3.4 Gender Confirming Surgical Care in Adolescence: Evidence, Timing, Options, and Outcomes

Abstract

Requests for gender- confirming surgical procedures have dramatically increased, particularly for adolescents with gender dysphoria. Although there is mounting evidence that surgery is safe, effective, and leads to improved quality of life for transgender adults, there are significant ethical challenges with respect to offering irreversible interventions for minors. Surgeons depend on mental health providers to assess for eligibility and readiness criteria for certain irreversible procedures in minors, particularly chest masculinization (“top surgery”) for the transmasculine population. In contrast, mental health professionals need to know about the surgical aspects care, across pre-, peri-, and postoperative stages. Lastly, mental health providers’ knowledge of potential future surgeries that may be sought during adulthood is important when families and youth have questions on current decisions (puberty blockers, hormones, and their effects on future surgical outcomes) and future emotional and sexual functioning.