Transgender pediatric surgical patients—Important perioperative considerations

Abstract

Transgender describes a variety of identities in which an individual's gender identity is different from expected based on the sex assigned at birth. In the United States, it is estimated that over 1 million adults and 150 000 youth identify as transgender, with increasing numbers being seen in healthcare and surgical settings. These numbers will continue to rise as visibility and acceptance grow. Current guidelines recommend transition‐related surgeries be reserved for older adolescents and adults. However, this is not the only circumstance in which the pediatric anesthesiologist may find themselves caring for a transgender patient. In order to provide the safest and most affirming care, it is crucial that the pediatric anesthesiologist develop a working knowledge of this unique and vulnerable population, including the potential impacts of gender‐affirming treatment on their perioperative care.

Pain outcomes following mastectomy or bilateral breast reduction for transgender and nontransgender patients who received pectoralis nerve blocks

“…It is well documented in the literature that women have higher pain scores than men 3 . In addition, studies suggest that transgender men (female to male) have higher pain scores than transgender females (male to female) and lower quality of life compared with nontransgender men 2‐5 . These data are from the adult population, as there are minimal data in the pediatric and adolescent population.…”

“…These data are from the adult population, as there are minimal data in the pediatric and adolescent population. It has also been shown that testosterone therapy in transgender men is associated with lower pain scores, and estrogen therapy in transgender women is associated with higher pain scores 3‐5 . However, there are no studies evaluating pain scores after pecs II block during mastectomy of the transgender patient.…”

“…This may be explained by the effects of hormone therapy (testosterone) on pain scores. Additionally, treatment for transgender patients, including surgery, has been shown to improve quality of life 3‐5 . Hormone therapy, in addition to motivation for recovery, better mood, and improved quality of life may contribute to these findings.…”

LGBTQ+ health and anaesthesia for obstetric and gynaecological procedures

“…Ideally, this affirming language is replicated in intake forms that allow patients to discretely self-identify their sex and gender identity, pronouns, sexuality and more demographic data. In addition, if a pregnancy test is needed preoperatively, the above authors provide examples of how this conversation can be initiated respectfully [35].…”

“…Two recent articles have replicated this framework but to identify important perioperative considerations when caring for transgender patients who are paediatric surgical patients [34,35]. The review article by Roque [35] emphasizes the importance of healthcare providers understanding and using basic, affirming terminology, specifically, as it relates to marginalized sex and sexual identities. Ideally, this affirming language is replicated in intake forms that allow patients to discretely self-identify their sex and gender identity, pronouns, sexuality and more demographic data.…”