Cartilage Reduction Research Articles

Gender-affirming surgeries for transgender and gender diverse individuals and associated health outcomes.

Gender-affirming care is treatment that recognizes and affirms the gender identity of transgender and gender-diverse (TGD) individuals. Though not all TGD people choose to surgically transition, gender-affirming surgeries (GAS) are an important part of many TGD people's transition. GAS can include a wide array of procedures aimed at aligning an individual's physical characteristics and gender identity. This review describes the most common procedures considered to be GAS, detailing important relevant considerations for each procedure. These include transfeminine procedures (i.e., breast augmentation, penile inversion vaginoplasty, orchiectomy, tracheal shave, and facial feminization); transmasculine procedures (i.e., chest masculinization, hysterectomy, phalloplasty, and metoidioplasty); and other procedures (i.e., fertility preservation and hair removal). Patient outcomes and the legal landscape for GAS are also discussed to contextualize these procedures within largest discourses surrounding gender-affirming care.

Surgical techniques and outcomes of thyroid chondroplasty in transfeminine individuals: A systematic review

Thyroid chondroplasty (TC) in facial gender affirming surgery (FGAS) is aimed at modifying the thyroid cartilage to achieve a more feminine laryngeal appearance. This study evaluated open versus endoscopic techniques to thyroid chondroplasty and associated outcomes and complications. A systematic review (SR) according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines for articles pertaining to TC was conducted. Data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) was reviewed for individuals who underwent “cervical tracheoplasty” for gender dysphoria. In the SR, 12 articles representing 368 patients were included for analysis. Nine articles described open approaches and three articles described endoscopic techniques. Rate of total complications was found to be 4.3% (n=12) in the open approach compared to 15% (n=13) in the endoscopic approach. Reports of positive aesthetic results was 92% for the open approach and 90% for the endoscopic approach. In the open approach, seven (2.5%) patients requested additional removal of cartilage and three (1.1%) requested scar revision. In the endoscopic approach, three (3.7%) patients requested additional cartilage removal in the endoscopic approach. NSQIP database found no incidence of wound or major complications among patients who underwent tracheoplasty alone. While the advantage of the endoscopic approach is a scarless neck incision, the rate of complications for endoscopic thyroid chondroplasty is higher than the open approach. Endoscopic approaches are still not widely used and continued investigations are warranted to improve familiarity of this approach and reduce postoperative complications.

Facial Feminization Considerations for the Transgender Patient

Facial feminization is a desire expressed by certain individuals who identify beyond the gender binary seeking to align their physical appearance and the gender with which they identify. Although there are many ways to achieve a more feminine facial appearance, several factors influence routes that patients choose. This Viewpoint explores the considerations of physicians aiming to advocate for transgender patients, and “leverage expertise to promote protection of gender-affirming care”1 through medical and surgical interventions to achieve facial feminization. Due to gaps in literature, this Viewpoint further addresses some of the clinical, ethical, and aesthetic issues that require support of physicians. Injectable fillers remain a popular option for achieving a more feminine look, as they are quick and reversible and valued among patients less inclined toward irreversible procedures.2 Additionally, using fillers presents fewer barriers for both patients and surgeons such that a psychiatric diagnosis of gender dysphoria is not required to proceed with treatment, and consultation does not require multiple time-consuming and costly sessions. Injectables provide the opportunity to explore features one would desire should they pursue more permanent solutions. To promote health equity, this option may be more cost effective for patients whose finances limit surgical options and is less likely to be a procedure that is delayed, thus preventing psychological distress and patient distrust. Although not permanent, the literature endorses patient satisfaction with this route.2 For many, however, the ideal solution for facial feminization is a more permanent one, which can lead to increasingly positive health outcomes for transgender patients. Having some permanence in facial feminization is not only symbolic but offers patients an opportunity to align their gender identity and physical appearance after years of grappling with gender dysphoria. Surgical procedures of choice include hairline augmentation, rhinoplasty, blepharoplasty, cheek augmentation, upper lip lift, and tracheal shave among many others. Although undergoing these procedures is often the long-term goal, there may be more barriers to care, including psychiatric evaluations and preoperative workups for procedures requiring anesthesia.3 Additionally, these procedures are not without medical and surgical risks, and may transform the patient in ways they do not envision. Treating surgeons must listen to patients and set realistic expectations for each treatment approach, weighing all risks and benefits, including psychosocial, emotional, and financial considerations. It is important that the surgeon offers all available approaches and does not exclude procedures they may view as unnecessary. When healthcare professionals view these procedures as merely cosmetic, elective, or not worth the risk, they invalidate transgender health and become a threat to this group’s well-being. Making the decision to pursue facial feminization surgery should not be taken lightly, and it is critical for surgeons to be aware of identity formation and the emotional impact many patients experience in transforming their appearance and relinquishing a past view of the self. Advocacy, emotional intelligence, and gender humility will achieve better health outcomes, reduce stigma, and lead to trusting therapeutic relationships. Table 1 illustrates the potential issues patients may encounter and actionable responses the treating physician may use. Table 1. - Patient Issues and Physician Responses Potential Issues for Patient Actionable Response Financial instability Discuss patient financial planning and consider payment plans as available, including thought on long-term goals and physical transitional goals of patient. Injectable procedures will be first line because they remain one of the most affordable routes of aligning one with their gender identity. However, it is necessary to discuss the cumulative cost of consistent injectables if patient funds will continue to be scarce. Uncertainty about desired “look” Offer clear and informed consent about the duration of physical changes and the options for reversal/adjustment in the case of dissatisfaction with results. Propose injectable procedures that provide a nonpermanent result and encourage multiple consultation visits to collaborate on final desired “look.” Comorbidities posing significant health risks in setting of surgical procedures Psychological and spiritual well-being must be weighed against physical health risks in a nonjudgmental manner by physician. Keep in mind the importance of not underestimating the impact of emotional and psychological health in bolstering physical health for patients. Uncertainty about surgery as an option Explore patient hesitation in taking surgical step. Encourage injectable procedures that provide a nonpermanent result as appropriate. Unresolved emotional or psychological issues Initial consultation to determine patient goals and expectations in a nonjudgmental manner by the physician. Explore the extent to which a patient’s current physique poses a threat to long-term happiness and how successful any physical alterations will be in positively affecting patient health and wellness. Implore psychologically therapeutic approaches before or in conjunction with surgical ones. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Secondary Facial Gender Surgery: Causes of Poor Outcomes and Strategies for Avoidance and Correction.

Facial feminization surgery covers a broad spectrum of procedures across both hard and soft tissues. Despite the fact that this is a decidedly predictable surgery, because of the high demand for the procedures, a growing number of patients are requiring revision surgery, whether to correct unexpected results or to treat mid-term to long-term functional and aesthetic complications. This Special Topic article categorizes unsatisfactory outcomes encountered after forehead surgery, lower jaw surgery, and thyroid chondroplasty; key steps to avoid these pitfalls; and strategies for structured analysis and operative planning in revision cases.

Chondrolaryngoplasty

Chondrolaryngoplasty (often referred to as a “tracheal shave” by the public) aims to decrease the gender dysphoria associated with the anterior prominence of the thyroid cartilage. The fullness in the anterior neck caused by the “Adam's apple” commonly contributes to misgendering of trans females. Transcervical approaches have traditionally been utilized for resection, although recently, transoral techniques have been described. Complications after transcervical approach chondrolaryngoplasty are uncommon and typically include mild, temporary dysphonia, dysphagia, or scar. It is vital to identify and protect the anterior attachment of the true vocal folds during this procedure to prevent disastrous permanent changes to the voice. Nevertheless, chondrolaryngoplasty remains a highly safe and effective procedure. Chondrolaryngoplasty (often referred to as a “tracheal shave” by the public) aims to decrease the gender dysphoria associated with the anterior prominence of the thyroid cartilage. The fullness in the anterior neck caused by the “Adam's apple” commonly contributes to misgendering of trans females. Transcervical approaches have traditionally been utilized for resection, although recently, transoral techniques have been described. Complications after transcervical approach chondrolaryngoplasty are uncommon and typically include mild, temporary dysphonia, dysphagia, or scar. It is vital to identify and protect the anterior attachment of the true vocal folds during this procedure to prevent disastrous permanent changes to the voice. Nevertheless, chondrolaryngoplasty remains a highly safe and effective procedure.

Diagnosis and Management of Vocal Complications after Chondrolaryngoplasty.

Transfeminine patients (transwomen/feminine nonbinary folks assigned male at birth) can undergo chondrolaryngoplasty ("tracheal shave") to feminize their neck appearance. While isolated cases of vocal complications have been reported following the procedure, aggregated outcomes have not been quantitatively studied. We present acoustic and stroboscopic data to describe a patient cohort with vocal complications after chondrolaryngoplasty and discuss reparative surgical technique. Subjective and objective data, including videostroboscopy, were collected from patients with voice complaints after chondrolaryngoplasty. Dislocated anterior commissures were reconstructed with feminization laryngoplasty. Postoperative voice data were recorded and statistically compared to preoperative data using paired t-tests. On consecutive chart review, of the 94 transfeminine women with prior outside history of chondrolaryngoplasty, 27 (29%) reported chronic postoperative hoarseness, deepened pitch, or loss of upper register. On endoscopy, short, lax vocal folds with persistent anterior glottic gap and phase asymmetry were commonly noted; anterior commissure dislocation was confirmed in-office by using needle localization through absent thyroid cartilage. After open resuspension of the anterior commissure with feminization laryngoplasty, post-repair modal-speaking, minimum, and maximum fundamental frequencies (F0) increased on average by 7, 8, and 5 semitones, respectively (p< 0.01), when compared to pre-repair values. On average, perioperative maximum phonation time did not change significantly (p= 0.15). Average self-assessment of vocal femininity increased by 48% (p< 0.01). Anterior commissure dislocation should be suspected with signs of vocal impairment after chondrolaryngoplasty. Following proper diagnosis, resuspension of the anterior commissure via feminization laryngoplasty approach can be an effective reparative technique. This work represents a 2011 OCEBM Level 4 evidence as a case series Laryngoscope, 133:2301-2307, 2023.

Social Perception of External Laryngeal Anatomy Related to Gender Expression in a Web-based Survey.

To quantify the effect of laryngeal prominence size on socially perceived attributes relating to gender expression. Chondrolaryngoplasty ("tracheal shave") is a common procedure performed for transgender women to feminize neck appearance. The extent of thyroid cartilage resection needed to convey socially-perceived feminine gender expression without destabilizing the voice is incompletely understood. Cross-sectional evaluation of a randomized allocation of images of varying laryngeal prominence to a non-repeated, random sample from November 2021 to December 2021. Photos of laryngeal prominence were isolated against a constant neck baseline with lateral, oblique, and frontal views. The images were embedded into a web-based survey with visual analog scales to capture perceived scaled gender expression (masculinity, femininity) and social traits (e.g., attractiveness, friendliness, leadership). We performed bivariate and multivariate analyses relating the laryngeal prominence to perceived gender expression and social traits. The analytic sample included 1,026 respondents. Laryngeal grades similar to the demonstrated "grade M" in this study and smaller demonstrated similar perceptions of increased femininity and decreased masculinity. Grades larger than M demonstrate significantly increased perceived masculinity and significantly decreased perceived femininity. The lateral and oblique views of the neck appear to be the most gender-informative. This crowd-sourced analysis of external laryngeal anatomy by a large population of observers provides clear, reproducible insights into social perceptions of gender identity and specifically femininity. These data will meaningfully inform patient counseling and surgical planning for gender-affirming interventions by establishing normative data representing the general public's perceptions. NA Laryngoscope, 133:2292-2300, 2023.

Rare Complications in Chondrolaryngoplasty: Preparation for Safe Outcomes.

Chondrolaryngoplasty ("tracheal shave") is a common procedure requested by transgender women as well as cisgender men and women. Management of intraoperative complications is crucial given the risk of damage to the vocal cords and loss of the airway in patients who are not intubated. We present two rare complications of chondrolaryngoplasty and their management.

Improving Safety in Chondrolaryngoplasty.

Improving Safety in Chondrolaryngoplasty.

Granular cell tumor of the trachea mimicking an infiltrating thyroid cancer. A case report.

Introduction and importanceGranular cell tumor (GCT) is a rare neurogenic neoplasm originating from Schwann cells that predominantly affects women and can involve skin and mucousae. In the respiratory system it most frequently involves bronchi and larynx, while it is rare in the trachea.Case presentationA 26-year old female smoker was hospitalized for a suspected hypoechoic nodule in the right thyroid lobe closely adherent to the trachea. At preoperative computed tomography tracheal lumen was totally clear. The patient underwent a total thyroidectomy with lymph node dissection and tracheal shaving. The postoperative course was complicated by an extensive subcutaneous bilatreral emphysema associated with respiratory distress appeared on the fifth day.Bronchoscopy revealed a right anterolateral subcentimeter lesion near the second tracheal ring. Histologically, the diagnosis was consistent with a tracheal GCT developing into the thyroid parenchyma. The patient was discharged on the twentieth postoperative day. At the follow-up bronchoscopy the lesion was completely healed and at the last 12 month follow-up the patient is doing well.Clinical discussionTracheal tumors are uncommon neoplasms accounting for about 2% of the total respiratory tree tumors. In literature we found <50 papers concerning tracheal GCT and in almost all of the cases patients complained about respiratory symptoms.ConclusionWe report here a rare case of benign GCT of the trachea with extraluminal development, in a young patient who did not complain about preoperative respiratory symptoms, presented on ultrasound as a thyroid nodule with suspected cytology.

Perioperative Care of the Transgender Patient

Background Information It is estimated that 3% of the population in the United States are transgender which is equivalent to approximately 1.4 million people. This number is only an estimate; many experts feel the number is actually much higher. With the rising number of people in this community we will be caring for more people with these health situations. Perioperative nurses must be aware of the unique physical as well as emotional changes that occur in the care of a transgender patient. Objectives of Project To deliver safe care for the transgender patient by providing information regarding the physical changes and how care should be altered. Process of Implementation For the second year we have presented information surrounding the differences and possible complications in the care of a person who has had sexual reassignment surgery (SRS) and/or who is on hormonal therapy. Some of the potential complications include difficult intubations due to a thyroid chondroplasty or a laryngoplasty done to alter the pitch of the voice or to change the shape of the neck. These procedures may damage the vocal cords, create tracheal stenosis or decrease the lumen of the trachea. Certain procedures involving the urethra may cause changes requiring the use of a much smaller urinary catheter or to have an urologist to insert it. Hormonal therapy can alter lab values, affect the GFR of the kidneys which must also be considered when using imaging, and place the patient at a higher risk for venous thromboembolism, cardiovascular disease, liver disease, breast cancer, prolactiomas and mood disorders. Transgender males who have not had “top” surgery may wear breast binders that can lead to restrictive problems in the respiratory system Statement of Successful Practice Staff was very curious and asked many questions regarding the potential for problems associated with SRS and hormonal therapy. The information provided a plan of action to provide safe and high quality care for all patients. Implications for Advancing the Practice of Perianesthesia Nursing To provide high quality, safe, effective, and culturally competent care for all patients in the perioperative arena. It is estimated that 3% of the population in the United States are transgender which is equivalent to approximately 1.4 million people. This number is only an estimate; many experts feel the number is actually much higher. With the rising number of people in this community we will be caring for more people with these health situations. Perioperative nurses must be aware of the unique physical as well as emotional changes that occur in the care of a transgender patient. To deliver safe care for the transgender patient by providing information regarding the physical changes and how care should be altered. For the second year we have presented information surrounding the differences and possible complications in the care of a person who has had sexual reassignment surgery (SRS) and/or who is on hormonal therapy. Some of the potential complications include difficult intubations due to a thyroid chondroplasty or a laryngoplasty done to alter the pitch of the voice or to change the shape of the neck. These procedures may damage the vocal cords, create tracheal stenosis or decrease the lumen of the trachea. Certain procedures involving the urethra may cause changes requiring the use of a much smaller urinary catheter or to have an urologist to insert it. Hormonal therapy can alter lab values, affect the GFR of the kidneys which must also be considered when using imaging, and place the patient at a higher risk for venous thromboembolism, cardiovascular disease, liver disease, breast cancer, prolactiomas and mood disorders. Transgender males who have not had “top” surgery may wear breast binders that can lead to restrictive problems in the respiratory system Staff was very curious and asked many questions regarding the potential for problems associated with SRS and hormonal therapy. The information provided a plan of action to provide safe and high quality care for all patients. To provide high quality, safe, effective, and culturally competent care for all patients in the perioperative arena.

Outcomes of Tracheal Resections in Well-Differentiated Thyroid Cancer-A case series and meta-analysis.

Tracheal invasion in thyroid cancer is a well-known form of advanced disease. There is an ongoing controversy over outcomes of tracheal shaving in this situation. The aim of this study was to compare the results of tracheal shaving to radical resections in patients with low-volume tracheal involvement. An institutional case series and a meta-analysis was conducted. All studies that included patients diagnosed with well-differentiated thyroid cancer (WDTC) and tracheal invasion were analyzed. Patients with low-volume tracheal invasion (according to the Shin classification) were extracted from the various studies and subsequently included in this study. The outcomes of tracheal shaving and radical resection were consolidated and compared. All recurrences and mortality over 10years of follow-up were calculated using the Kaplan-Meier method. Institutional case series included 22 patients diagnosed with WDTC and tracheal invasion that underwent resection. There was one case of recurrence (4.5%) during the follow-up period and no mortality. The meta-analysis yielded a total of 284 patients from six studies who met the inclusion criteria. The 10-year overall survival was 82.4% for the shave group and 80.8% for the resection group. The combined Kaplan-Meier curves revealed no statistically significant difference between the two techniques (hazard ratio [HR] = 0.86, P = .768). The combined 10-year local control rate of the shave group was 90.2%. The outcomes of tracheal shaving in low-volume invasion are similar to more aggressive forms of tracheal resections. Shave resection is oncologically safe in carefully selected WDTC patients demonstrating minimal tracheal invasion.

Recommended Maximum Laryngeal Prominence Size in Adult Females: A Cross-Sectional Study Proposing a Laryngeal Prominence Size Standard for Chondrolaryngoplasty in Male-to-Female Transgender Individuals.

Although the World Professional Association for Transgender Health has provided international, multidisciplinary, evidence-based standards of care for various aspects of transgender health care, there is a lack of evidence-based guidelines for facial feminization surgery, including chondro laryngoplasty. The aim of this study was to define the recommended maximum laryngeal prominence size in adult females to propose an evidence-based laryngeal prominence size standard for chondrolaryngoplasty in male-to-female transgender individuals. This cross-sectional study was conducted in a tertiary care hospital. The study sample consisted of cisgender patients aged 18 to 60 years old with no history of surgery or radiotherapy in the head and neck area who visited the Otolaryngology/Head and Neck Surgery outpatient clinic. Laryngeal prominence size data were collected using three-dimensional scanning of the head and neck area. Seventy-nine participants, 43 males and 36 females, were included in data analysis. Laryngeal prominence size was larger in male participants (median, 0.16 mm; range, 0 to 9.40 mm) than in female participants (median, 0.00 mm; range, 0 to 1.24 mm) (p < 0.001). The proportion of participants with a laryngeal prominence size larger than 0 mm was greater in male participants (55.81 percent) than in female participants (22.22 percent) (p = 0.002). To the authors' knowledge, this is the first study to assess laryngeal prominence size in the general population. Their results suggest that 2 mm would be the recommended maximum laryngeal prominence size in females. Therefore, a laryngeal prominence size standard of 2 mm could be considered for chondrolaryngoplasty in male-to-female transgender individuals.

Insurance Coverage of Facial Gender Affirmation Surgery: A Review of Medicaid and Commercial Insurance

To provide a portrait of gender affirmation surgery (GAS) insurance coverage across the United States, with attention to procedures of the head and neck. Systematic review. Policy review of US medical insurance companies. State policies on transgender care for Medicaid insurance providers were collected for all 50 states. Each state's policy on GAS and facial gender affirmation surgery (FGAS) was examined. The largest medical insurance companies in the United States were identified using the National Association of Insurance Commissioners Market Share report. Policies of the top 49 primary commercial medical insurance companies were examined. Medicaid policy reviews found that 18 states offer some level of gender-affirming coverage for their patients, but only 3 include FGAS (17%). Thirteen states prohibit Medicaid coverage of all transgender surgery, and 19 states have no published gender-affirming medical care coverage policy. Ninety-two percent of commercial medical insurance providers had a published policy on GAS coverage. Genital reconstruction was described as a medically necessary aspect of transgender care in 100% of the commercial policies reviewed. Ninety-three percent discussed coverage of FGAS, but 51% considered these procedures cosmetic. Thyroid chondroplasty (20%) was the most commonly covered FGAS procedure. Mandibular and frontal bone contouring, rhinoplasty, blepharoplasty, and facial rhytidectomy were each covered by 13% of the medical policies reviewed. While certain surgical aspects of gender-affirming medical care are nearly ubiquitously covered by commercial insurance providers, FGAS is considered cosmetic by most Medicaid and commercial insurance providers, potentially limiting patient access. Level V.

Chondrolaryngoplasty in transgender women: Prospective analysis of voice and aesthetic satisfaction

Introduction: Chondrolaryngoplasty or “tracheal shaving” is cosmetic surgery to reduce the laryngeal prominence in transgender women. Complications may include damage to the vocal folds and epiglottic destabilization or aesthetic dissatisfaction. Objective: To assess and compare acoustic and perceptual voice outcomes and aesthetic satisfaction of transgender women submitted to chondrolaryngoplasty. Methods: Prospective interventional cohort of transgender women submitted to chondrolaryngoplasty between March 2018 and October 2019. Voice analysis included simple-blind application of the GRBAS Hirano scale by speech therapist and measurement of the fundamental frequency, in the preoperative and 1-month postoperative periods. The visual analog scale was used to analyze the aesthetic satisfaction, before and 6-months after chondrolaryngoplasty. Results: Fifteen patients participated, with a mean age of 31.7 ± 8.3 years (range 22–51 years). The mean postoperative follow-up period was 15.3 ± 6.1 months (range 6–25 months). There was a significant improvement in the visual analog scale for aesthetic satisfaction, with a preoperative mean = 0.7 ± 1.0 and a postoperative mean = 9.3 ± 1.1 (95% CI for difference = 7.3 to 9.6; p < 0.001). All patients presented a positive variation. The preoperative mean fundamental frequency was 171.3 ± 41.2 Hz and the postoperative, 177.1 ± 39.5 Hz, with no statistical significance (95% CI for difference = −30.1 to 41.7; p = 0.74). There was no statistically significant difference in the pre- and postoperative comparison of each component of the GRBAS scale. One (7%) patient presented a hyperpigmented scar and 2 (13%) reported hoarseness during the first postoperative week. There were no major complications such as disinsertion of the epiglottis or vocal folds. Conclusion: Chondrolaryngoplasty led to significant aesthetic satisfaction in transgender women. The surgery caused no noticeable vocal change in pitch or perception.

Associations Between Transgender Exclusion Prohibitions and Insurance Coverage of Gender-Affirming 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.

Feminization of Transgender Women With Thyroid Chondroplasty and Laryngoplasty.

In recent years, gender affirmation surgery has broadened significantly from its previous focus on genital conformation only to include other areas of the body as well. As society reconsiders its interpretations of masculinity, femininity, and gender definitions, transgender individuals have realized that they will only be able to truly transition if they are recognized by the public in their chosen societal role. The authors review the literature and describe their own techniques for feminizing thyroid chondroplasty and laryngoplasty.

Social anxiety among transgender and gender nonconforming individuals: The role of gender-affirming medical interventions.

Transgender and gender nonconforming (TGNC) individuals are at heightened risk for psychological distress, including social anxiety (SA). The current study aimed to examine whether gender-affirming medical interventions (GAMIs) are associated with lower SA among TGNC individuals. Two hundred ninety-one transfeminine and 424 transmasculine participants completed the Trans Health Survey, which assessed SA and interest in or utilization of GAMIs (genital surgery, chest surgery, hormone use, speech therapy, tracheal shave or Adam's apple removal, hair removal). Transfeminine individuals who had completed genital surgery, chest surgery, tracheal shave or Adam's apple removal, hair removal, hormone treatment, or speech therapy reported lower SA than those planning to undergo the intervention, and those who had completed genital or chest surgery reported lower SA than those considering it. Transmasculine individuals who had completed chest surgery, a hysterectomy, or used hormones reported lower SA than those who were planning to do so, and those who had completed genital surgery had lower SA than those considering it. Among those expressing interest, utilization of GAMIs is associated with less SA. GAMIs may result in greater conformity to societal expectations regarding binary gender norms, thus decreasing discrimination, rejection, victimization, and nonaffirmation. Increased alignment of physical characteristics and gender identity may increase self-esteem. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Theory of Planned Behavior on the Determinants of Cosmetic Hormones Use to Overcome Gender Dysphoria among Transgenders in Yogyakarta, Indonesia

Background : Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between an individual’s gender identity and the gender assigned at birth (and the associated gender role and/or primary and secondary sex characteristics). Gender reassignment surgery is performed to change primary and/or secondary sex characteristics. For a male to female gender reassignment, surgical procedures may include genital reconstruction (vaginoplasty, penectomy, orchidectomy, clitoroplasty) and cosmetic surgery (breast implants, facial reshaping, rhinoplasty, abdominoplasty, thyroid chondroplasty (laryngeal shaving), voice modification surgery (vocal cord shortening), hair transplants). This study aimed to examine the determinants of cosmetic hormones among transgender in Yogyakarta, Indonesia, using Theory of Planned Behavior (TPB). Subje cts and Met hod : This was a cross-sectional study carried out in Yogyakarta, Indonesia, in November 2018. A sample of 201 transgender was selected by snowball sampling and fixed disease sampling, consisting of 67 transgender using cosmetic hormone and 134 transgender not using the cosmetic hormone. The dependent variable was the use of cosmetic hormones. The independent variables were age, knowledge, education, intention, attitude, perceived behavioral control, and subjective norm. The data were collected by questionnaire and analyzed by path analysis. Results : Cosmetic hormone use was directly increased by strong intention (b= 1.65; 95% CI= 0.98 to 2.31; p<0.001), positive attitude (b= 1.15; 95% CI= 0.48 to 1.81; p= 0.001), but decreased by strong perceived behavioral control not to use cosmetic hormone (b= -1.02; 95% CI= -1.70 to -0.34; p=0.003). Cosmetic hormone use was indirectly affected by age, education, locus of control, attitude, perceived behavioral control, subjective norm, and social norm. Conclusion : Cosmetic hormone use is directly increased by strong intention, positive attitude, but decreased by strong perceived behavioral control not to use the cosmetic hormone. Cosmetic hormone use is indirectly affected by age, education, the locus of control, attitude, perceived behavioral control, subjective norm, and social norm. Keywords : cosmetic hormone, transgender, Theory of Planned Behavior Correspondence : Destinady Kadiser Miden. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, Surakarta 57126, Central Java. Email: destinady.kmiden@gmail.com. Mobile: 085328999232. Journal of Health Promotion and Behavior (2018), 3(3): 212-222 https://doi.org/10.26911/thejhpb.2018.03.03.08

Thyroid chondroplasty: Smoothing the thyroid cartilage— A retrospective study of thyroid chondroplasty for feminine neck appearance

ABSTRACT Background: Thyroid chondroplasty is a surgical intervention for reduction of the Adam's apple, performed in trans women to achieve a more feminine appearance of the neck. This procedure is necessary since hormonal therapy given as part of gender affirming medical interventions has no effect on the mature larynx.Objectives: We aim to describe our thyroid chondroplasty surgical technique and outcome of all thyroid chondroplasties performed during the study period.Methods: A retrospective chart review of all thyroid chondroplasty procedures performed in a tertiary referral center between 2006 and 2015. Patients' clinical characteristics and surgical outcome were recorded and analyzed.Results: Twenty-seven trans women underwent thyroid chondroplasty in our institution. Post-operative complications included a single patient who suffered from false vocal fold (ventricular folds) hematoma that resolved spontaneously. Five other patients had an erythematous scar. No other complications were observed.Conclusion: Thyroid chondroplasty is a safe procedure for achieving a feminine neck contour in trans women.