Should Gender‐Affirming Surgery Be Prioritized During the COVID‐19 Pandemic?

Abstract

Before the coronavirus disease 2019 (COVID-19) pandemic, a transgender woman was scheduled for gender-affirming surgery (GAS) in the form of facial feminization surgery (FFS), including rhinoplasty, frontal sinus reduction, and laryngeal chondroplasty. In response to the international medical crisis, a shelter-in-place order was implemented, and her surgeon was mandated to postpone elective surgical procedures indefinitely. Now, the shelter-in-place order has expired, and surgeons around the globe are preparing for transition back toward more widespread health care delivery. The patient's surgeon has begun performing medically necessary, nonurgent procedures. The surgeon's hospital has a low COVID-19 census, has adequate personal protective equipment (PPE), and is testing all preoperative patients for COVID-19. The patient calls to inquire about her FFS. She is informed that GAS was recently categorized as ''routine priority'' by professional guidelines and therefore will be rescheduled later. She disagrees with this determination, arguing that FFS should be prioritized over other elective procedures due to severe gender dysphoria (GD) and its effects on her overall health. She is also concerned her insurance authorization for the procedures will be jeopardized. This case is hypothetical. Point: It is reasonable to deprioritize GAS procedures during the COVID-19 pandemic. GAS procedures are an important part of genderaffirming care (GAC) but do not in themselves represent a cure for GD or guarantee symptomatic relief. GD, the psychological distress that results from incongruence between gender identity and natally assigned gender, causes clinically significant impairment in social, occupational, and other important areas of functioning. 1 Furthermore, the stigma and

Understanding the Impact of the COVID-19 Pandemic on the Mental Health of Transgender and Gender Nonbinary Individuals Engaged in a Longitudinal Cohort Study

“…Beginning in March 2020, healthcare systems in the U.S. ceased providing nonessential (i.e., non-emergent) healthcare services to combat the spread of COVID-19 (COVIDSurg Collaborative, 2020). This move may have further restricted access to gender-affirming medical care; such interruptions in gender-affirming care may increase psychological distress among TGNB people (Flaherty, Sharma, Crosby, & Nuara, 2020;van der Miesen, Raaijmakers, & van de Grift, 2020).…”

Prevalence and associations of COVID-19 testing in an online sample of transgender and non-binary individuals

“…For instance, having limited access to gender-affirming surgery increased the odds of testing, which may show that while gender-affirming surgery was limited during the pandemic, the ability to get tested for COVID-19 was readily accessible for people who are already engaged with the health system when it was offered. In addition, previous research has noted the additional concerning mental health challenges that may occur due to limited or postponed gender-affirming surgery, 47 48 which suggest that this postponement may lead to increased testing but may not reduce COVID-19 incidence in this population, and further research on the impact of limited or postponed surgery must be done.…”

Extra-Pulmonary Complications in SARS-CoV-2 Infection: A Comprehensive Multi Organ-System Review

“…Navigating gender-affirming care has been especially challenging during this pandemic [112]. Gender affirming surgeries (GAS) have been postponed until further notice, causing severe gender dysphoria [112].…”

“…Navigating gender-affirming care has been especially challenging during this pandemic [112]. Gender affirming surgeries (GAS) have been postponed until further notice, causing severe gender dysphoria [112]. Stigmatization of transgender and non-binary conforming (TGNC) individuals foments social, emotional, and occupational impairment, which could lead to a decline in physical and mental health [112].…”

“…Gender affirming surgeries (GAS) have been postponed until further notice, causing severe gender dysphoria [112]. Stigmatization of transgender and non-binary conforming (TGNC) individuals foments social, emotional, and occupational impairment, which could lead to a decline in physical and mental health [112]. Logistically speaking, postponing GAS can also jeopardize insurance approvals, which may set their transition back even further [112].…”