Trends in Gender-affirming Surgery in Insured Patients in the United States

Lane, Megan; Ives, Graham C.; Sluiter, Emily C.; Waljee, Jennifer F.; Yao, Tsung Hung; Hu, Hsou Mei; Kuzon, William M.

doi:10.1097/gox.0000000000001738

Cited by 158 publications

(127 citation statements)

References 8 publications

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“…Gender-affirming surgery is currently recommended for individuals aged at least 16 years of age but often ≥18 years 12. Recent insurance database analysis and patient-reported outcome studies identified patients as young as 14 years old undergoing a gender-affirming mastectomy 18 19. Some research works suggest there are psychosocial benefits to individuals receiving gender mastectomy in their teens 18 20–22.…”

Section: Medical Gender Affirmation: Risks and Benefits In Minorsmentioning

confidence: 99%

Medically assisted gender affirmation: when children and parents disagree

et al. 2019

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Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have disagreements concerning their gender-affirming medical care. Through arguments based on ethical, paediatric, adolescent and transgender health research, we illustrate ethical dilemmas that may arise in treating transgender and gender diverse youth. We discuss three potential avenues for providing gender-affirming care over parental disagreement: legal carve-outs to parental consent, the mature minor doctrine and state intervention for neglect. Our discussion approaches this parent–child disagreement in a manner that prioritises the developing autonomy of transgender youth in the decision-making process surrounding medically assisted gender affirmation. We base our arguments in the literature surrounding the risks and benefits of gender-affirming therapy in transgender children and the existing legal basis for recognising minors’ decision-making authority in certain medical situations.

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Section: Medical Gender Affirmation: Risks and Benefits In Minorsmentioning

confidence: 99%

Medically assisted gender affirmation: when children and parents disagree

et al. 2019

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“…DISCUSSION An estimated 0.6% of the US population identifies as transgender and an increasing number of these individuals seek gender-affirming surgery. 7 As a result, pathologists will be more frequently encountering specimens from genderaffirming surgery. Currently, there is a lack of established guidelines on how to best sample breast tissue from these surgeries.…”

Section: Comparative Analysis Between Gender-affirming Surgery and Rmmentioning

confidence: 99%

Pathologic Evaluation of Breast Tissue From Transmasculine Individuals Undergoing Gender-Affirming Chest Masculinization

Hernández¹,

Schwartz²,

Warfield³

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Bilateral mastectomy for chest masculinization is one of the gender-affirming procedures for transmasculine individuals. Objective.— To optimize gross handling protocols and assess histopathologic findings in transmasculine breast tissue specimens. Design.— We identified all gender-affirming mastectomies from 2015 to 2018. We sequentially identified reduction mammoplasty (RM) cases for macromastia from the same period as control. Significant findings were defined as atypical ductal or lobular hyperplasia (ADH, ALH), ductal or lobular carcinoma in situ (DCIS, LCIS), or invasive carcinoma. Results.— Significant findings were present in 6 of 211 gender-affirming mastectomies (2.8%) as follows: ADH (n = 5) and LCIS together with ALH (n = 1). By comparison, 19 of 273 RM specimens (7%) yielded significant findings as follows: ALH (n = 11), ADH (n = 4), LCIS (n = 2), DCIS (n = 1), and invasive lobular carcinoma (n = 1). In the gender-affirming group, 142 transmen underwent androgen therapy before surgery, of whom 2 had significant pathologic findings. Thirty and 41 individuals had a family history of breast cancer in the gender-affirming and RM group, of whom 1 and 3 individuals had significant pathologic findings, respectively. Conclusions.— Our study demonstrates that we handle transmasculine mastectomy specimens by examining 2.8 times more slides on average than for RMs, with a 2.5 times lower rate of significant pathologic findings. Prior family history of breast cancer or the use of androgen therapy before surgery in gender-affirming individuals did not increase the risk of identifying significant breast lesions. We recommend submitting 4 tissue blocks per mastectomy for individuals undergoing gender-affirming breast surgery.

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“…Despite this phalloplasty chaos, we emphasize that masculinizing genital GCS is medically necessary with well-demonstrated health benefits for properly selected patients. With an increased volume of these procedures being performed [78] , and with further research in all domains, we anticipate continual advances in this difficult and challenging area of surgery.…”

Section: Stagingmentioning

confidence: 99%

Phalloplasty: understanding the chaos

2020

Plast Aesthet Res

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Wide variation in overall strategies and surgical specifics for masculinizing genital surgery has created a "phalloplasty chaos" that is confusing to both surgeons and patients seeking gender confirming surgery. The purpose of this article is to review masculinizing genital confirming surgery, or "phalloplasty", focusing on specific goals and categorizing each component of the surgical process. Experienced surgeons from several highvolume centers review and categorize the commonly employed strategies and techniques for gender confirming phalloplasty, including the permutations of approaches to cutaneous flap for phallic construction, the sequence and staging of procedures, and strategies for urethral construction. There is no clear advantage or reduction in complications associated with particular sequences of urethral and phallic reconstruction. Because no single technique or staging strategy has proven superior for gender confirming genital surgery, it is paramount that surgeons are knowledgeable of all available options and the associated advantages, disadvantages, and risks.

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Trends in Gender-affirming Surgery in Insured Patients in the United States

Abstract: Supplemental Digital Content is available in the text.

Cited by 158 publications

References 8 publications

Medically assisted gender affirmation: when children and parents disagree

Medically assisted gender affirmation: when children and parents disagree

Pathologic Evaluation of Breast Tissue From Transmasculine Individuals Undergoing Gender-Affirming Chest Masculinization

Phalloplasty: understanding the chaos

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