Surgery: Gender Affirmation

55 Pages·2016·1.24 MB·English

by  Ruben Hopwood

Surgical Gender Affirmation
Ruben Hopwood, MDiv, PhD
Coordinator, Transgender Health Program, Fenway Health
Timothy Cavanaugh, MD
Medical Director, Transgender Health Program, Fenway Health
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Continuing Medical Education
Disclosure
 Program Faculty: Tim Cavanaugh, MD
 Current Position: Medical Director, Transgender Health Program, Fenway Health
 Disclosure: No relevant financial relationships. All hormone therapy for transgender
people is off-label.
 Program Faculty: Ruben Hopwood, PhD
 Current Position: Coordinator, Transgender Health Program, Fenway Health, and
Psychology Fellow, Boston University, The Danielsen Institute
Disclosure: No relevant financial relationships. All hormone therapy for transgender
people is off-label.
It is the policy of The National LGBT Health Education Center, Fenway Health that all CME planning
committee/faculty/authors/editors/staff disclose relationships with commercial entities upon
nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and,
if identified, they are resolved prior to confirmation of participation. Only participants who have no conflict of
interest or who agree to an identified resolution process prior to their participation were involved in this CME
activity.
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Learning Objectives
1. Participants will be able to identify and broadly
define surgical options available both to trans men
and trans women.
2. Participants will be able to identify potential surgical
complications for major gender affirming surgeries
3. Participants will be able to discuss consequences of
or alternatives when surgery is not available or
desired
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Surgery: Gender Affirmation (GAS); Sex
Reassignment (SRS); Genital
Reconstruction (GRS)
 Surgery has proven to be an effective intervention for the
patient with gender dysphoria.
 Patient satisfaction following surgery is high,
 And reduction of gender dysphoria following surgery has
psychological and social benefits.
 As with any surgery, the quality of care provided before, during,
and after surgery has a significant impact on patient outcomes.
 Not for everyone!
 Is someone ready?
 Insurance coverage historically has been difficult to obtain.
Lawrence, A. A. (2003). Factors Associated With Satisfaction
or Regret Following Male-to-Female Sex Reassignment
Surgery. Archives of Sexual Behavior, 32(4), 299–315.
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Utilization of Surgery
MtF Chest Surgery
Don't
Want
28%
Want
Someday
54% Have
Had
18%
Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., &
Keisling, M. (2011). Injustice at every turn: A report of the National
Transgender Discrimination Survey.Washington, DC: National
Center for Transgender Equality and National Gay and Lesbian
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Task Force.
Utilization of Surgery
FtM Hysterectomy
FtM Chest Surgery
Don't
Want
8%
Don't
Want
Want 23%
Want
Someday
Have Someday
51% Have
Had 57%
Had
41%
20%
FtM Metoidioplasty
FtM Phalloplasty
Have
Had
2% Want
Want
Someday
Someday
26%
52%
Don't
Want
45% Don't
Have
Want
Had
72%
3%
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Language
 Non-judgmental
 The majority of transgender people who have had surgical
or medical alterations of their bodies are very satisfied with
the results
 Devaluing
 Sadly, health care providers often use disparaging language
or tones of voice when talking to clients about the clients’
surgical or medical body alterations or desires for body
alterations
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Psychotherapy is not an
absolute requirement for
hormone therapy and surgery
WPATH, SOC, v.7, 2011
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Criteria for Surgical Referrals
Mastectomy & creation of a male chest in FTMs (one
referral)
1. Persistent, well-documented gender dysphoria
2. Capacity to make a fully informed decision and give
consent for treatment
3. Age of majority
4. If significant medical or mental health concerns are
present, they must be reasonably well controlled
 Hormone therapy is not a prerequisite per WPATH but
may be required by insurance plans
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Criteria for Surgical Referrals
Breast augmentation in MTFs (one referral)
1. Persistent, well-documented gender dysphoria
2. Capacity to make fully informed decision and to give
consent for treatment
3. Age of majority
4. If significant medical or mental health concerns are
present, they must be reasonably well controlled
 It is recommended that MTF patients take feminizing
hormones for a minimum of 12 months, and
preferably for 24 months, prior to augmentation for
better results.
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