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April 2017

What Surgeons Need to Know About Gender Confirmation Surgery When Providing Care for Transgender Individuals: A Review

Author Affiliations
  • 1Division of Plastic Surgery, Department of General Surgery, Oregon Health & Science University, Portland
  • 2Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
  • 3private practice, San Francisco, California
  • 4Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine and the Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
  • 5private practice, Evanston, Illinois
  • 6Department of Family Medicine, Northshore University Healthsystem, Lincolnwood, Illinois
  • 7Division of Endocrinology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
  • 8Department of Public Health, San Francisco, California
  • 9Department of Plastic Surgery, University Hospital Gent, Gent, Belgium
  • 10University Plastic Surgery, Morton Grove, Illinois
JAMA Surg. 2017;152(4):394-400. doi:10.1001/jamasurg.2016.5549

Importance  In 2014, the US Department of Health and Human Services decided that its 1981 exclusion of transsexual surgical treatments from Medicare coverage was based on outdated, incomplete, and biased science and did not reflect current evidence or standards of care, and the exclusion was therefore lifted. As a direct result of this decision, surgeons nationwide are seeing an increase in consultations for surgical therapy to help transgender and gender-nonconforming individuals. Although some clinicians may have the technical training for such surgical procedures, in many cases, they may not have a full understanding of the complex and comprehensive care required to provide optimal health care for transgender individuals.

Observations  Gender confirmation surgery is a developing field in the United States and other areas of the world. The World Professional Association for Transgender Health started a global education initiative intended to provide surgeons and other health care professionals with the necessary background knowledge to understand and treat this patient population. This article provides an overview of best practices as set forth in the seventh edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People by the World Professional Association for Transgender Health, including mental health, endocrinology, and surgery for trans women and trans men.

Conclusions and Relevance  Experts in each aspect of transgender health have summarized the content of the global education initiative in this article. It provides valuable information to surgeons of all disciplines and other health care professionals to help guide the treatment and management of transgender individuals.