

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“…A small increase in the utility of gender-affirming care among self-pay patients in inclusion states was also noted. This may be due to cohort effects, arising from the culturally liberal nature of Northeastern states, better care access in those states, 13 or a response to the nationwide loosening of federal restrictions on gender-affirming care.…”

Section: Discussionmentioning

confidence: 99%

Legislations Mandating Insurance Coverage Are Highly Effective in Delivering Surgical Care of Transgender Patients

Faletsky

Jonczyk

Guo

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Although gender-affirming surgery is increasingly performed, few studies have examined any temporal correlation between legislations mandating transgender care and the actuation of such surgical care. Methods: We assembled a retrospective cohort utilizing the National Inpatient Sample database from 2000 to 2018. We stratified utility trends of gender-affirming surgery based on insurance payer types and regions in a crisscrossing effort to detect any temporal or cause-effect relationship between legislations and outcomes. All regions according to the latest National Inpatient Sample categorization were examined based on the nature of their member state’s legislations relating to gender-affirming care coverage. Diametrically, opposite regions were selected for further comparisons. Interrupted time series analyses were used to demonstrate any significant uptrend since implementation of relevant legislations. Results: In states with explicit inclusion of gender-affirming care, our interrupted time series analyses showed a significant increase in the number of patients on state-dependent insurance (Medicaid and private insurance) receiving gender-affirming surgery around the time during which state legislations began mandating care ( P < 0.01) and thereafter ( P < 0.01). This significance was not seen in the same regions among patients under nonstate-dependent payers (Medicare and self-pay), nor was it seen in either payer group in states without explicit inclusion of gender-affirming care. At the federal level, statistical significance was noted among Medicare recipients across all states around the time federal legislations took effect and thereafter. Conclusion: Legislations mandating coverage seem highly effective in actuating surgical care of transgender patients in corresponding jurisdictions, which may provide a roadmap for further care expansion.

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“…[1][2][3][4] As the stigma associated with such procedures has started to recede, the field began a rapid growth with the current workforce insufficient to meet demand. [5][6][7] With this growth, a paradigm shift will be critical to preserving the quality of care. This is in part brought on by the rising popularity of procedures far more rarely attempted in previous decades.…”

Section: Introductionmentioning

confidence: 99%

Unreasonable Expectations: A Call for Training and Educational Transparency in Gender-affirming Surgery

Boskey

Kant

2023

Plastic and Reconstructive Surgery - Global Open

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Summary: Although in most areas of practice, there is a reasonable expectation that doctors are sufficiently trained to offer care, this is not true in the case of gender-affirming procedures, which are not required learning in any surgical residency. At the current time, the field of gender surgery is too rapidly evolving, with available resources too scarce for fellowship or residency training to be a realistic requirement for offering these procedures, as the demand already outstrips the available workforce. However, patients are currently given too little information about surgeons’ history with these procedures to provide truly informed consent. There is, as such, an ethical mandate to mold the culture of gender-affirming surgery such that surgeons are expected to routinely disclose relevant information about their training, experience, and outcomes to facilitate patient decision-making about care.

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Legislation, Market Size, and Access to Gender-affirming Genital Surgery in the United States

Cited by 12 publications

References 48 publications

A Critical Assessment of the Transgender Health Care Workforce in the United States and the Capacity to Deliver Gender-Affirming Bottom Surgery

A Critical Assessment of the Transgender Health Care Workforce in the United States and the Capacity to Deliver Gender-Affirming Bottom Surgery

Legislations Mandating Insurance Coverage Are Highly Effective in Delivering Surgical Care of Transgender Patients

Unreasonable Expectations: A Call for Training and Educational Transparency in Gender-affirming Surgery

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