Reassignment Surgery Research Articles

National Estimates of Gender-Affirming Surgery in the US

While changes in federal and state laws mandating coverage of gender-affirming surgery (GAS) may have led to an increase in the number of annual cases, comprehensive data describing trends in both inpatient and outpatient procedures are limited. To examine trends in inpatient and outpatient GAS procedures in the US and to explore the temporal trends in the types of GAS performed across age groups. This cohort study includes data from 2016 to 2020 in the Nationwide Ambulatory Surgery Sample and the National Inpatient Sample. Patients with diagnosis codes for gender identity disorder, transsexualism, or a personal history of sex reassignment were identified, and the performance of GAS, including breast and chest procedures, genital reconstructive procedures, and other facial and cosmetic surgical procedures, were identified. Weighted estimates of the annual number of inpatient and outpatient procedures performed and the distribution of each class of procedure overall and by age were analyzed. A total of 48 019 patients who underwent GAS were identified, including 25 099 (52.3%) who were aged 19 to 30 years. The most common procedures were breast and chest procedures, which occurred in 27 187 patients (56.6%), followed by genital reconstruction (16 872 [35.1%]) and other facial and cosmetic procedures (6669 [13.9%]). The absolute number of GAS procedures rose from 4552 in 2016 to a peak of 13 011 in 2019 and then declined slightly to 12 818 in 2020. Overall, 25 099 patients (52.3%) were aged 19 to 30 years, 10 476 (21.8%) were aged 31 to 40, and 3678 (7.7%) were aged12 to 18 years. When stratified by the type of procedure performed, breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients. Performance of GAS has increased substantially in the US. Breast and chest surgery was the most common group of procedures performed. The number of genital surgical procedures performed increased with increasing age.

Endocrinological Approach to Adolescents with Gender Dysphoria: Experience of a Pediatric Endocrinology Department in a Tertiary Center in Turkey

A significant rise in the number of trans adolescents seeking medical interventions has been reported in recent years. The aim of this study was to report the clinical features, treatment, and follow-up of adolescents with gender dysphoria (GD) with our increased experience. Twenty-six male-to-female (MTF) and twenty-seven female-to-male (FTM) adolescents who were referred to the GD-outpatient clinic between 2016 and 2022 were reviewed. The clinical and laboratory findings of thirty transgender adolescents (15 FTM /15 MTF) who received medical intervention were evaluated retrospectively. Most individuals (60.4%) were admitted between 2020 and 2022, and the remaining (39.6%) were admitted between 2016 and 2019. At the time of referral, median age was 16.3 years [interquartile range (IQR) 1.53; range 13.2-19.4] in 26 MTF, and 16.4 years (IQR 1.74; range 11.7-21.6) in 27 FTM adolescents. The median age at pubertal blockage with gonadotropin-releasing hormone analog and androgen receptor blocker was 16.4 years (IQR 1.4; range 11.7-17.8) in 22 adolescents (9 MTF, 13 FTM), and 17.4 years (IQR 1.4; range 15.5-19.4) in 6 MTF individuals, respectively. Cross-sex hormone therapy was commenced in 21 adolescents (12 MTF, 9 FTM) at the median age of 17.7 years (IQR 0.61; range 16-19.5). Fifteen individuals (8 MTF, 7 FTM) have been transferred to the adult endocrinology department in transition clinics. All treatments were generally well tolerated and effective, including bicalutamide, and no significant side effects were observed. Transition clinics played an important role in the better management of gender reassignment processes.

Gender/sex markers, bio/logics, and U.S. identity documents

Policies about changing gender/sex on identity documents provide insights into definitions of gender/sex, and impact especially transgender and/or nonbinary lives. We investigated these on U.S. driver's licenses and birth certificates to understand variability in these policies, including in comparison to an earlier report in 2014, and to explore what kinds of “bio/logics” (decision rules rooted in biological or biologistic thinking) might be at play. Results show that the most common requirements in 2020 included proof of gender affirming surgery, a letter from a medical doctor, and hormone therapy. Compared to 2014, results showed an increase in requirements for hormone therapy and letters from therapists or medical doctors, and a decrease in requirements for gender affirming surgery. We highlight how this suggests a shift to “pubertal bio/logics”: rooting gender/sex definitions in secondary sex characteristics. This contrasts with previous requirements that pointed to “newborn bio/logics”: rooted in genital definitions of gender/sex affirmed by a surgico-medical authority. Both support policy framings of gender/sex as a biophenomenon, though with different impacts for trans and/or nonbinary livability. Our study provides insights into U.S. state definitions of gender/sex, and their multiple and contradictory biological views on gender/sex, with implications especially for transgender and/or nonbinary individuals’ lives.

The Implementation of MUI's Fatwa on the Position of Transgender Individuals, Gender Reassignment Surgery and Genital Refinement

This research describes the implementation of the fatwa issued by the Indonesian Council of Ulama (MUI) regarding the position of transgender individuals, gender reassignment surgery, and genital perfection in Pangkep regency, South Sulawesi, Indonesia. The research employs a qualitative methodology through interviews and a literature review. The research results show the implementation of the MUI fatwa on the position of transgender individuals is hindered by several factors. Firstly, the recognition of human rights as regulated in the law emphasizes that basic human rights and freedoms are inherent rights that should be protected, respected, and upheld for the improvement of human dignity, welfare, happiness, intelligence, and justice. Secondly, the MUI fatwa is not legally binding in the concept of the Indonesian state. Thirdly, the fatwa cannot be fully implemented in areas where transgender individuals are recognized. The researchers concluded that the implementation of genital perfection provides legal status for transgender individuals with dual genders or genital anomalies. الملخص تتحدث هذه الدراسة عن تنفيذ الفتوى التي أصدرها مجلس علماء إندونيسيا (MUI) بشأن موقف الأفراد المتحولين جنسياً، وجراحة إعادة تعيين الجنس، والكمال الجنسي في منطقة بانكيب بجنوب سولاويسي. وتعتمد الدراسة منهجيةً نوعيةً من خلال المقابلات ومراجعة المكتبية. وتشير النتائج إلى أن تنفيذ فتوى MUI بشأن موقف الأفراد المتحولين جنسياً يتعرض لعدة عوامل عائقة، فأولاً، فإن اعتراف حقوق الإنسان التي تنظمها القانون تشدد على أن حقوق الإنسان الأساسية والحريات هي حقوق متأصلة يجب حمايتها واحترامها وتعزيزها لتحسين الكرامة والرفاهية والسعادة والذكاء والعدالة الإنسانية. ثانيًا، فإن فتوى MUI ليست ملزمة قانونًا في مفهوم الدولة الإندونيسية. وثالثًا، فإن الفتوى لا يمكن تنفيذها بالكامل في المناطق التي تم الاعتراف فيها بالأفراد المتحولين جنسيًا. ويتصل تنفيذ الفتوى المتعلقة بجراحة إعادة تعيين الجنس والكمال الجنسي بالإرث والزواج والنسب والعبادة. حيث يحق للأفراد المتحولين جنسيًا الذين يخضعون لجراحة إعادة تعيين الجنس الحصول على حقوق الإرث وفقًا لجنسهم قبل الجراحة، في حين يحق لأولئك الذين يخضعون للكمال الجنسي الحصول على حقوق الإرث وفقًا لجنسهم بعد الجراحة. الأفراد الذين يخضعون لجراحة تحويل الجنس والتبديل الجنسي لا يسمح لهم بالزواج من الجنس الآخر، ويعتبر زواجهم معادلًا لزواج المثليين. الأفراد الذين يخضعون لتحسين الأعضاء التناسلية يمكنهم الزواج من أي شخص ينتمي إلى الجنس الذي ينتمي إليه بعد العملية. أما أطفال الأفراد الذين يخضعون لتحسين الأعضاء التناسلية، فيتبعون نسب أبيهم. ينبغي للأفراد الذين يخضعون لجراحة تحويل الجنس العبادة وفقًا لجنسهم قبل الجراحة، في حين يجب على الأفراد الذين يخضعون لتحسين الأعضاء التناسلية العبادة وفقًا لجنسهم بعد الجراحة. وفي الختام، يوفر تنفيذ تحسين الأعضاء التناسلية الوضع القانوني للأفراد ذوي الجنس المزدوج أو التشوهات الجنسية. مفتاح البحث: فتوى MUI , المتحولون جنسيًا, جراحة إعادة تعيين الجنس, الكمال الجنسي, حقوق الإنسان Abstrak Penelitian ini menjelaskan tentang implementasi fatwa MUI tentang kedudukan Waria, operasi perubahan dan penyempurnaan kelamin di kabupaten Pangkep Sulawesi Selatan, Indonesia. Penelitian ini menggunakan metode kualitatif melalui wawancara dan kajian pustaka. Hasil penelitian menunjukkan bahwa implementasi fatwa MUI mengenai kedudukan individu transgender terkendala oleh beberapa faktor. Pertama, ada pengakuan hak asasi manusia yang diatur dalam Undang-Undang yang menegaskan bahwa hak asasi manusia dan kebebasan dasar adalah hak kodrati yang melekat pada manusia dan harus dilindungi, dihormati, dan ditegakkan demi peningkatan martabat kemanusiaan, kesejahteraan, kebahagiaan, kecerdasan, dan keadilan. Kedua, fatwa MUI tidak mengikat secara hukum dalam konsep negara Indonesia. Ketiga, fatwa tersebut tidak dapat sepenuhnya diterapkan di daerah di mana individu transgender diakui. Peneliti menyimpulkan bahwa implementasi operasi perbaikan kelamin memberikan status hukum bagi individu transgender dengan jenis kelamin ganda atau kelainan organ kelamin. Kata Kunci: Fatwa; Implementasi; Transgender; Perbaikan Kelamin; Operasi Kelamin

Description d’une technique de vaginoplastie utilisant un lambeau péritonéal prélevé par voie cœlioscopie pour les affirmations de genre homme-à-femme (HtF)

The aim of this article is to provide a comprehensive description of the peritoneal flap technique in male-to-female (MtF) gender affirmation surgery, particularly in cases of insufficient depth after penile inversion vaginoplasty. Our short-term results reveal that the peritoneal flap vaginoplasty, adapted from the Davydov procedure, has shown significant potential for improving functional and aesthetic outcomes, including the creation of a self-lubricating neovagina. However, the complexity of the procedure requires advanced surgical expertise and appropriate postoperative care. Patient selection also plays an essential role as not all patients are ideal candidates for this procedure. Despite its promises, the widespread adoption of the peritoneal flap technique in male-to-female (MtF) gender affirmation surgery is hindered by several challenges, including the need for specialized training and potential postoperative complications. Thus, this technique should be considered as an alternative or complement to traditional methods, depending on individual patient factors. Further research and extensive clinical trials are needed to better understand its potential and limitations in order to enhance the arsenal of effective surgical options for MtF gender affirmation surgery.

Chirurgie de réassignation : techniques chirurgicales pour le thorax

Thoracic reassignment surgeries are the most common gender reassignment surgeries. They represent the first and sometimes the only step in the reassignment process for transgender patients. Surgical techniques for thoracic reassignment derive from those used for the cisgender population and are accessible to plastic surgeons who do not usually treat transgender patients. On the other hand, there are some anatomical differences between men and women that they should understand, for instance, the positioning of the neo-NAC, the neo-inframammary fold and the scars. It is therefore important to understand these anatomical differences in order to optimize the cosmetic results of these surgeries so that they correspond to the expectations of these patients. In addition, the plastic surgeon will also have to be careful to adapt his approach to the relational level, with these patients, such as avoiding misgendering or using the "dead name". Finally, even if these operations are theoretically covered at 100% by the French health insurance, a request for prior agreement may be required in certain cases.

The Limited Coverage of Facial Feminization Surgery in the United States: A Literature Review of Policy Constraints and Implications.

There is a literature gap regarding facial feminization surgery (FFS) access and coverage. Our goal is to compile information from previous studies and assess the current policy landscape for these surgeries in the US. We also explored why some policies do not cover them, identify states with better coverage, and determine the most covered procedures. PubMed, Medline, Embase, and Scopus were searched for studies that reviewed policies on FFS coverage. Studies on surgical techniques or other gender-affirming surgeries (GASs) that did not involve FFS were excluded. Seven studies were included for analysis. In 2014, the Department of Human Health Services (HHS) lifted the transgender exclusion policy, leading to an increase in policies regarding GASs for both private and state insurance. However, there are differences in medical necessity requirements among policies, which may not align with the World Professional Association for Transgender Health (WPATH) criteria. States that prohibit exclusion tend to offer better coverage for FFS. These states are mainly located in the western and northeast regions, whereas states in the southern and middle east regions have less coverage. Among the procedures, chondrolaryngoplasty is the most covered, while facial and cervical rhytidectomy are the least covered. To enhance transgender care, it is crucial to reach a consensus on how to offer coverage for facial feminization surgery. However, there is a lack of adequate research on this topic, and there is a need for resources and tools to assess the results of FFS procedures. One significant constraint of this study is that it does not provide a systematic review of the literature.

Formalization of Prosecutorial Supervision and Atrophy of the Real Human Rights Functions of the Prosecutor’s Office, Including the Fight Against Corruption in Law Enforcement Agencies, in the Kyrgyz Republic as a Result of the Deprivation of the Prosecutor’s Office of the Authority to Investigate Criminal Cases in 2023

The need to leave the authority to investigate malfeasance with the prosecutor's office of the Kyrgyz Republic, the relevance of other legislative initiatives on the reform of law enforcement agencies, as well as the need for laws in the field of counteracting the promotion of non-traditional sexual relations, since propaganda is gaining momentum in the Kyrgyz Republic more and more every day , including the veiled one, especially through social networks, sexual perversions, gender reassignment, pedophilia, propaganda of everything that destroys a person in all respects. Based on the speech of the President of the Kyrgyz Republic in honor of the 30th anniversary of the Constitution of the Kyrgyz Republic on May 5, 2023, the main threats to the Kyrgyz statehood and national security are named. Under such circumstances, today's legislative initiatives to exclude investigative functions from the prosecutor's office in the absence of any need justified by objective indicators and without an objective analysis of the activities of the investigative work of prosecutors are perceived as an attempt to sabotage the constitutional institution, designed to protect the rights and protected by law. interests of citizens, society and the state.

Multidimensional Assessment of Patient-Reported Outcomes After Gender-Affirming Surgeries Using a Validated Instrument.

Limited literatures used validated instruments to evaluate patient-reported outcomes (PROs) for transgender and gender-diverse population undergoing gender-affirming surgeries (GASs). This study aimed to evaluate PROs using a newly validated psychometric instrument, Vanderbilt Mini Patient-Reported Outcome Measures-Gender (VMP-G). Vanderbilt Mini Patient-Reported Outcome Measures-Gender assesses 4 scales: quality of life, self-concept, satisfaction, and gender dysphoria. Scores range from 20 to 100, with higher scores representing superior PROs. Descriptive analysis was performed, and outcomes were compared in different races/ethnicities, gender identities, age, types of GAS, and time. Patients seeking GAS at Vanderbilt University Medical Center from October 11, 2021, to October 11, 2022, were included. Data were collected anonymously via the Research Electronic Data Capture survey tool at preoperative or postoperative clinic visits. A total of 207 patients completed VMP-G. Average age was 31.8 years (SD, ±11.5 years). Fifty-three percent of patients were postoperative GAS. In bivariate and linear regression analyses, postoperative patients scored higher on all scales compared with preoperative patients ( P < 0.001). After adjustment, postoperative patients scored 12.5 higher on VMP-G compared with preoperative patients ( P < 0.01). In subset analyses, GAS was associated with improved PROs in White, non-White, binary, and nonbinary and patients younger than 21 years ( P < 0.05). After GAS, patients younger than 21 years reported similar outcomes, compared with patients older than 21 years ( P > 0.05). No PROs differences were reported between patients who underwent top versus bottom surgery ( P = 0.2). Postoperative patients reported low rates of regret (2.8%). Scores on the VMP-G were sustained even 1 year after GAS. Each month after GAS was associated with a score improvement of 0.02 in the gender dysphoria domain after adjusting for patient demographics ( P = 0.02). Using a validated GAS-specific measure, we found that surgery sustainably improves patients' self-reported outcomes including gender dysphoria.

The Effect of Preoperative Diagnosis of Depression and/or Anxiety on Patient-Reported Outcomes Following Chest Wall Masculinization Surgery.

Individuals with gender dysphoria have disproportionately high rates of depression and anxiety compared to the cisgender population. Although the benefits of gender affirmation surgery have been well documented, it is unclear whether depression and anxiety affect postoperative patient-reported outcomes (PRO). The authors evaluated the impact of preoperative anxiety or depression on clinical and PRO in patients undergoing chest masculinization surgery. Patients who underwent chest masculinization surgery within a 5-year period were reviewed. Demographics and clinical variables were abstracted from medical records. PRO of chest, nipple, and scar satisfaction were obtained postoperatively with the BODY-Q. Groups were stratified by preoperative anxiety, preoperative depression, both, or no history of mental health diagnosis. Univariate and multivariate analyses were performed. Of 135 patients with complete survey responses, 10.4% had anxiety, 11.9% depression, 20.7% both diagnoses, and 57.0% no diagnosis. Clinical data and outcomes were similar. Patients with preoperative depression correlated with lower satisfaction scores for scar appearance (P = .006) and were significantly more likely to report feelings of depression postoperatively (P = .04). There were no significant differences in chest or nipple satisfaction among groups. Although anxiety and depression are prevalent in gender minorities, we found no association with postoperative clinical outcomes. Patients with preoperative depression were more likely to report lower satisfaction with scar appearance and feelings of depression postoperatively. However, there were no differences in chest or nipple satisfaction. These results highlight the importance of perioperative mental health counseling but also suggest that patients can be satisfied with their results despite a coexisting mental health diagnosis.

Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

There has been increasing legislative interest in regulating gender-affirming surgery, in part due to the concern about decisional regret. The regret rate following gender-affirming surgery is thought to be approximately 1%; however, previous studies relied heavily on ad hoc instruments. To evaluate long-term decisional regret and satisfaction with decision using validated instruments following gender-affirming mastectomy. For this cross-sectional study, a survey of patient-reported outcomes was sent between February 1 and July 31, 2022, to patients who had undergone gender-affirming mastectomy at a US tertiary referral center between January 1, 1990, and February 29, 2020. Decisional regret and satisfaction with decision to undergo gender-affirming mastectomy. Long-term patient-reported outcomes, including the Holmes-Rovner Satisfaction With Decision scale, the Decision Regret Scale, and demographic characteristics, were collected. Additional information was collected via medical record review. Descriptive statistics and univariable analysis using Fisher exact and Wilcoxon rank sum tests were performed to compare responders and nonresponders. A total of 235 patients were deemed eligible for the study, and 139 responded (59.1% response rate). Median age at the time of surgery was 27.1 (IQR, 23.0-33.4) years for responders and 26.4 (IQR, 23.1-32.7) years for nonresponders. Nonresponders (n = 96) had a longer postoperative follow-up period than responders (median follow-up, 4.6 [IQR, 3.1-8.6] vs 3.6 [IQR, 2.7-5.3] years, respectively; P = .002). Nonresponders vs responders also had lower rates of depression (42 [44%] vs 94 [68%]; P < .001) and anxiety (42 [44%] vs 97 [70%]; P < .001). No responders or nonresponders requested or underwent a reversal procedure. The median Satisfaction With Decision Scale score was 5.0 (IQR, 5.0-5.0) on a 5-point scale, with higher scores noting higher satisfaction. The median Decision Regret Scale score was 0.0 (IQR, 0.0-0.0) on a 100-point scale, with lower scores noting lower levels of regret. A univariable regression analysis could not be performed to identify characteristics associated with low satisfaction with decision or high decisional regret due to the lack of variation in these responses. In this cross-sectional survey study, the results of validated survey instruments indicated low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy. The lack of dissatisfaction and regret impeded the ability to perform a more complex statistical analysis, highlighting the need for condition-specific instruments to assess decisional regret and satisfaction with decision following gender-affirming surgery.

Robotics in Gender Affirming Surgery: Current Applications and Future Directions.

Genital surgery for the treatment of gender dysphoria has undergone significant evolution since its inception in the first half of the 20th century. Robotic approaches to the pelvis allow for improved visualization and reduced abdominal wall morbidity, making the robotic surgical system a very useful tool in the gender affirming genital surgeon's armamentarium. In penile inversion vaginoplasty, robotically harvested peritoneal flaps can be used to augment the vaginal canal, thereby leading to improved vaginal depth, as well as improve operative efficiency by facilitating a two-surgeon approach. In transgender men, the robotic approach to vaginectomy assists with visualization to confirm complete obliteration of the vaginal canal. Robotic surgery will play a central role in the continued evolution of the field of gender affirming surgery.

Arrhythmogenic substrate elimination for safe testosterone therapy in symptomatic Brugada syndrome patients.

Brugada Syndrome (BrS) is a cardiogenetic disease known for its association with sudden cardiac death (SCD) in individuals with structurally normal hearts. The prevalence of BrS is higher in males, who also face a greater risk of SCD. Its higher prevalence and worse outcome in male subjects may be due to testosterone effects on ion channels expression and function. The influence of testosterone on cardiac action potentials, both genomically and non-genomically, underscores its potential role in unmasking the syndrome and triggering life-threatening arrhythmias. Notably, testosterone replacement therapy (TRT), used for hypogonadism and gender reassignment, has been linked to BrS unmasking. The role of epicardial ablation in symptomatic BrS patients where hormonal therapy cannot be discontinued is unknown. In this study we describe the first two cases of substrate mapping and ablation in BrS patients experiencing arrhythmic events while on TRT. In both cases, high-density epicardial mapping revealed abnormal areas of prolonged and fragmented electrograms in the right ventricular (RV) outflow tract and anterior wall. These abnormalities were completely abolished by radiofrequency ablation (RFA). After ablation, both patients showed a persistent normalization of the ECG and were free from ventricular arrhythmias at follow-up, despite ongoing TRT. RFA can be considered as a therapeutic option in symptomatic BrS patients with a high-risk profile who cannot discontinue TRT, being essential for restoring their normal physiology or preserving their sexual identity. As testosterone use is increasing, further studies are warranted to define a standardized diagnostic and therapeutic strategy in this specific subset of BrS patients.

Robotics in Microsurgery and Supermicrosurgery.

Microsurgery has changed the ability to perform highly precise and technical surgeries through the utilization of high-powered microscopes and specialized instruments to manipulate and repair anatomical structures as small as a few millimeters. Since the first human trials of robotic-assisted microsurgery in 2006, the expansion of microsurgery to supermicrosurgery (luminal diameter less than 1 mm) has enabled successful repair of previously inaccessible structures. Surgical robotic systems can offer two distinct operative advantages: (1) minimal access surgery-by entering body cavities through ports, flap harvest can be redesigned to affect a minimally invasive approach for flaps such as the rectus abdominis muscle, the latissimus flap, and the deep inferior epigastric perforator flap; and (2) precision-by eliminating physiologic tremor, improving ergonomics, increasing accessibility to difficult spaces, and providing motion scaling, precision is significantly enhanced. Robotic-assisted microsurgery is a promising application of robotics for the plastic surgeon and has played an important role in flap harvest, head and neck reconstruction, nerve reconstruction, gender-affirming surgery, and lymphatic reconstruction-all the while minimizing surgical morbidity. This article aims to review the history, technology, and application of microsurgery and supermicrosurgery in plastic surgery.

ЮРИДИЧЕСКАЯ ХРОНИКА

In the August Legal Chronicle, read comments on the Acts of the Supreme Court on the proceedings in criminal appeal, on the jurisdiction of criminal cases, the fate of income from the sale of only housing of bankrupt, on the unity of the system of state bodies and the mutual responsibility of the taxpayer and state bodies, as well as the commentary on the law on the gender reassignment.

Characterizing Gender-Affirming Voice Intervention Discussion on Social Media: A Cross-Platform Analysis

Gender-affirming voice treatments, such as voice training and surgery, are highly impactful for transgender patients experiencing vocal dysphoria and may be discussed on social media platforms including Twitter and Reddit. Our goal was to characterize the content and sentiment of social media posts pertaining to gender-affirming voice interventions to better understand the needs of this patient population. Retrospective data-mining study. A total of 18,695 Tweets from 2001 to 2021 and 23,742 r/Transvoice Reddit submissions and comments from 2009 to 2020 were extracted via publicly available application programming interfaces and analyzed using language processing and sentiment analysis techniques. One thousand eighty-six highly emotive r/Transvoice posts related to voice modification treatments were manually reviewed for further classification. Online discussion of gender-affirming voice has increased over time and is centered on vocal feminization. Recurrent themes included use of online training resources, singing voice, and barriers to care such as cost and variable experiences with health care providers. Sentiment analysis demonstrated that posts discussing gender-affirming voice training had higher average sentiment scores than those discussing voice surgery, on both Twitter (0.252 vs 0.161; P<0.001) and Reddit (0.349 vs 0.301; P<0.001). Frequently appearing themes in highly negative surgery posts included mixed outcomes (9.3%), surgical complications (9.3%), and recovery time (8.5%). Common themes shared by the positive subgroup analysis included peer support, vocal quality, and importance of practice. Gender-diverse patients share various concerns and resources relating to voice intervention in the online communities of Twitter and Reddit. The discussion has been growing over the past decade and is mostly positive, with significant social support and resource-sharing within the community. Aggregated online sentiment toward gender-affirming voice surgery is more negative than voice training, largely due to concerns about surgical outcomes and variability, risks, and recovery period.

Occupational Therapy’s Role for Gender Affirming Surgeries: Vaginoplasty and Vulvoplasty

This article explores the new surgical population of gender affirming surgery, specifically vaginal surgeries for transgender and gender diverse people. There are established perioperative rehabilitation guidelines for nearly all other surgeries. A growing population of people is seeking gender affirming healthcare which includes vaginal surgery. This article reviews the guidelines set forth by the World Professional Association for Transgender Health Standards of Care (Version 8), explores the occupational needs of this population, as well as provides suggestions for future versions of official documents of the American Occupational Therapy Association to provide more inclusive language for the unique needs of this population following surgery.

Inclusive Healthcare Settings: Promoting Post-operative Follow-up in Transgender Voice Care through Awareness and Education

Objectives: Gender-affirming laryngeal surgeries are becoming more common. Surgical outcomes for benign laryngeal disease are often affected by post-operative care. Documented barriers to medical care faced by transgender persons may affect their ability to participate in post-operative care visits and may affect their overall outcome. This study was initiated to compare the post-operative follow-up rates between patients who underwent gender-affirming laryngeal surgery and those who underwent voice surgery for non-neoplastic vocal fold lesions.

Cancer screening and management in the transgender population: Review of literature and special considerations for gender affirmation surgery.

Literature focused on cancer screening and management is lacking in the transgender population. To action to increase contributions to the scientific literature that drives the creation of cancer screening and management protocols for transgender and gender nonconforming (TGNC) patients. We performed a systematic search of PubMed on January 5th, 2022, with the following terms: "TGNC", OR "transgender", OR "gender non-conforming", OR "gender nonbinary" AND "cancer screening", AND "breast cancer", AND "cervical cancer", AND "uterine cancer", AND "ovarian cancer", AND "prostate cancer", AND "testicular cancer", AND "surveillance", AND "follow-up", AND "management". 70 unique publications were used. The findings are discussed under "Screening" and "Management" categories. Screening: Current cancer screening recommendations default to cis-gender protocols. However, long-term gender-affirming hormone therapy and loss to follow-up from the gender-specific specialties contribute to a higher risk for cancer development and possible delayed detection. The only known screening guidelines made specifically for this population are from the American College of Radiology for breast cancer. Management: Prior to undergoing Gender Affirmation Surgery (GAS), discussion should address cancer screening and management in the organs remaining in situ. Cancer treatment in this population requires consideration for chemotherapy, radiation, surgery and/or reconstruction. Modification of hormone therapy is decided on a case-by-case basis. The use of prophylactic vs aesthetic techniques in surgery is still debated. When assessing transgender individuals for GAS, a discussion on the future oncologic risk of the sex-specific organs remaining in situ is essential. Cancer management in this population requires a multidisciplinary approach while the care should be highly individualized with considerations to social, medical, surgical and gender affirming surgery related specifications. Special considerations have to be made during planning for GAS as surgery will alter the anatomy and may render the organ difficult to sample for screening purposes. A discussion with the patient regarding the oncologic risk of remaining organs is imperative prior to GAS. Other special considerations to screening such as the conscious or unconscious will to unassociated with their remaining organs is also a key point to address. We currently lack high quality studies pertinent to the cancer topic in the gender affirmation literature. Further research is required to ensure more comprehensive and individualized care for this population.

Images: Irregular sleep-wake rhythm disorder in transgender individuals.

Kokash A, Vendrame M. Images: irregular sleep-wake rhythm disorder in transgender individuals. J Clin Sleep Med. 2023;19(11):1981-1984.