Reassignment Surgery Research Articles

Are Gender-Affirming Plastic Surgeons Adequately Compensated? An Analysis of Relative Value Units.

Gender-affirming surgery (GAS) has a complicated history within US health care. As GAS procedures and reimbursement availability continue to uptrend, the present study aims to investigate whether compensation is equitable between GAS procedures and general plastic surgery procedures. The National Surgical Quality Improvement Program database was queried for all surgeries performed by plastic surgeons from 2016 to 2020. Cases were assigned to the GAS or non-GAS cohort using ICD-10 codes. Duplicate Current Procedural Terminology (CPT) codes were removed for analysis. Operative time, total wRVUs, wRVUs per hour (wRVU/h), reoperation/readmission rate, and number of concurrent procedures were compared between the cohorts. A total of 132,319 non-GAS and 3,583 GAS were identified. After duplicate CPT removal, 299 cases (21 unique CPTs) remained in the GAS cohort and 20,022 (37 unique CPTs) in the non-GAS cohort. Operative time was higher in the GAS cohort (262.9 vs 120.7 min, P < 0.001), as were total wRVUs (59.4 vs 21.6, P < 0.001). Reoperation/readmission rate (7.0% vs 6.0%) and wRVU/h (15.8 vs 15.1) were not significantly different (all P > 0.05). There was a positive correlation between total operative time and total wRVUs (P < 0.001) and a negative correlation between total operative time and wRVU/h (P < 0.001). Proportional wRVUs are allocated to gender affirming plastic procedures. However, the RVU scale does not allocate proportional wRVUs to longer operative times for both GAS and general plastic surgeries. Compensation for gender affirming plastic surgeries is higher than that of general plastic surgeries; however, there is no difference in wRVUs per hour on comparison.

Autobiography and Transgender Worlds: Body and Queer Corporeality

In the context of rapidly changing biomedical interventions and emerging non-surgical practices of gender transformation, the paper explores various issues associated with trans procedures that trans people in the three autobiographies go through namely, Manobi Bandyopadhyay’s A Gift of Goddess Lakshmi, A. Revathi’s The Truth About Me: A Hijra Life Story, and Living Smile Vidya’s I am Vidya: A Transgender’s journey. One of the main events of the three autobiographies is the sex change surgery that the three protagonists, Somnath (later, Manobi after sex change operation) in A Gift of Goddess Lakshmi, Doraisamy (later, Revathi after sex change operation) in The Truth About Me, and Preeti (later, Vidya after sex change operation) Living Smile Vidya’s I am Vidya: A Transgender’s journey undergo. The paper problematizes various issues related to trans procedures that Somnath, Doraisamy and Preeti undergo and attempts to find answers to questions such as if Somnath’s and Doriaswamy’s undergoing transgender procedures can be ‘simply’ equated with other forms of body modification such as tattooing, piercing and cosmetic surgery, and is not to be considered as a ‘complete, pathological rearrangement of identity’; can these transgender procedures be called a way of reorganizing the protagonists’ body to suit their image of themselves; is it possible to extricate social and political implications of transgender procedures that the three protagonists experience; if ‘trans’ procedures that the three protagonists experience can be seen in context of pseudo-medical accounts of transsexual autobiographies that tolerate body-modificatory practices so far as they enable a move away from strangeness and towards normalcy; do the protagonists opt for ‘trans’ procedures to alleviate the pain of being strange and engender a process of becoming ‘normal’; and whether or not trans practices constitute some form of self-mutilation.

Bone health in transgender assigned female at birth people: effects of gender-affirming hormone therapy and gonadectomy.

Gender-affirming hormone therapy (GAHT) and gender-affirming surgery (GAS) may be desired by transgender and gender-diverse (TGD) individuals who want to affirm their gender identity. Testosterone is the basis of GAHT for transgender individuals assigned female at birth (AFAB), whereas GAS can involve hysterectomy, bilateral salpingectomy, bilateral oophorectomy (BO), thorax masculinization, and phalloplasty. Our study aimed to evaluate the effects of GAHT on the bone health of TGD AFAB individuals who have undergone or not undergone BO. This was a single-center, longitudinal study with retrospectively collected data. TGD AFAB GAHT-naïve individuals were enrolled and underwent dual-energy X-ray absorptiometry scans and laboratory tests (hormonal and bone metabolism parameters) at baseline and after 5 and 10 years of GAHT. Two hundred and forty-three TGD AFAB people were included in this study. Seventy-five subjects had completed data for 5 years and 19 subjects for 10 years of GAHT. At baseline, low bone density (Z-score < -2.0) was found in 2.5% (6/243) of subjects for lumbar spine (LS), whereas total hip (TH) and femoral neck (FN) Z-scores and laboratory tests were within the normal female range. After stratifying by physical activity, the physically active group showed significantly higher LS BMD and Z-scores (p ≤ 0.05). Five years after the start of GAHT, a significant reduction in LS (p ≤ 0.05), TH (p ≤ 0.001), and FN (p ≤ 0.01) Z-scores was detected. A significant reduction in the Z-scores of all three bone sites was observed only in the subgroup that had undergone BO. After 5 years of GAHT, estradiol levels were significantly decreased compared to those in baseline (p ≤ 0.001). Significantly higher estradiol levels were detected in the 5-year no-BO subgroup compared to those in the 5-year BO subgroup (p ≤ 0.001). A significant reduction in LS and TH Z-scores were observed after 10 years of GAHT. At this time, estradiol levels were significantly decreased compared to those in baseline (p ≤ 0.01). Bone density in TGD AFAB individuals is comparable to that in their peers prior to GAHT and BO, but those subjects who underwent BO had a reduced Z-score at LS, FN, and TH after 5 years and at LS after 10 years of GAHT.

Breast care considerations for transgender and gender-diverse patients.

Transgender and gender-diverse (TGD) persons represent a small but growing population in the United States. Accessing inclusive, equitable, and evidence-based healthcare remains a challenge for this patient population. Many TGD persons seek gender-affirming care, including gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS), to help ameliorate the physical and mental aspects of their gender incongruence. Both GAHT and GAS induce clinically important histopathologic and anatomic changes in breast tissue. Consequently, breast care in TGD persons has become an increasingly recognized topic of importance in gender-affirming care. However, there remains a scarce but growing base of literature specifically addressing the unique healthcare needs of breast care in TGD patients. This article will review how to establish trusting patient-provider relationships for TGD patients, gender inclusivity in breast clinics and imaging centers, the influence of GAHT and GAS on breast tissue, breast cancer screening recommendations and barriers, and breast cancer risk and treatment considerations in TGD persons.

Gender Identity Disorder and Improvement of Life Satisfaction and Psychological Well-being Indices After Sex Reassignment Surgery: A Multicenter Prospective Cohort Study

Gender Identity Disorder and Improvement of Life Satisfaction and Psychological Well-being Indices After Sex Reassignment Surgery: A Multicenter Prospective Cohort Study

Nondiscrimination Protections in Gender-affirming Surgery: US Government's Proposed Update to Section 1557 of the Affordable Care Act.

Nondiscrimination Protections in Gender-affirming Surgery: US Government's Proposed Update to Section 1557 of the Affordable Care Act.

Visualizing the Emergence of Political Homophobia: Anti-LGBTQ+ and Anti-Ukrainian Sentiment in Russian Public Opinion

On February 24, 2022, Russia invaded Ukraine, escalating a conflict that began in 2014 with the annexation of Crimea. Before the annexation, Russia’s anti-gay propaganda legislation set a precedent for homophobic laws worldwide. Over the past decade, Russia implemented numerous anti-LGBTQ+ laws, including the recent ban on gender reassignment. Through state-controlled media, Russian leadership portrayed both of these efforts as defending the nation against Western influence. So, I ask: Did it work? In this visualization, we see that before the introduction of anti-gay propaganda legislation and the Ukrainian conflict, public opinion data showed no statistically significant correlation between attitudes on the two issues. However, following these events, a positive association emerged between support for anti-gay views and anti-Ukrainian sentiment. These findings shed light on the growth of political homophobia within the Russian context, where gender and sexuality issues have become intertwined with a national security narrative.

Confronting Three Contemporary Categories of False "Health Care"

The modern definition of health care has, regrettably, expanded far beyond what can reasonably be considered care. Abortion, gender reassignment, and physician-assisted suicide damage bodies and end lives, rather than healing patients. In this article, Mundy describes where modern ideas of what passes for health care have gone wrong and how to better understand what it means to practice medicine.

An Evaluation of Race and Socioeconomic Status with Resource Utilization and Direct Post-Operative Outcomes in Gender-Affirming Bottom Surgery

An Evaluation of Race and Socioeconomic Status with Resource Utilization and Direct Post-Operative Outcomes in Gender-Affirming Bottom Surgery

The pedicled Antero lateral thigh flap for gender affirming surgery: what is different? First case series outcomes of a single center from Turkey.

The aim of this study is to share our preliminary outcomes of the pedicled Antero Lateral Thigh flap (ALTf) phalloplasty technique, which we presume to be the first reported case series of a single center from Turkey. A cross-sectional study, comprising all cases who underwent pedicled ALTf phalloplasty in our clinic, between January 2015 and December 2019, was designed. Demographic data, case characteristics and surgical details including complications were recorded. The mean age of our 26 cases was 30 (28-34) years. The mean penile length and diameter were 15.07 ± 0.98 cm and 3.9 ± 0.34 cm, respectively. Tactile sensation was evaluated by touching the radix, corpus and tip of the neo-phallus showing response in 17 (65.4%), 7 (26.9%) and 2 (7.7%) of the cases, respectively. In 14 (53.8%) of all our cases no complication was reported at all. However, in 12 (46.1%) cases, although no intraoperative complication occurred; postoperative complications were observed as Clavien-2 (3.8%), Clavien-3a (3.8%) and Clavien-3b (71%). Postoperative satisfaction rates were found 77.14% (38-94). Although relevant studies are limited, in addition to low complication rates and high satisfactory outcomes, by leading to a concealable donor site, the pedicled ALTf can be used as a preferred phalloplasty technique, especially in transmen with religious or cultural sensibility.

Об усилении административной ответственности за навязывание несовершеннолетним нетрадиционных семейных ценностей

The article substantiates recommendations for strengthening measures of administrative responsibility for imposing non-traditional family values on minors. The scientific methodology used is dialectical, formal legal, general scientific methods (analysis, synthesis), as well as the comparative legal method. Based on an analysis of current legislation and law enforcement practice, the authors propose, in order to comply with the ban on imposing ideas on minors, promoting gender reassignment and same-sex marriage, to make appropriate changes to Article 6.21 of the Code of Administrative Offenses of the Russian Federation to establish a ban on the adoption of a child (children) by a person who has changed gender.

Elderly transgender mental health: Global and local challenges

ABSTRACT Elderly transgender mental health has been a neglected facet of mental health for many years. The current article reviews the global and local challenges faced when catering to elderly transgender mental health. These include trauma and stigma that may be faced when seeking mental health services, in addition to the stigma of belonging to the transgender community. There are many barriers in access to health-care services that have been highlighted, and there are factors such as social discrimination, victimization, hate crime, and domestic violence that add to the barriers. Lack of proper clinics that cater to their needs, improper coverage in health-care insurance, and lack of coverage of sex-change operations also add to the existing burden. Workplace issues and their impact on mental health along with stigma and workplace discrimination are also discussed. The review tries to give an overview of the issues faced, so that clinicians treating these populations are appraised of the same.

Detailed Retrospective Analysis of Phalloplasty By a Transgender Surgery Center

Detailed Retrospective Analysis of Phalloplasty By a Transgender Surgery Center

Guidelines on Photoepilation: Techniques for Intimate Body Areas

General best practice guidelines for safe laser/IPL hair reduction have already been published in peer reviewed professional medical journals. The safe operation of a laser/IPL for hair reduction demands creation of a facility safety protocol, compliance with laser/IPL system set-up, designated client parameters and dosimetry. Compliance with national, regional and local regulations are equally applicable for hair removal prior to gender reassignment surgery. These guidelines briefly review the options for hair reduction and the mode of action of photoepilation but concentrate on classification of birth male and birth female intimate body areas and treatment procedure including planning prior to gender reassignment surgery. There is a dedicated review section on pilonidal sinus treatment procedure as well as delegation of photoepilation, adverse effects, safety precautions, pain control and client aftercare.

Psychiatric, socio-legal and perioperative aspects of vaginoplasty

The number of scientific papers on gender-confirming surgeries as well as the surgeries themselves have increased by leaps and bounds in recent years. This leads to sometimes considerable waiting times for people seeking treatment. Social media and the internet do not always provide reliable and high-quality information. Therefore, it is necessary that both surgically and conservatively active urologists are familiar with topics regarding transgender persons. The establishment of structured training, the guarantee of minimum quality standards in the treatment of transgender persons and the further education and training of medical staff pose particular challenges. The German Society for Urology (DGU) and the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) have already founded their own working groups on the surgical side, which coordinate their work. Under the auspices of the professional societies DGU and DGPRÄC, aguideline on surgical procedures for gender incongruence was developed under the umbrella of the AWMF ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften") which is currently being finalised. For along time, the health care of transgender people has been moving in afield of tension between the right of self-determination of those seeking treatment, on the one hand, and the fear of making the wrong medical decisions, on the other. In contrast to most other conditions in urology, the goal of treatment is largely determined by the person seeking treatment and does not necessarily follow predetermined schedules or content. The treatment should primarily aim at reducing the individual's suffering and promoting quality of life.

Postoperative Regret Among Transgender and Gender-Diverse Recipients of Gender-Affirming Surgery

This Viewpoint examines prevalence of and factors associated with surgical regret among transgender and gender-diverse individuals who undergo gender-affirming surgery.

People Who Undergo Gender Reassignment Surgery: An Overview

&#x0D; &#x0D; &#x0D; Transforming people with gender dysphoria into the desired gender is accomplished through gender reassignment surgery, also known as sex reassignment surgery. When there is a mismatch between a person's gender identity and the sex they were given at birth, it is referred to as gender dysphoria. The last 15 years' significance of research has been heavily scrutinised. A person's perception of their own sexual identity, gender identity, sexual orientation (heterosexual, homosexual, or bisexual), and the likelihood of developing neuropsychiatric disorders are all programmable in our brains during the early stages of development. In order to allow people to freely explore, society should reconsider assigning specific gender roles. Understanding various biological differences in trans people as well as their positive and negative experiences with gender affirming surgery is the goal of the current study.&#x0D; &#x0D; &#x0D;

Breast cancer screening awareness among transgender individuals in Bangkok, Thailand

Background: Transgender women have higher rates of mortality associated with cancer diagnosis owing to inadequate transgender-specific cancer screening, leading to delayed diagnosis. Gender-affirming hormone therapy, age, and genetics are risk factors for breast cancer in transgender women. For transgender men, the risks were similar to those for cisgender women. However, population-based data on breast cancer screening and awareness among these sex groups are limited. Aim: This study aimed to assess breast cancer screening awareness, screening utilization, and factors associated with screening awareness among transgender individuals in Bangkok, Thailand. Methods: This multi-centered study included participants aged 18–80 years without a history of breast cancer. Data were collected using a structured questionnaire from October 2021 to October 2022. Sociodemographic data, hormonal use, gender affirming surgery, breast cancer screening awareness, utilization, and reasons for not undergoing screening were recorded. Associations with breast screening awareness were analyzed using multiple logistic regression analysis. Results: In Bangkok, 402 transgender women and 333 transgender men were surveyed. Among them, 92.8% and 64.6% of the women and men groups, respectively, had received gender-affirming hormone therapy. The women group had a higher awareness of breast cancer screening (70.9%) than the men group (60.8%). However, only 4% and 17.1% of the women and men patients, respectively, underwent breast cancer screening. A history of gender-affirming hormone therapy use was associated with a higher likelihood of breast cancer screening awareness among women. Among the men, older participants who later underwent breast-reduction surgery had a family history of breast cancer, and other types of cancer were positively associated with higher breast cancer screening awareness. Conclusion: Although awareness of breast cancer screening among urban transgender individuals is high, multiple factors limit their access to breast cancer screening.

RECEIPT OF GENDER-AFFIRMING SURGERY AMONG MEDICARE BENEFICIARIES

Abstract While transgender and gender diverse (TGD) people may never seek treatment related to their gender identity, many require access to gender-affirming treatments, including surgery. Starting in 2014, Medicare began covering gender-affirming surgery (GAS) on a case-by-case basis. In this study, we use national Medicare data to compare receipt of GAS by beneficiary characteristics. We classified TGD beneficiaries using an algorithm that combines diagnosis and procedure codes. Our study compared characteristics for all TGD identified beneficiaries and those who received GAS using a population-averaged logistic model using a generalized estimating equation (GEE) adjusting for dual status, age group, race/ethnicity, original reason for entitlement, and CMS region. Our sample accounted for 49,945 observations for 11,162 individuals, with a total of 290 identified records of GAS. In our adjusted analysis, we found that TGD beneficiaries in certain parts of the country had lower odds of GAS compared to their counterparts. Compared to CMS Region 1 (which includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont), those living in Region 3 (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia), Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee), and Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) had a significantly lower odds of receiving GAS. Access to gender-affirming care may be influenced by CMS regional contractors, as well as state-by-state variation in Medicaid coverage for gender-affirming care. Further research is needed to explain why beneficiaries may have lower access to GAS to inform policy recommendations.

Prevalence and predictors of cancer screening in transgender and gender nonbinary individuals

Background Current cancer screening guidelines for transgender individuals are guided primarily by expert opinion, and are extrapolated from guidelines for cisgender populations, despite the additional unique risks that transgender populations face in cancer risk and cancer care. Aims We examined adherence to current recommended screening guidelines as well as drivers of cancer screening in 192 transgender and gender-nonbinary (TGNB) individuals participating in Project AFFIRM, a multi-site longitudinal cohort study of TGNB individuals. Methods We used a chi-squared analysis to look for significant associations between predictors and adherence to breast, cervical, prostate and colon cancer screening. We analyzed predictors by 3 different categories: sex/gender identity, healthcare access, and socioeconomic status. Results Screening rates were low for breast, cervical, prostate and colon cancer in TGNB populations compared to national rates for cisgender populations. Among several significant predictors, gender-affirming surgery (hysterectomy) (p-value = <0.0001) and telling others they are transgender at a younger age (< 18) (p-value = 0.0344) were associated with increased screening adherence, while having HIV was associated with decreased screening adherence (p-value = 0.0045). Discussion Our results suggest that interacting with the healthcare system to obtain comprehensive cancer screening can be difficult to navigate among the other healthcare needs of TGNB individuals both on an individual and systems level. Future efforts to mitigate the barriers to screening adherence should be targeted at the healthcare system level.