Promoting Gender Reassignment Surgical Service in Thailand among International Transgenders

This research paper examines the growing popularity of the medical tourism industry in Thailand, analyzing whether it is an affordable, world-class healthcare system or just another business strategy to attract tourists. This study, by focusing on various areas of Thai healthcare, including their cost structure, quality, overall professionalism, infrastructure, sheds light on the findings collected from primary and secondary sources about healthcare services in Thailand. This study has used a mixed method of data analysis with a combination of qualitative information obtained from healthcare professionals with quantitative data collected through surveying domestic and foreign tourists who have already used the healthcare services in Thailand. The results show that medical tourism in Thailand is not just affordable, but also meets international accreditation standards and has been able to establish a reputation in specific medical areas with complexities for example Sex Reassignment Surgery (SRS). The research also reveals the challenges faced by medical tourists due to language barriers, causing major concerns and serious misconceptions. While Thailand has established itself as a prominent medical tourism destination for individuals seeking medical treatment from nearby countries as well as patients from other distant continents. The research recognizes the need for collaboration between healthcare providers, policymakers, and the tourism sector to improve the overall medical tourism experience, finding better marketing strategies and working on existing issues, which can improve the sector and create a better experience.

Transgender and gender diverse (TGD) veterans have a greater prevalence of suicide morbidity and mortality than cisgender veterans. Gender-affirming surgery (GAS) has been shown to improve mental health for TGD veterans. In 2021, the Veterans Health Administration (VHA) announced the initiation of a rulemaking process to cover GAS for TGD patients. This study explores patients' and providers' perspectives about access to GAS and other gender-affirming medical interventions not offered in the VHA including barriers, facilitators, and clinical and policy recommendations. TGD patients (n = 30) and VHA providers (n = 22). Semi-structured telephone interviews conducted from August 2019 through January 2020. Two TGD analysts used conventional and directed content analysis to code transcribed data. VHA policy exclusions were the most cited barrier to GAS. Additional barriers included finding information about GAS, traveling long distances to non-VHA surgeons, out-of-pocket expenses, post-surgery home care, and psychological challenges related to the procedure. Factors facilitating access included surgical care information from peers and VHA providers coordinating care with non-VHA GAS providers. Pre- and post-operative care through the VHA also facilitated receiving surgery; however, patients and providers indicated that knowledge of these services is not widespread. Respondents recommended disseminating information about GAS-related care and resources to patients and providers to help patients navigate care. Additional recommendations included expanding access to TGD mental health specialists and establishing referrals to non-VHA GAS providers through transgender care coordinators. Finally, transfeminine patients expressed the importance of facial GAS and hair removal. A policy change to include GAS in the VHA medical benefits package will allow the largest integrated healthcare system in the United States to provide evidence-based GAS services to TGD patients. For robust and consistent policy implementation, the VHA must better disseminate information about VHA-provided GAS-related care to TGD patients and providers while building capacity for GAS delivery.

An estimated 0.6% of the U.S. population identifies as transgender and an increasing number of patients are presenting for gender-related medical and surgical services. Utilization of health care services, especially surgical services, by transgender patients is poorly understood beyond survey-based studies. In this article, our aim is 2-fold; first, we intend to demonstrate the utilization of datasets generated by insurance claims data as a means of analyzing gender-related health services, and second, we use this modality to provide basic demographic, utilization, and outcomes data about the insured transgender population. The Truven MarketScan Database, containing data from 2009 to 2015, was utilized, and a sample set was created using the Gender Identity Disorder diagnosis code. Basic demographic information and utilization of gender-affirming procedures was tabulated. We identified 7,905 transgender patients, 1,047 of which underwent surgical procedures from 2009 to 2015. Our demographic results were consistent with previous survey-based studies, suggesting transgender patients are on average young adults (average age = 29.8), and geographically diverse. The most common procedure from 2009 to 2015 was mastectomy. Complications of all gender-affirming procedures was 5.8%, with the highest rate of complications occurring with phalloplasty. There was a marked year-by-year increase in utilization of surgical services. Transgender care and gender confirming surgery are an increasing component of health care in the United States. The data contained in existing databases can provide demographic, utilization, and outcomes data relevant to providers caring for the transgender patient population.

Needs of transgender children and adolescents presenting to an urban gender health program

We characterized referral trends over time at a transgender clinic within an integrated health system in Northern California. We identified the transition-related requests of pediatric transgender and gender-nonconforming patients and evaluated differences in referrals by age group. Medical records were analyzed for all patients <18 years of age in the Kaiser Permanente Northern California health system who were referred to a specialty transgender clinic between February 2015 and June 2018. Trends in treatment demand, demographic data, service requests, and surgical history were abstracted from medical charts and analyzed by using descriptive statistics. We identified 417 unique transgender and gender-nonconforming pediatric patients. The median age at time of referral was 15 years (range 3-17). Most (62%) identified on the masculine spectrum. Of the 203 patients with available ethnicity data, 68% were non-Hispanic. During the study period, the clinic received a total of 506 referrals with a significant increase over time (P < .001). Most referrals were for requests to start cross-sex hormones and/or blockers (34%), gender-affirming surgery (32%), and mental health (27%). Transition-related requests varied by age group: younger patients sought more mental health services, and older patients sought hormonal and surgical services. Eighty-nine patients underwent gender-affirming surgeries, mostly before age 18 and most frequently mastectomies (77%). The increase in referrals supports the need for expanded and accessible health care services for this population. The transition-related care of patients in this large sample varied by age group, underscoring the need for an individualized approach to gender-affirming care.

116 Experience of patients attending the National Maternity Hospital for gender affirmation surgery

Purpose: This investigation examined how coverage of gender-affirming surgery differs between states that do and do not have prohibitions against explicit transgender exclusions in private insurance. Methods: Insurance policies for gender-affirming surgery were obtained from the three largest insurers, by market share, in each state. Policies were reviewed manually between May and August of 2019. The number of major gender-affirming surgical services covered by each policy was recorded. This investigation examined coverage of facial feminization/masculinization, augmentation mammoplasty, mastectomy, phalloplasty, vaginoplasty, thyroid chondroplasty, and hair removal. Descriptive statistics were calculated to compare the number of services covered in states that do and do not prohibit transgender exclusions in private insurance. Results: The total number of gender-affirming surgical services covered by insurance policies ranged from zero to seven. The mean number of services covered in states prohibiting transgender exclusions in private insurance was 4.52, whereas the mean in states without prohibitions against transgender exclusions was 3.83. The mean difference was 0.69 (95% confidence interval = 0.17-1.21, p = 0.004). Although almost all policies covered phalloplasty, vaginoplasty, and mastectomy, the policies of the top insurers in states without prohibitions against transgender exclusions were significantly less likely to cover hair removal (p = 0.03), thyroid chondroplasty (p = 0.0008), and facial feminization/masculinization (p = 0.01). Conclusion: Insurers in states prohibiting transgender exclusions in private insurance offered coverage of a small but significant number of additional gender-affirming surgical services compared with states allowing transgender exclusions. Although a core group of services was covered almost universally, insurers based in states allowing transgender exclusions were much less likely to cover services that are sometimes thought of as less central to transgender care.

The University of Michigan has played an important role in advancing gender-affirming surgery programs in the United States. The University of Michigan was home to a little-known gender identity clinic shortly after the opening of the first such clinic at Johns Hopkins. Since 1995, the University of Michigan Comprehensive Services Program (UMCGSP) has been continually offering surgical services to transgender and gender diverse patients. Here, we present the history of both programs, drawn from program documents and oral history, and explore their implications for the future sustainability of gender-affirming surgery programs. The original gender identity clinic opened in 1968, and operated in a multidisciplinary fashion, similar to other clinics at the time. Eventually, the clinic was closed due to disinvestment and lack of sufficient providers to maintain the program, problems which are being increasingly recognized as barriers for similar programs. The modern program, UMCGSP is perhaps the longest continually running gender-affirming surgical program at an academic center. In spite of challenges, key investments in education, statewide community engagement, and the development of a comprehensive care model have helped UMCGSP avoid the pitfalls of the earlier clinic and remain relevant throughout its nearly 30-year history. In the face of rising challenges to gender-affirming care in the United States, much can be learned from the sustainability of the UMCGSP. Institutions seeking to maintain gender-affirming surgery programs should ensure the availability of comprehensive care and promote the education of the health care workforce.

UK figures estimate that in 1998 there were 3170 people over the age of 15 years assigned as male at birth who had presented with gender dysphoria. This figure is...