An Overview of Gender-affirming Surgical Fellowships in the United States

Abstract

PURPOSE: In recent years, there has been a significant increase in the awareness and demand of gender transition surgery. Surgical transition often occurs in specialized centers due to the involvement of a multidisciplinary team. Thus, residents may have limited clinical experience in gender transition and seek out fellowships. This study aims to assess the formation and characteristics of gender-affirming surgical fellowships in the United States. METHOD: A cross-sectional study was performed on all institutions with an accredited plastic surgery residency program in the United States. The official website for each program was reviewed for the presence of a gender transition fellowship. The authors then contacted program coordinators through email or telephone interview to collect data on the characteristics of the fellowship. RESULTS: The authors included 102 academic institutions in this study, less than half (n=48, 47%) were known as ‘Leader in LGBT Healthcare’ centers. Seven transgender fellowships were identified; however, data was only available for 6 fellowships. All fellowships (n=6) had a 12 month duration and the average stipend was $81,225. All offered training in masculinizing and feminizing chest reconstruction. Five provided training in both masculinizing and feminizing genital reconstruction (83%), whereas one fellowship provided training in neither. Strikingly, significantly more fellowships offered facial feminization training than facial masculinization (83% vs 33%, p<0.001). CONCLUSION: The creation of transgender surgery fellowships in plastic surgery reflects the growing demand for gender-affirming surgical training and provision. Although there is universal fellowship training in chest reconstruction, there are fewer learning opportunities for genital reconstruction and facial masculinization surgery.