Gender Confirmation Surgery: Principles and Techniques for an Emerging Field

274 Pages·2020·14.153 MB·English

by  Loren S. Schechter

Gender Confi rmation
Surgery
Principles and Techniques
for an Emerging Field
Loren S. Schechter
Editor
123
Gender Confirmation Surgery
Loren S. Schechter
Editor
Gender Confirmation
Surgery
Principles and Techniques for an
Emerging Field
Editor
Loren S. Schechter
Department of Plastic Surgery
The Center for Gender Confirmation Surgery
Weiss Memorial Hospital
Chicago, IL
USA
ISBN 978-3-030-29092-4 ISBN 978-3-030-29093-1 (eBook)
https://doi.org/10.1007/978-3-030-29093-1
© Springer Nature Switzerland AG 2020
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface
It has been a privilege dedicating my career to caring for transgender and
gender diverse individuals. I have seen time and time again how safe and
effective medical care can assist individuals in expressing their gender iden-
tity, help to alleviate gender dysphoria, improve quality of life, and reduce
negative health outcomes. But I have also seen the adverse effects of barriers
to medically necessary care—such as the distress associated with a lack of
insurance coverage and the frustration of long wait times and distant travel
due to shortages of qualified healthcare providers. The positive progress in
recent years inspires and encourages me. We have improved access to medi-
cal care and advanced social equality related to gender diversity. The land-
mark decision to remove Medicare’s ban on gender confirmation surgery in
2014 changed the landscape for healthcare coverage. Numerous private
insurance plans and many state programs followed Medicare’s lead and now
cover medically necessary gender confirming surgery. Still, there are great
hurdles ahead. Each day, transgender and gender diverse individuals experi-
ence marginalization, discrimination, and bias. Battles over military service,
bathroom access, and legal recognition of one’s gender identity continue.
Person by person and law by law, we must continue to educate those around
us and fight for equality and justice.
This book is written for healthcare professionals—physicians, mental
health professionals, nurses, allied health professionals, and students with an
interest in gender confirmation surgery. Its purpose is to address a range of
issues related to the care of transgender and gender diverse individuals so as
to allow caregivers to provide thoughtful, ethical, and compassionate care.
Beyond this, this book serves as a tool to educate the next generation of
healthcare providers on the complex medical and social issues facing our
patients.
We assembled a group of internationally distinguished professionals to
author chapters in their areas of expertise. In this book, we explore medical
care—mental health, endocrinology, surgery, and physical therapy. But we
delve much deeper than this—chapters examine historical context, social sci-
ence, legal rights, and religious views. I believe that this is the most up-to-
date and comprehensive text regarding surgical care for transgender and
gender diverse individuals.
v
vi Preface
Thank you to our authors who spent countless hours writing these out-
standing chapters. Thank you to our readers for recognizing the importance
of comprehensive care for transgender and gender diverse individuals. Thank
you to transgender and gender diverse individuals and advocates for the tire-
less work to make our world a better place. Let’s keep forging ahead.
Chicago, IL, USA Loren S. Schechter
Contents
1 History, Societal Attitudes, and Contexts . . . . . . . . . . . . . . . . . . . 1
Jamison Green
2 Etiology of Gender Dysphoria . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Randi Ettner
3 History of Gender Identity and Surgical Alteration
of the Genitalia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
David M. Whitehead and Loren S. Schechter
4 Language and Terminology in Transgender Health . . . . . . . . . . 41
Gail Knudson
5 The Mental Health Assessment for Surgery . . . . . . . . . . . . . . . . . 47
Dan H. Karasic
6 Primary Care for the Transgender and Gender
Nonconforming Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Frederic M. Ettner
7 Hormone Therapy for Transgender Women . . . . . . . . . . . . . . . . 59
Vin Tangpricha and Joshua D. Safer
8 Hormone Therapy for Transgender Men . . . . . . . . . . . . . . . . . . . 65
Joshua D. Safer and Vin Tangpricha
9 Medical Management of the Adolescent Individual
with Gender Dysphoria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Jennifer L. Miller and Courtney Finlayson
10 Male-to-Female Breast Augmentation and Body Contouring . . 75
Thomas Satterwhite and Stelios C. Wilson
11 The Importance of Facial Gender Confirmation Surgery . . . . . 91
Jens Urs Berli and Eric Plemons
12 Facial Gender Affirmation Surgery: Facial
Feminization Surgery and Facial Masculinization Surgery . . . . 99
Jordan Deschamps-Braly
13 Fertility Preservation Options for Transgender
and Trans Masculine Patients Planning Hysterectomy . . . . . . . . 115
Katherine T. Hsiao
vii
viii Contents
14 Penile Inversion Vaginoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Jess Ting and Marci Bowers
15 Intestinal Vaginoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Jiri George Melich and Slawomir Marecik
16 Chest Masculinization Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Cori A. Agarwal and Daniel P. Donato
17 Urethral Anatomy and Urethral Reconstruction
in Phalloplasty and Metoidioplasty . . . . . . . . . . . . . . . . . . . . . . . . 161
Ervin Kocjancic and Valerio Iacovelli
18 MLD (Musculocutaneous Latissimus Dorsi) Phalloplasty . . . . . 171
Rados Djinovic
19 Radial Forearm (RF) and Anterolateral
Thigh (ALT) Phalloplasty Reconstruction . . . . . . . . . . . . . . . . . . 181
Walter Lin and Bauback Safa
20 Management of Urethral Complications Following
Metoidioplasty and Phalloplasty . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Jessica Schardein, Aaron C. Weinberg, Lee C. Zhao, and
Dmitriy Nikolavsky
21 Strategies to Optimize Sexual Function with Feminizing
and Masculinizing Genital Gender- Affirming Surgery . . . . . . . . 215
Maurice Marcel Garcia
22 Postoperative Care from the Primary Care Perspective . . . . . . . 229
Asa Radix
23 Religious Attitudes Toward Gender-Confirming Surgery . . . . . 237
Leonard A. Sharzer, David A. Jones, Mehrdad Alipour, and
Kelsey Jacob Pacha
24 Establishment of a Gender Confirmation Program . . . . . . . . . . 259
Loren S. Schechter and Rebecca Schechter
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Contributors
Cori A. Agarwal, MD Division of Plastic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, USA
Mehrdad Alipour, PhD Institute of Arab and Islamic Studies, Exeter, UK
Jens Urs Berli, MD Department of Plastic and Reconstructive Surgery,
Oregon Health and Science University, Portland, OR, USA
Marci Bowers, MD Mills-Peninsula Hospital, Burlingame, CA, USA
San Mateo Surgery Center, San Mateo, CA, USA
Jordan Deschamps-Braly, MD, FACS Deschamps-Braly Clinic of Plastic
& Craniofacial Surgery, San Francisco, CA, USA
Rados Djinovic, MD Department of Urology, Sava Perovic Foundation –
Center for Genito-Urinary Reconstructive Surgery, Belgrade, Serbia
Daniel P. Donato, MD Division of Plastic Surgery, The University of Texas
Medical Branch, Galveston, TX, USA
Frederic M. Ettner, MD Department of Family Medicine, University of
Chicago Pritzker School of Medicine, Chicago, IL, USA
Randi Ettner, PhD Clinical and Forensic Psychologist, Evanston, IL, USA
Courtney  Finlayson, MD Department of Pediatrics, Ann and Robert
H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Maurice Marcel Garcia, MD, MAS Division of Urology, Cedars-Sinai
Medical Center, Los Angeles, CA, USA
Department of Urology & Department of Anatomy, University of California
San Francisco (UCSF), Los Angeles, CA, USA
Cedars-Sinai Medical Center Transgender Surgery and Health Program,
Los Angeles, CA, USA
Jamison Green, PhD, MFA Independent Scholar, Vancouver, WA, USA
Katherine T. Hsiao, MD Department of Obstetrics and Gynecology, Sutter
Health, San Francisco, CA, USA
Valerio  Iacovelli, MD Department of Surgical Sciences, Tor Vergata
University of Rome – San Carlo di Nancy Hospital, Rome, Italy
ix
x Contributors
David A. Jones, MA(Cantab), MA, MSt, DPhil(Oxon), FHEA St. Mary’s
University, Twickenham, UK
Dan H. Karasic, MD Department of Psychiatry, University of California
San Francisco, Health Sciences Clinical Professor of Psychiatry, San
Francisco, CA, USA
Gail Knudson, MD, MEd, FRCPC Faculty of Medicine, University of
British Columbia, Vancouver, BC, Canada
Ervin Kocjancic, MD Department of Urology, University of Illinois Health
and Science, Chicago, IL, USA
Walter Lin, MD The Buncke Clinic, San Francisco, CA, USA
Slawomir  Marecik, MD, FACS, FASCRS Department of Colorectal
Surgery, Advocate Lutheran General Hospital & University of Illinois at
Chicago, Park Ridge, IL, USA
Jiri George Melich, MD, FRCS Department of Surgery, Royal Columbian
Hospital, University of British Columbia, Vancouver, BC, Canada
Jennifer L. Miller, MD Department of Pediatrics, Ann and Robert H. Lurie
Children’s Hospital of Chicago, Chicago, IL, USA
Dmitriy Nikolavsky, MD Department of Urology, SUNY Upstate Medical
University, Syracuse, NY, USA
Kelsey Jacob Pacha, MA, M.Div. Master of Divinity and Master of Arts in
Religion and Psychology, Pacific School of Religion, Berkeley, CA, USA
Eric Plemons, PhD School of Anthropology, University of Arizona, Tucson,
AZ, USA
Asa Radix, MD, MPH, FACP Department of Medicine, Callen-Lorde
Community Health Center, New York, NY, USA
Bauback Safa, MD MBA The Buncke Clinic, San Francisco, CA, USA
Joshua D. Safer, MD, FACP, FACE Center for Transgender Medicine and
Surgery, Mount Sinai Health System, New York, NY, USA
Thomas Satterwhite, MD Align Surgical Associates, Inc, San Francisco,
CA, USA
Jessica  Schardein, MD, MS Department of Urology, SUNY Upstate
Medical University, Syracuse, NY, USA
Loren S. Schechter, MD Department of Plastic Surgery, The Center for
Gender Confirmation Surgery, Weiss Memorial Hospital, Chicago, IL, USA
Rebecca Schechter, MD Highland Park, IL, USA
Leonard  A.  Sharzer, MD, MS(Surg.), MA(Div), Rabbi Finkelstein
Institute for Religious and Social Studies, The Jewish Theological Seminary,
New York, NY, USA