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Gender-affirming surgery more likely in adults transitioning from male to female vs. female to male

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May 10, 2017

Transgender adults transitioning from female to male may be twice as likely as those transitioning from male to female to undergo gender-affirming surgery, and low rates of surgery may be due to financial cost, lack of interest or low priority placed on surgery, according to findings published in Endocrine Practice.

“Prior to insurance coverage for transgender care, among transgender individuals who wanted hormone therapy, only a minority had any surgery,” Joshua D. Safer, MD, endocrinology and medical director of the Center for Transgender Surgery and Medicine at Boston Medical Center, told Endocrine Today. “Among transgender individuals who did have surgery, there was far less genital surgery than many in society seem to believe. Transgender [adults transitioning from female to male] were very interested in chest surgery but only a minority were interested in the genital surgeries currently available to them. For transgender [adults transitioning from male to female], surgeries to make changes to visible parts of the body were as important as surgeries for parts of the body hidden by clothing. That is, relative to societal expectations, facial feminization surgery was more important and genital surgery less important.”

Joshua D. Safer, MD
Joshua D. Safer

Safer and colleagues evaluated 99 transgender patients (28 transitioning from female to male) undergoing hormone therapy at Boston Medical Center between 2004 and 2015 to determine the prevalence of gender-affirming surgeries.

Thirty-five percent of all participants underwent at least one gender-affirming surgical intervention; 25% had one or more surgical interventions in the chest area, 13% had surgery in the genital area and 8% had facial plastic surgery.

Among those transitioning from female to male, 54% underwent a transgender surgical intervention, 28% had surgery in both genital and chest areas, 50% had chest reconstruction surgery and 14% had surgery in the genital area. Gender-affirming surgery was almost twice as likely among those transitioning from female to male compared with those transitioning from male to female.

A transgender surgical intervention was performed in 27% of those transitioning from male to female; four had surgeries in both chest and genital areas, 17% had chest reconstruction surgery, 13% had at least once surgical intervention in the genitourinary tract. Compared with those transitioning from female to male, those transitioning from male to female were almost three times less likely to have chest or “top” surgery.

“The old regimens for transgender medical intervention were a complete program that included diagnosis, hormone treatment and genital surgery,” Safer said. “That is clearly a false framework. Providers should anticipate that even among transgender individuals who want medical treatment like hormone therapy, many will not want surgery and even among those who want surgery, the surgeries desired may be different than providers expect.” – by Amber Cox

For more information:

Joshua D. Safer, MD, can be reached at the BMC Center for Transgender Medicine and Surgery, 1 Boston Medical Center Place Boston, MA 02118.

Disclosure: The researchers report no relevant financial disclosures.

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Caroline Davidge-Pitts
This is an interesting study looking at prevalence of gender-affirming surgeries in the transgender population. The study raises an important point in that each patient’s goals may be different, and it should not be assumed (by providers and society) that every patient has had or wants gender-affirming procedures. The U.S. transgender survey showed a discrepancy between transgender individuals who had gender-affirming procedures vs those who reported that they would “want it someday.” This speaks to lack of accessibility to these procedures in the past, so it would be interesting to see how this clinic-based study’s data would change now that insurance coverage has improved and there is access to more transgender health clinics around the country.

Caroline Davidge-Pitts, MD

Assistant Professor of Medicine, Department of Endocrinology, Diabetes, Metabolism, Mayo Clinic, Rochester Minnesota

Disclosure: Davidge-Pitts reports no relevant financial disclosures.