Evaluation and Treatment of Gender Dysphoria to Prepare for Gender Confirmation Surgery

Hadj-Moussa, Miriam; Ohl, Dana A.; Kuzon, William M.

doi:10.1016/j.sxmr.2018.03.006

Cited by 23 publications

(30 citation statements)

References 26 publications

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“…Treatment of gender dysphoria should be individualized and involve a combination of psychotherapy, social gender transition, cross-sex hormone therapy, gender-affirming surgery, and/or ancillary procedures and services with the "goal of all treatment modalities to alleviate distress and affirm the patient's experienced gender identity." 11 Health-related QOL is particularly poor in transgender youth and adolescents (aged 6-23 years) with significantly lower health-related QOL than similar youth without chronic disease and all chronic disease comparison groups except for rheumatology and cerebral palsy. 12 Given the poor QOL of patients suffering from gender dysphoria, surgical treatment via gender affirming surgery is an option to help patients improve their health-related QOL.…”

Section: Discussionmentioning

confidence: 93%

“…Transgender adults are more than three times more likely to have ever thought about suicide, nearly six times more likely to have ever attempted suicide, nearly four times more likely to have experienced serious psychological distress, and more than three times more likely to have emotions that interfere with their relationships, social life, ability to do chores, and work performance. 10 Gender dysphoria as defined by Hadj-Moussa et al 11 is "the experience of marked distress due to incongruence between genetically determined gender and experienced gender." Treatment of gender dysphoria should be individualized and involve a combination of psychotherapy, social gender transition, cross-sex hormone therapy, gender-affirming surgery, and/or ancillary procedures and services with the "goal of all treatment modalities to alleviate distress and affirm the patient's experienced gender identity."…”

Section: Discussionmentioning

confidence: 99%

“…Gender dysphoria as defined by Hadj‐Moussa et al 11 is “the experience of marked distress due to incongruence between genetically determined gender and experienced gender.” Treatment of gender dysphoria should be individualized and involve a combination of psychotherapy, social gender transition, cross‐sex hormone therapy, gender‐affirming surgery, and/or ancillary procedures and services with the “goal of all treatment modalities to alleviate distress and affirm the patient's experienced gender identity.” 11 Health‐related QOL is particularly poor in transgender youth and adolescents (aged 6–23 years) with significantly lower health‐related QOL than similar youth without chronic disease and all chronic disease comparison groups except for rheumatology and cerebral palsy 12 …”

Section: Discussionmentioning

confidence: 99%

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Evaluating Patient Benefit From Laryngochondroplasty

Tang

2020

The Laryngoscope

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Objectives/Hypothesis: To elucidate and review current literature on the surgical technique for laryngochondroplasty in male-to-female transgender patients. To determine the degree of benefit afforded to male-to-female transgender patients by laryngochondroplasty using the Glasgow Benefit Inventory (GBI). Study Design: Retrospective case series. Methods: After institutional review board approval was obtained, the GBI survey was given to patients who underwent laryngochondroplasty by the author. Demographic information was analyzed including age, race, wait time to surgery, distance traveled, median zip code income, and concomitant gender-affirming surgeries such as vaginoplasty, breast augmentation, or facial feminization. Results: From April 2016 to April 2020, 209 patients received laryngochondroplasty within the Kaiser Permanente Northern California Medical System. Of those, 91 received laryngochondroplasty with the author and were given the GBI, with 73 patients (80%) responding. Patients were on average 31.4 years old, traveled 45.4 miles to the surgical site, lived in a zip code with a median income of $86,793.61, and waited 95.7 days for surgery. Patients had a statistically significant improvement in all three subscores (general, social, and physical) of the GBI as well as in their overall score. Conclusions: Laryngochondroplasty is a safe and effective procedure to reduce thyroid cartilage prominence (Adam's apple) in male-to-female transgender patients. There was a statistically significant improvement in the overall score and all subscores of the GBI after laryngochondroplasty

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluating Patient Benefit From Laryngochondroplasty

Tang

2020

The Laryngoscope

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“…Earlier studies focused on patient characteristics and identified several variables that were associated with regret in their patient populations. These variables include psychological variables (11,22,23), such as previous history of depression (15,26), character pathology (26) or personality disorder (5,15), history of psychotic disorder (15,28), overactive temperament (26), negative self-image (26) or other psychopathology (15,19,26), as well as various social or familial factors that include history of family trauma (19,29), poor family support (5,11,15,28), belonging to a non-core group (28), previous marriage (15,19), and biological parenthood (15,19). Landen et al identified poor family support as the most important variable predicting future postoperative regret in transgender men and women undergoing gender-affirming surgery in Sweden between 1972-1992 (28).…”

Section: Feasibility Of Obtaining Desired Outcome Mental Health Evaluationmentioning

confidence: 99%

“…Defined as subsequent application for reversal surgery, the authors found that 3.8% of their study population regretted their surgery. Other factors previously associated with regret include: sexual orientation (5,7,15,19), impaired postoperative sexual function [most notably in transgender women; (29)], previous military service (29), a physically strenuous job (29), history of criminality (5), age at time of surgery and transition [>30 year increased risk; (5,6,11,15,19,29)], asexual or hyposexual status preoperatively (15,29), too much or too little ambivalence regarding prospect of surgery (29), and/ or an absence of gender nonconformity in childhood (15).…”

Section: Feasibility Of Obtaining Desired Outcome Mental Health Evaluationmentioning

confidence: 99%

Guiding the conversation—types of regret after gender-affirming surgery and their associated etiologies

Narayan¹,

Hontscharuk²,

Danker³

et al. 2021

Ann Transl Med

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Background: A rare, but consequential, risk of gender affirming surgery (GAS) is post-operative regret resulting in a request for surgical reversal. Studies on regret and surgical reversal are scarce, and there is no standard terminology regarding either etiology and/or classification of the various forms of regret.This study includes a survey of surgeons' experience with patient regret and requests for reversal surgery, a literature review on the topic of regret, and expert, consensus opinion designed to establish a classification system for the etiology and types of regret experienced by some patients.Methods: This anonymous survey was sent to the 154 surgeons who registered for the 2016 World Professional Association for Transgender Health (WPATH) conference and the 2017 USPATH conference.Responses were analyzed using descriptive statistics. A MeSH search of the gender-affirming outcomes literature was performed on PubMed for relevant studies pertaining to regret. Original research and review studies that were thought to discuss regret were included for full text review. Results:The literature is inconsistent regarding etiology and classification of regret following GAS. Of the 154 surgeons queried, 30% responded to our survey. Cumulatively, these respondents treated between 18,125 and 27,325 individuals. Fifty-seven percent of surgeons encountered at least one patient who expressed regret, with a total of 62 patients expressing regret (0.2-0.3%). Etiologies of regret were varied and classified as either:(I) true gender-related regret (42%), (II) social regret (37%), and (III) medical regret (8%). The surgeons' experience with patient regret and request for reversal was consistent with the existing literature.Conclusions: In this study, regret following GAS was rare and was consistent with the existing literature.Regret can be classified as true gender-related regret, social regret and medical regret resulting from complications, function, pre-intervention decision making. Guidelines in transgender health should offer preventive strategies as well as treatment recommendations, should a patient experience regret. Future studies and scientific discourse are encouraged on this important topic.

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