Letter to the Editor: Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence

Expósito-Campos, Pablo; D’Angelo, Roberto

doi:10.1097/gox.0000000000003951

Cited by 6 publications

(6 citation statements)

References 5 publications

(9 reference statements)

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“…29 Existing studies on gender-affirming surgery in adolescents are often limited by small sample sizes and short follow-up periods, which may not provide a comprehensive understanding of the long-term rates of regret associated with these procedures. 35,36 Further research is needed to fully understand the long-term outcomes and establish evidence-based guidelines.…”

Section: Discussionmentioning

confidence: 99%

National Legislative Favorability and Insurance Coverage for Adult and Adolescent Gender-Affirming Surgery

LaValley,

Diaddigo,

Asadourian

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Despite established medical necessity, laws prohibiting coverage discrimination, and increasing numbers of transgender and gender diverse patients seeking gender-affirming surgeries (GAS), cost and restrictive insurance policies continue to be the most common barriers. As recent legislation places further restrictions on GAS, this study aims to provide an updated review of insurance policies and assess the relationship between legislative favorability and coverage. Methods: Insurance policies of groups representing 80% market coverage in each state were collected for gender-affirming chest, genital and facial surgery. Policies were categorized based on previously published methodologies: never-covered (N), case-by-case (CC), and preauthorization (PA). The relationship between established scores of legislative favorability and policy coverage in each state was analyzed and compared across regions. Results: Of the 316 analyzed policies, coverage was preauthorized most often for genital (94.0%), masculinizing top (93%), feminizing top (74%), and facial reconstruction (24%), respectively. Higher legislative scores in the Northeast and West, as well as individual states were predictive of increased genital, facial, and all forms of adolescent GAS, but were not correlated to chest GAS. Conclusion: Compared to previous studies, our findings suggest that there is a growing acceptance of GAS as medically necessary. However, the correlation between legislative scores and genital, face, and adolescent GAS coverage may suggest increased reliance on sociopolitical factors for access in the absence of comprehensive medical guidelines, which are more established for chest reconstruction. Significantly higher coverage of masculinizing versus feminizing chest surgery suggests additional burden of proof for GAS with a cosmetic overlap.

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Section: Discussionmentioning

confidence: 99%

National Legislative Favorability and Insurance Coverage for Adult and Adolescent Gender-Affirming Surgery

LaValley,

Diaddigo,

Asadourian

et al. 2023

Plastic &Amp; Reconstructive Surgery

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show abstract

“…90 (The number who detransition, regret, and/or have been harmed is unknown due to the lack of adequate longterm outcome studies. [91][92][93][94] ) It has also long been observed in studies that in the absence of medicalization and social transition, the majority 77 Block, op. cit.…”

Section: Kraschel Et Al Statementioning

confidence: 99%

Politics Aside, Healthcare Considerations Motivate More Caution before Medical Intervention for Trans-Identifying Youth

Cohn¹

2023

Controversial Ideas

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The 2022 article “Legislation restricting gender-affirming care for transgender youth: Politics eclipse healthcare” by K. L. Kraschel et al. implies that attempts in the United States to restrict medical interventions for gender dysphoria are due to political motivations. Although there are likely some whose stance on these interventions is based upon politics, there are sound medical reasons, independent of politics, for advocating for more cautious medical intervention protocols. Neglecting mention of these reasons obscures the fact that medical intervention outcomes are difficult to predict and that serious risks and irreversible consequences are present. In other countries, following extensive evidence review, supportive alternatives to medical intervention are being prioritized instead. Here, several claims of Kraschel et al. regarding the state of medical intervention healthcare are compared to the research evidence and shown to fall short. Healthcare issues alone justify challenging current United States medical treatment protocols.

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“…We would like to thank Expósito-Campos and D’Angelo for their letter 1 in response to our systematic review. 2 The first remark in their letter criticizes the adequacy of the search strategy. On this matter, we followed the PRISMA guidelines and a comprehensive search strategy was designed and conducted by an experienced librarian and the study’s principal investigator using the PICO framework (participants, interventions, comparisons, outcomes).…”

Section: Sirmentioning

confidence: 99%

“…Additionally, a controlled vocabulary and defined keywords were used to search for relevant studies; this is exhibited in Supplemental Digital Content 1. 2 Regarding the inclusion of the study conducted by Jiang et al, 3 it was included because it complied with the selection criteria which was clearly stated in our methods section. 2 Certainly, the objective of the study in mention was “to review their experience performing gender-affirming vulvoplasty and to determine which factors influenced patient choice or surgeon recommendation of vulvoplasty, as well as to assess the patient’s satisfaction or regret with this choice.” 3 Therefore, based on authors’ discretion and agreement, it was concluded that the study referred to regret with the choice of undergoing the procedure.…”

Section: Sirmentioning

confidence: 99%

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Reply: Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence

Escandón

Bustos²,

Bustos

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Letter to the Editor: Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence

Cited by 6 publications

References 5 publications

National Legislative Favorability and Insurance Coverage for Adult and Adolescent Gender-Affirming Surgery

National Legislative Favorability and Insurance Coverage for Adult and Adolescent Gender-Affirming Surgery

Politics Aside, Healthcare Considerations Motivate More Caution before Medical Intervention for Trans-Identifying Youth

Reply: Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence

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