Prevalence and Types of Gender-Affirming Surgery Among A Sample of Transgender Endocrinology Patients Prior to State Expansion of Insurance Coverage

Kailas, Maya; Lu, Hsun Ming Simon; Rothman, Emily F.; Safer, Joshua D.

doi:10.4158/ep161727.or

Cited by 74 publications

(44 citation statements)

References 19 publications

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“…This finding is similar to a recent retrospective chart review conducted at a specialized endocrinology clinic where 35% of transgender patients had a history of gender-affirming surgery. 36 Consistent with our study, this chart review found that TM patients underwent chest construction surgery more often than hysterectomy and/or oophorectomy, and that TF patients underwent either breast augmentation or genital surgery more often than facial feminization surgery. A recent survey study of both TM and TF adults found that 23% of respondents reported past chest surgery and 11% reported past genital reconstruction surgery.…”

Section: Discussionsupporting

confidence: 89%

Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults

et al. 2017

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Purpose: Gender-affirming surgeries and hormone therapy are medically necessary treatments to alleviate gender dysphoria; however, significant gaps exist in the research and clinical literature on surgery utilization and age of hormone therapy initiation among transgender adults.Methods: We conducted a retrospective review of electronic health record data from a random sample of 201 transgender patients of ages 18–64 years who presented for primary care between July 1, 2010 and June 30, 2015 (inclusive) at an urban community health center in Boston, MA. Fifty percent in our analyses were trans masculine (TM), 50% trans feminine, and 24% reported a genderqueer/nonbinary gender identity. Regression models were fit to assess demographic, gender identity-related, sexual history, and mental health correlates of gender-affirming surgery and of age of hormone therapy initiation.Results: Overall, 95% of patients were prescribed hormones by their primary care provider, and the mean age of initiation of masculinizing or feminizing hormone prescriptions was 31.8 years (SD=11.1). Younger age of initiation of hormone prescriptions was associated with being TM, being a student, identifying as straight/heterosexual, having casual sexual partners, and not having past alcohol use disorder. Approximately one-third (32%) had a documented history of gender-affirming surgery. Factors associated with increased odds of surgery were older age, higher income levels, not identifying as bisexual, and not having a current psychotherapist.Conclusion: This study extends our understanding of prevalence and factors associated with gender-affirming treatments among transgender adults seeking primary care. Findings can inform future interventions to expand delivery of clinical care for transgender patients.

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Section: Discussionsupporting

confidence: 89%

Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults

et al. 2017

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“…* This is different from cisgender individuals, whose gender identity aligns with the sex assigned at birth. Most transgender/genderqueer AFAB individuals do not undergo surgical removal of their natal reproductive organs, 2–4 and as a result, cancers of these organs, including the cervix, can still develop. 5–7…”

Section: Introductionmentioning

confidence: 99%

Motivators and Barriers to Accessing Sexual Health Care Services for Transgender/Genderqueer Individuals Assigned Female Sex at Birth

et al. 2019

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Purpose: Individuals who were assigned female sex at birth (AFAB) but do not conform to the gender binary (i.e., transgender/genderqueer) often do not seek out necessary sexual health care, including Papanicolaou (Pap) tests, placing them at heightened risk of cervical cancer. Despite growing awareness, scant research has focused on the sexual health care experiences of this population in Midwestern and rural states. Methods: We used two approaches to develop a more detailed understanding of factors that determine sexual health care use. Seventeen transgender/genderqueer AFAB individuals completed a quantitative knowledge survey then participated in a semistructured qualitative interview to further elaborate their experiences with sexual health care services as well as the motivators and barriers related to accessing the health care system. We produced descriptive summaries of quantitative data and conducted a thematic analysis of interview transcripts. Results: The sample was mostly young adults, of whom nearly all were white and 65% self-identified as transgender men. Participants displayed good knowledge about human papillomavirus (HPV) and Pap tests; however, 41% rated themselves as “unaware” and 59% rated themselves as “aware but not well informed” about HPV. Fifty-nine percent had ever obtained a Pap test. We identified one facilitating factor (health care provider's role and relationship) and three inhibiting factors (availability of competent care; distress about seeking sexual health care; health care setting characteristics) related to obtaining Pap tests. Conclusion: As this study was conducted in the U.S. Midwest, findings extend the geographic scope of existing knowledge and may inform future risk reduction interventions and clinical practice.

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“…Persons who were assigned male sex at birth who have feminine gender identities are referred to as transgender women (also as trans women, transfeminine, or male-to-female). Conversely, persons who were assigned female sex at birth who have masculine gender identities are referred to as transgender straints, or a paucity of access to surgeons who perform gender-affirming surgery (7,8). These rates are now increasing as many third-party payers expand coverage for gender-affirming surgery.…”

Section: Terminologymentioning

confidence: 99%

Imaging Findings in Transgender Patients after Gender-affirming Surgery

Stowell¹,

Grimstad²,

Kirkpatrick³

et al. 2019

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Gender-affirming surgeries expand the options for physical transition among transgender patients, those whose gender identity is incongruent with the sex assigned to them at birth. Growing medical insight, increasing public acceptance, and expanding insurance coverage have improved the access to and increased the demand for gender-affirming surgeries in the United States. Procedures for transgender women, those patients with feminine gender identity, include breast augmentation using implants and genital reconstruction with vaginoplasty. Some transgender women receive medically unapproved silicone injections for breast augmentation or other softtissue contouring procedures that can lead to disfigurement, silicone pulmonary embolism, systemic reactions, and even death. MRI is preferred over CT for postvaginoplasty evaluation given its superior tissue contrast resolution. Procedures for transgender men, patients with a masculine gender identity, include chest masculinization (mastectomy) and genital reconstruction (phalloplasty or metoidioplasty, scrotoplasty, and erectile device implantation). Urethrography is the standard imaging modality performed to evaluate neourethral patency and other complications, such as leaks and fistulas. Despite a sizeable growth in the surgical literature about gender-affirming surgeries and their outcomes, detailed descriptions of the imaging features following these surgeries remain sparse. Radiologists must be aware of the wide variety of anatomic and pathologic changes unique to patients who undergo gender-affirming surgeries to ensure accurate imaging interpretation.

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Prevalence and Types of Gender-Affirming Surgery Among A Sample of Transgender Endocrinology Patients Prior to State Expansion of Insurance Coverage

Cited by 74 publications

References 19 publications

Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults

Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults

Motivators and Barriers to Accessing Sexual Health Care Services for Transgender/Genderqueer Individuals Assigned Female Sex at Birth

Imaging Findings in Transgender Patients after Gender-affirming Surgery

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