gender identity disorder, transgender persons, sexual transition,
gender transition, male-to-female, gender non-conform,
gender-transform, gender incongruence
* Key words used in accordance with the PI(C)O method
“transsexualism” OR “transgender” OR “transgenderism” AND (“reassignment surgery” OR “sex reassignment”) AND “quality of life” | |
(DE “Transgender” OR DE “Transsexualism” OR DE “Gender Identity Disorder”) AND (DE “Sex Change” OR DE “Surgery” OR “reassignment surgery” OR “sex reassignment”) AND “quality of life” | |
| (“Transsexualism”[Mesh]) AND (“Sex Reassignment Surgery”[Mesh]) AND (“Quality of Life”[Mesh]) ((“Transgender Persons”[Mesh]) OR “Transsexualism”[Mesh]) AND (“Quality of Life”[Mesh]) (“Quality of life”) AND (“gender reassignment surgery” OR “sex reassignment operation” OR “gender transformation operation” OR “sex reassignment surgery” OR “penile inversion vaginoplasty” AND sex* AND chang* OR sex* AND reassign* OR gender-reassign*) AND (gender-dysphor* OR transsex* OR gender-nonconform* OR gender-non-conform* OR transgend* OR transident* OR gender-incongruence OR gender-varian* OR gender-transform* OR gender-identity-disorder* OR sexual-transition OR gender-transition OR sexual-dysphor* OR transvest* OR autogyn* OR trans-sex* OR trans-gend* OR trans-ident* OR “male-to-female”) |
(gender-dysphor* OR transsex* OR gender-nonconform* OR gender-non-conform* OR trans-gend* OR trans-ident* OR gender-incongruence OR gender-varian* OR gender-transform* OR gender-identity-disorder* OR sexual-transition OR gender-transition OR sexual-dysphor* OR transvest* OR autogyn* OR trans-sex* OR trans-gend* OR trans-ident* OR “male-to-female”) AND (“gender reassignment surgery” OR “sex reassignment operation” OR “gender transformation operation” OR “sex reassignment surgery” OR “penile inversion vaginoplasty” OR sex* chang* OR sex* reassign* OR gender-reassign*) AND (“quality of life”) |
* Catch phrases and key words used in the literature search
Among others, we excluded studies that did not focus exclusively on trans persons or that didn’t collect data on quality of life by using a standardized questionnaire. We also excluded studies in underage trans people.
The Figure shows the study selection process.
Flow chart illustrating the study selection process
All included articles are non-randomized studies with an evidence level of III ( e2 ). In the case of studies that reported on the quality of life of trans women as well as trans men ( 17 – 21 ) we ensured that the data for trans women were evaluated separately or that the ratio of M–F/F–M favored trans women. Table 1 shows further key study data; Table 2 shows the quality characteristics of the studies.
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* 1 Numbers of study participants after removal of dropouts ( table 2 ); exception: Lindqvist et al. ( 23 ), see Table 2
* 2 M–F, male-to-female; F–M, female to male, sex reassignment surgery
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Ainsworth et al. ( ) | — | — | n = 25 (10.12%) M–F* had sex reassignment surgery n = 47 (19.02%) had sex reassignment surgery and facial feminization surgery n = 28 (11.3%) had facial feminization surgery n = 147 (59.51%) had no surgery Time of survey not stated, hormone therapy | Moderate to high: selection bias, classification bias, bias owing to deviations in interventions |
Bouman et al. ( ) | 20.51% | Non-respondents n = 6 (15.38%) Lost to follow-up n = 1 (2.56%) Deceased n = 1 (2.56%) | 27 M–F (= 87.1%) completed the QoL questionnaire, hormone therapy | Moderate to high: selection bias |
Cardoso da Silva et al. ( )* | 75.26%* (n= 30 M–F [15.7%] excluded) | — | Dropout rate very high, no reasons given 31 M–F (65.95%) had corrective surgery, hormone therapy | Moderate to high: selection bias, attrition bias |
Castellano et al. ( ) | 11.76% | Non-respondents n= 8 (11.76%) | Only the domain general quality of life score and subdomains ‧sexuality and body were requested, hormone therapy | Moderate to high: selection bias Moderate: detection bias |
Jokic-Begic et al. ( ) | 25% | Lost to follow-up n = 1 (12.5%) Refused participation n = 1 (12.5%) | Very small study population, socioeconomic and clinical circumstances, psychotherapy, hormone therapy | Moderate to high: selection bias |
Kuhn et al. ( ) | — | — | No detail on interventions in the control group,no separate data analysis for M–F and F–M, hormone therapy | Moderate to high: selection bias, bias owing to deviations in interventions |
Lindqvist et al. ( )* | 77.37%* | Deceased or moved without changing address and entry in residents‘ register | Very high dropout rate, only 17 patients completed the questionnaire at all 4 follow-up points, hormone therapy | Moderate to high: selection bias, attrition bias |
Papadopulos et al. ( ) | 61.15% | Unavailable/incorrect phone number n = 38 (31.40%) Refused participation n = 14 (11.57%) Quesionnaire not completed n = 22 (18.18%) | Inclusion criteria: only patients who had had corrective surgery or those who did not require such surgery, hormone therapy | Moderate to high: selection bias |
Parola et al. ( ) | — | — | Hormone therapy | Moderate to high: selection bias |
van der Sluis et al. ( ) | 62.5% | Non-respondents n = 6 (25%) Lost to follow-up n = 3 (12.5%) Deceased n = 5 (20.84%) Refused participation n = 1 (4.16%) | Small study population Secondary vaginoplasty Hormone therapy | Moderate to high: selection bias |
Weyers et al. ( ) | 28.57% | Non-respondents n= 17 (24.29%) Refused participation n=3 (4.29%) | Hormone therapy | Moderate to high: selection bias |
Yang et al. ( ) | — | — | n = 73 (34.92%) had facial feminization surgery n = 43 (20.57%) had breast augmentation surgery Only n = 4 (1.91%) had sex reassignment surgery Socioeconomic and clinical circumstances Hormone therapy in only n = 37 (17.7%) | Moderate to high: selection bias, bias owing to deviations in interventions |
Zimmermann et al. ( ) | 55.56% | Non-respondents n = 45 (50%) Incomplete questionnaire n = 3 (3.34%) Inclusion criteria not met n = 2 (2.23%) | Absolute values from FLZ questionnaire not shown, only p-values reported, no separate evaluation of FLZ questionnaire for F–M and M–F, hormone therapy | Moderate to high: selection bias |
* 1 M–F male to female; F–M female to male, reassignment surgery
* 2 Prospective study design
* 3 Of originally 190 participants, n = 160 (84.21%) completed the questionnaire preoperatively and n = 47 (24.73%) postoperatively
* 4 Out of a total of 190 study participants, n = 146 (76.84%) completed the questionnaire preoperatively, n = 108 (56.84%) 1 year postoperatively, n = 64 (33.68%) 3 years postoperatively, and n = 43 (22,63%) 5 years postoperatively. Most of the 190 participants completed the questionnaire at least at two follow-up points.
The studies made use of the following instruments:
None of the questionnaires constitutes an investigative tool that is specifically tailored to trans persons. Table 3 shows the result scales. Table 2 shows the confounding variables and, as far as it is possible to assess this, the risk of bias.
SF-36 ( , , – ) | 36 items | 0 | 100 |
WHOQOL-100 ( , ) | 100 items | 0 | 100 |
SHS ( – ) | VAS, 4 items on a 7 point Likert scale | 4 | 28 |
SWLS ( – ) | VAS, 5 items on a 7 point Likert scale | 5 | 35 |
CLLS ( – ) | VAS, short scale (L-1) | 0 | 10 |
*For the studies referenced in parentheses, it was not possible to calculate effect sizes
The SF-36 and WHOQOL-100 are validated, reliable and disease–non-specific instruments for measuring health-related quality of life ( 30 , 31 ). They can be used to gain information on the individual health status and allow for observing disease-related stresses over time. The questionnaires collect data on numerous aspects of daily life, which in their totality reflect quality of life. They are used internationally and therefore make cross-cultural studies an option ( 32 ).
Studies that used the SF-36 to answer the question of postoperative quality of life ( 18 , 20 , 22 – 25 ) observed after sex reassignment surgery an improvement in “social functioning”, “physical” and “emotional role functioning”, “general health perceptions”, “vitality”, and “mental health” (p = 0.025 to p >0.05). In two of these studies ( 22 , 24 ), “mental health” in trans women after sex reassignment surgery did not differ significantly from the standard sample. This explains the formally non-significant result. Ainsworth and Spiegel ( 22 ) showed that trans women without surgical intervention when compared indirectly with cis women from the SF-36 standard sample reported significantly poorer “mental health” (39.5 vs 48.9; p <0.05). Lindqvist et al. ( 23 ) and Weyers et al. ( 24 ) found an improvement in “self-perceived health” in the first postoperative year (p <0.05 and p <0.009), which deteriorated later but did not fall as low as its original score (p <0.0001). Furthermore, the studies concluded that “physical pain” increased postoperatively and “physical functioning” decreased; the postoperative follow-up periods varied between 3 months ( 18 ) and 5 years ( 23 ). According to Lindqvist et al. ( 23 ), “physical pain” in trans women five years postoperatively was comparable to that in the standard population (72.5 vs 72.7; SD 26.5).
Studies that used the WHOQOL-100 came up with the following results: Cardoso da Silva et al. ( 26 ) observed postoperatively an increase in “sexual activity” (p = 0.000) compared with the preoperative evaluation (prospective study design). Furthermore they found a postoperative improvement in the “psychological domain” (p = 0.041) and “social relationships” (p = 0.007), but a deterioration in “physical health” (p = 0.002) and “independence” (p = 0.031). Accordingly, deteriorations were seen in the areas of “energy” and “fatigue”, “sleep”, “negative feelings”, “mobility”, and “activities of daily living” (p <0.05). Castellano et al. ( 17 ) found after sex reassignment surgery for the group of trans women compared with the group of cis women no significant differences relating to “sexual activity” (65.85 vs 66.28; p >0.05), “body image” (64.64 vs 65.47; p >0.05), and the “quality of life score” (67.87 vs 69.49; p >0.05).
The King’s Health Questionnaire (KHQ) is a validated questionnaire for evaluating the impact of urinary incontinence on quality of life ( 33 ), a topic of central importance for trans persons ( 34 ). This questionnaire interrogates the quality of life domains always in association with urinary incontinence as the main problem. Kuhn et al. ( 19 ) showed that “general health” in trans persons was experienced as poorer to a relevant extent (Cohen’s d = 4.126; p = 0.019), and “physical” (d = -7.972; p <0.0001) and “personal limitations” (d = -7.016; p <0.001) were experienced to a greater extent. In contrast to this, trans persons felt less limited in terms of “role limitation” (d = 3.311; p = 0.046). For “emotions”, “sleep”, “incontinence”, and “symptom severity”, the differences to the control group did not reach significance. The control group consisted of cis women who had undergone abdominopelvic surgery. The evaluation of the visual analogue scale (VAS) showed a lower (d = 14.136; p <0.0001) degree of general life satisfaction in the group of trans persons.
The SHS ( 35 ), SWLS ( 36 ), and CLLS ( 37 ) are validated and internationally used visual analogue scales to evaluate life satisfaction. The SHS evaluates individual happiness and associated physical, mental, and social wellbeing ( 35 ). The SWLS was used as a short-form scale in the cited studies (also known as L-1) and included only the question on general life satisfaction ( 36 ). The CLLS evaluates emotional wellbeing associated with life satisfaction as well as subjective health ( 37 ).
Studies that used the SHS, SWLS, and CLLS ( 27 , 28 ) to evaluate postoperative life satisfaction reported a high degree of “subjective happiness” (5.6; SD 1.4 and 5.9; SD 0.6), of “satisfaction with life“ (27.7; SD 5.8 and 27.1; SD 2.1) and “subjective wellbeing” (8.0 [range: 4–10] and 7.9; SD 0.7) in trans women after intestinal vaginoplasty. The studies cited earlier differ with regard to the following items: Bouman et al. ( 27 ) studied a population of young trans women (mean age: 19.1 years) with penoscrotal hypoplasia after primary laparoscopic intestinal vaginoplasty. The study participants had received puberty blockers during their transition therapy, which resulted in penoscrotal hypoplasia and made penile inversion vaginoplasty ( box ) impossible. Van der Sluis et al. ( 28 ) studied an older population (mean age: 58 years) of trans women after secondary intestinal vaginoplasty—that is, patients who required secondary intestinal reconstruction owing to vaginal stenosis or insufficient vaginal length after penile inversion vaginoplasty. The postoperative follow-up period varied between 1–7.5 years ( 27 ) and 17.2–34.3 years ( 28 ). In spite of the different patient populations, these studies found that sex reassignment surgery had a positive effect on life satisfaction.
The FLZ is a validated multidimensional questionnaire for evaluating individual general life satisfaction ( 38 ). It is used in life quality and rehabilitation research and enables the recording of changes if administered repeatedly. It is available in a German language version only; for this reason, its results apply only to German speaking populations.
Studies that used the FLZ questionnaire ( 21 , 29 ) found that the postoperative life satisfaction of trans women in terms of “health” does not differ from that of the general population. Additionally, Papadopoulos et al. ( 29 ) found no differences for “friends”, “hobbies”, “income”, “work”, and “relationship.” A subanalysis of the module “health” found postoperatively in both studies a relevant decrease in “fitness” (d = 0.521; p <0.001) and “energy” (d = 0.494; p <0.003). Zimmerman et al. ( 21 ) additionally found a significant decrease in “ability to relax/equilibrium” (p = 0.002), “fearlessness/absence of anxiety” (p = 0.015), and “absence of discomfort/pain” (p = 0.037). Both studies ( 21 , 29 ) were retrospective surveys that were undertaken once only in a time period between 6 months and 58 months postoperatively. Papadopoulos et al. ( 29 ) included only subjects into the study who did not require any further corrective surgery after sex reassignment surgery or who had already undergone a second procedure for the purpose of minor corrections.
Two prospective studies documented postoperatively a notable improvement in quality of life ( 23 , 26 ). Four studies found that the life quality of trans women after sex reassignment surgery was no different from that of cis women ( 17 , 20 , 22 , 24 ). Sex reassignment surgery has also been shown to have a positive effect on life satisfaction ( 27 , 28 )—the exception was urinary incontinence, in which case life satisfaction dropped ( 19 ). Lindqvist et al. ( 23 ) and Weyers et al. ( 24 ) observed an improvement in self-perceived health in the first postoperative year, which then drops, albeit not all the way down to its original level. This is consistent with the honeymoon phase described by De Cuypere et al. ( 39 ), which has been described as a euphoric period in the first year after surgery. Several studies ( 18 , 20 – 25 ) showed that physical pain increased after surgery and physical functioning deteriorated. This is easily explained by the surgery itself, however; the postoperative follow-up periods in these studies varied between 3 months ( 18 ) and 5 years ( 23 ).
Altogether the study results imply that sex reassignment surgery has an overall positive effect on partial aspects, such as mental health, sexuality, life satisfaction, and quality of life.
These results were confirmed by Barone et al. ( 40 ) and Murad et al. ( 15 ) in their review articles, which were published in 2017 and 2010, respectively. Barone et al. ( 40 ) in a systematic review evaluated patient reported results after sex reassignment surgery; among others, regarding life satisfaction. Murad et al. ( 15 ) in a meta-analysis focused on quality of life and psychosocial health after hormone therapy (main aspect) and sex reassignment surgery. In sum, both studies found improvements in quality of life and life satisfaction after sex reassignment surgery, and an improvement at the psychosocial level. Hess et al. ( 11 ) concluded that the study participants benefited from sex reassignment surgery—they too found high rates of satisfaction postoperatively in Germany.
As sex reassignment surgery often constitutes the final step of sex reassignment measures, hormone therapy as well as accompanying psychotherapy may have had a confounding effect. Not all studies adjusted for confounding factors. A lack of randomization and control or the use of a matched control group ( 17 , 19 ) in the studies also introduced methodological bias ( table 2 ). Furthermore, the high dropout rates of 12% ( 17 ) to 77% ( 23 ) (median: 56%), which are mainly due to non-respondents, should be assessed critically. In our experience, however, the patient population of trans women is often reticent and is not interested in study participation because of personal reasons (“to not be reminded of that time”). Other authors have shared this observation ( 18 , 24 ), which may also explain the occasionally high dropout rates. There is also the possibility that dissatisfied patients were among the dropouts. Owing to socioeconomic and clinical conditions, the studies from Croatia ( 18 ) and China ( 25 ) need to be evaluated separately. On the one hand, the authors of both studies draw attention to the public’s lack of awareness and understanding (and the associated psychological stress for trans women) in these countries, and, on the other hand, statutory sickness funds did not cover the costs of all treatments, which were therefore accessible to only few patients. This explains the notably lower participant numbers of 3 ( 18 ) and 4 ( 25 ) male-to-female transitions after sex reassignment surgery. None of the included studies reported potential suicide rates.
The strength of this review lies in the fact that we included only studies that used standardized questionnaires. Tests (such as the SF-36 or WHOQOL-100) represent validated and reliable measuring instruments, for some of which reference standard populations exist, and they enable international and intercultural comparison. Furthermore, standardized questionnaires have the advantage of a high degree of objectivity in terms of conducting, evaluating, and interpreting studies.
The available study data show that sex reassignment surgery has a positive effect on partial aspects—such as mental health/wellbeing, sexuality, and life satisfaction—as well as on quality of life overall.
It should be noted that the studies are almost exclusively retrospective analyses of mostly uncontrolled and small cohorts, for which no valid or specific measuring instruments are available to date. Because of the high dropout and non-response rates, the current data should be interpreted with caution.
In spite of the essentially positive results, the data are not satisfactory at this point in time. Due to the studies’ limited follow-up times, no conclusions can be drawn as yet about the long term consequences of such procedures. Furthermore, many studies did not use standardized questionnaires and/or scores, which makes comparisons between individual studies difficult.
Acknowledgments.
Translated from the original German by Birte Twisselmann, PhD.
Conflict of interest statement
The authors declare that no conflict of interest exists.
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The idea of getting stuck in the wrong body sounds like the premise for a movie in "Freaky Friday," a mother and a daughter swap bodies, and in "Big" and "13 Going on 30," teenagers experience life in an adult's body. These movies derive their humor from the ways in which the person's attitude and thoughts don't match their appearance. A teenager trapped in her mother's body, for example, revels in breaking curfew and playing air guitar, while a teenager trapped in an adult's body is astounded by the trappings of wealth that come with a full-time job. We laugh because the dialogue and actions are so contrary to what we'd expect from someone who is a mother, or from someone who is an employed adult.
But for some people, living as an incongruous gender is anything but a joke. A transgender person is someone who has a different gender identity than their birth sex would indicate. We interchange the words sex, sexuality and gender all the time, but they don't actually refer to the same thing. Sex refers to the parts we were born with; boys, we assume, have a penis, while girls come equipped with a vagina. Sexuality generally refers to sexual orientation , or who we're attracted to in a sexual and/or romantic sense. Gender expression refers to the behavior used to communicate gender in a given culture. Little girls in the U.S., for example, would be expected express their feminine gender by playing with dolls and wearing dresses, and little boys would be assumed to express their masculinity with penchants for roughhousing and monster trucks. Another term is g ender identity, the private sense or feeling of being either a man or woman, some combination of both or neither [source: American Psychological Association ].
Sometimes, a young boy may want to wear dresses and have tea parties, yet it's nothing more than a phase that eventually subsides. Other times, however, there is a longing to identify with another gender or no gender at all that becomes so intense that the person experiencing it can't function anymore. Transgender is an umbrella term for people who identify outside of the gender they were assigned at birth and for some gender reassignment surgeries are crucial to leading a healthy, happy life.
Real-life experience, hormone replacement therapy, surgical options: transgender women, surgical options: transgender men, gender reassignment: regrets.
Transgender people may begin identifying with a different gender, rather than the one assigned at birth, in early childhood, which means they can't remember a time they didn't feel shame or distress about their bodies. For other people, that dissatisfaction with their biological sex begins later, perhaps around puberty or early adulthood, though it can occur later in life as well.
It's estimated that about 0.3 percent of the U.S. population self-identify as transgender, but not all who are transgender will choose to undergo a gender transition [source: Gates ]. Some may choose to affirm their new gender through physically transforming their bodies from the top down, while others may prefer to make only certain cosmetic changes, such as surgeries to soften facial features or hair removal procedures, for example.
Not all who identify with a gender different than their birth sex suffer from gender dysphoria or go on to seek surgery. Transgender people who do want gender reassignment surgery, however, must follow the standards of care for gender affirmation as defined by the World Professional Association for Transgender Health (WPATH).
In 1980, when gender identity disorder (GID) was first recognized, it was considered a psychiatric disorder. In 2013, though, GID was, in part, reconsidered as biological in nature, and renamed gender dysphoria . It was reclassified as a medical condition in the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a common language and standards protocol manual for the classification of mental disorders. With this classification, transgender people must be diagnosed prior to any treatment [source: International Foundation for Gender Education ].
Gender dysphoria is diagnosed when a person has a persistent desire to become a different gender. The desire may manifest itself as disgust for one's reproductive organs, hatred for the clothing and other outward signs of one's given gender, and/or a desire to act and be recognized as another gender. This desire must be continuously present for six months in order to be recognized as a disorder [source: WPATH].
In addition to receiving the diagnosis from a mental health professional, a person seeking reassignment must also take part in psychotherapy. The point of therapy isn't to ignite a change, begin a conversion or otherwise convince a transgender person that it's wrong to want to be of a different gender (or of no specific gender at all) . Rather, counseling is required to ensure that the person is realistic about the process of gender affirmation and understands the ramifications of not only going through with social and legal changes but with permanent options such as surgery. And because feeling incongruous with your body can be traumatizing and frustrating, the mental health professional will also work to identify any underlying issues such as anxiety, depression, substance abuse or borderline personality disorder.
The mental health professional can also help to guide the person seeking gender reassignment through the next step of the process: real-life experience.
WPATH requires transgender people desiring gender reassignment surgery to live full-time as the gender that they wish to be before pursuing any permanent options as part of their gender transition. This period is a known as real-life experience (RLE) .
It's during the RLE that the transgender person often chooses a new name appropriate for the desired gender, and begins the legal name-change process. That new name often comes with a set of newly appropriate pronouns, too; for example, when Chastity Bono, biologically born as Sonny and Cher's daughter in 1969, began her transition in 2008 she renamed herself as Chaz and instructed people to use "he" rather than "she" [source: Donaldson James ].
In addition to a new name and pronouns, during this time gender-affirming men and women are expected to also adopt the clothing of their desired gender while maintaining their employment, attending school or volunteering in the community. Trans women might begin undergoing cosmetic procedures to rid themselves of body hair; trans men might take voice coaching in attempt to speak in a lower pitch. The goal of real-life experience is to expose social issues that might arise if the individual were to continue gender reassignment. How, for example, will a boss react if a male employee comes to work as a female? What about family? Or your significant other? Sometimes, during RLE people realize that living as the other gender doesn't bring the happiness they thought it would, and they may not continue to transition. Other times, a social transition is enough, and gender reassignment surgery isn't pursued. And sometimes, this test run is the confirmation people need to pursue physical changes in order to fully become another gender.
In addition to the year-long real-life experience requirement before surgical options may be pursued, WPATH recommends hormonal therapy as a critical component to transitioning before surgery. Candidates for hormone therapy may choose to complete a year-long RLE and counseling or complete six months of a RLE or three-months of a RLE/three months of psychotherapy before moving ahead with hormone therapy.
Upon successfully completing a RLE by demonstrating stable mental health and a healthy lifestyle, the transitioning individual becomes eligible for genital reconstructive surgery — but it can't begin until a mental health professional submits a letter (or letters) of recommendation indicating that the individual is ready to move forward [source: WPATH].
Hormone replacement therapy (HRT) , also called cross-sex hormones, is a way for transgender individuals to feel and look more like the gender they identify with, and so it's a major step in gender reassignment. In order to be eligible for hormone therapy, participants must be at least 18 years old (though sometimes, younger adolescents are allowed to take hormone blockers to prohibit their naturally occurring puberty) and demonstrate to a mental health professional that they have realistic expectations of what the hormones will and won't do to their bodies. A letter from that mental health professional is required, per the standards of care established by WPATH.
Hormone therapy is used to balance a person's gender identity with their body's endocrine system. Male-to-female candidates begin by taking testosterone-blocking agents (or anti-androgens ) along with female hormones such as estrogen and progesterone . This combination of hormones is designed to lead to breast growth, softer skin, less body hair and fewer erections. These hormones also change the body by redistributing body fat to areas where women tend to carry extra weight (such as around the hips) and by decreasing upper body strength. Female-to-male candidates begin taking testosterone , which will deepen the voice and may cause some hair loss or baldness. Testosterone will also cause the clitoris to enlarge and the person's sex drive to increase. Breasts may slightly shrink, while upper body strength will increase [source: WPATH].
It usually takes two continuous years of treatment to see the full results of hormone therapy. If a person were to stop taking the hormones, then some of these changes would reverse themselves. Hormone therapy is not without side effects — both men and women may experience an increased risk for cardiovascular disease, and they are also at risk for fertility problems. Some transgender people may choose to bank sperm or eggs if they wish to have children in the future.
Sometimes hormonal therapy is enough to make a person feel he or she belongs to the desired gender, so treatment stops here. Others may pursue surgical means as part of gender reassignment.
Surgical options are usually considered after at least two years of hormonal therapy, and require two letters of approval by therapists or physicians. These surgeries may or may not be covered by health insurance in the U.S. — often only those that are considered medically necessary to treat gender dysphoria are covered, and they can be expensive. Gender reassignment costs vary based on each person's needs and desires; expenses often range between $7,000 and $50,000 (in 2014), although costs may be much greater depending upon the type (gender reconstructive surgeries versus cosmetic procedures) and number of surgeries as well as where in the world they are performed [source: AP ].
Gender affirmation is done with an interdisciplinary team, which includes mental health professionals, endocrinologists, gynecologists, urologists and reconstructive cosmetic surgeons.
One of the first surgeries male-to-female candidates pursue is breast augmentation, if HRT doesn't enlarge their breasts to their satisfaction. Though breast augmentations are a common procedure for cisgender women (those who identify with the gender they were assigned at birth), care must be taken when operating on a biologically male body, as there are structural differences, like body size, that may affect the outcome.
The surgical options to change male genitalia include orchiectomy (removal of the testicles), penile inversion vaginoplasty (creation of a vagina from the penis), clitoroplasty (creation of a clitoris from the glans of the penis) and labiaplasty (creation of labia from the skin of the scrotum) [source: Nguyen ]. The new vagina, clitoris and labia are typically constructed from the existing penile tissue. Essentially, after the testicles and the inner tissue of the penis is removed and the urethra is shortened, the skin of the penis is turned inside out and fashioned into the external labia and the internal vagina. A clitoris is created from excess erectile tissue, while the glans ends up at the opposite end of the vagina; these two sensitive areas usually mean that orgasm is possible once gender reassignment is complete. Male-to-female gender reconstructive surgery typically takes about four or five hours [source: University of Michigan ]. The major complication from this surgery is collapse of the new vaginal cavity, so after surgery, patients may have to use dilating devices.
Trans women may also choose to undergo cosmetic surgeries to further enhance their femininity. Procedures commonly included with feminization are: blepharoplasty (eyelid surgery); cheek augmentation; chin augmentation; facelift; forehead and brow lift with brow bone reduction and hair line advance; liposuction; rhinoplasty; chondrolargynoplasty or tracheal shave (to reduce the appearance of the Adam's apple); and upper lip shortening [source: The Philadelphia Center for Transgender Surgery]. Trans women may pursue these surgeries with any cosmetic plastic surgeon, but as with breast augmentation, a doctor experienced with this unique situation is preferred. One last surgical option is voice modification surgery , which changes the pitch of the voice (alternatively, there is speech therapy and voice training, as well as training DVDs and audio recordings that promise the same thing).
Female-to-male surgeries are pursued less often than male-to-female surgeries, mostly because when compared to male-to-female surgeries, trans men have limited options; and, historically, successful surgical outcomes haven't been considered on par with those of trans women. Still, more than 80 percent of surgically trans men report having sexual intercourse with orgasm [source: Harrison ].
As with male-to-female transition, female-to-male candidates may begin with breast surgery, although for trans men this comes in the form of a mastectomy. This may be the only surgery that trans men undergo in their reassignment, if only because the genital surgeries available are still far from perfect. Forty percent of trans men who undergo genital reconstructive surgeries experience complications including problems with urinary function, infection and fistulas [sources: Harrison , WPATH].
Female-to-male genital reconstructive surgeries include hysterectomy (removal of the uterus) and salpingo-oophorectomy (removal of the fallopian tubes and ovaries). Patients may then elect to have a metoidioplasty , which is a surgical enlargement of the clitoris so that it can serve as a sort of penis, or, more commonly, a phalloplasty . A phalloplasty includes the creation of a neo-phallus, clitoral transposition, glansplasty and scrotoplasty with prosthetic testicles inserted to complete the appearance.
There are three types of penile implants, also called penile prostheses: The most popular is a three-piece inflatable implant, used in about 75 percent of patients. There are also two-piece inflatable penile implants, used only 15 percent of the time; and non-inflatable (including semi-rigid) implants, which are used in fewer than 10 percent of surgeries. Inflatable implants are expected to last about five to 10 years, while semi-rigid options typically have a lifespan of about 20 years (and fewer complications than inflatable types) [source: Crane ].
As with trans women, trans men may elect for cosmetic surgery that will make them appear more masculine, though the options are slightly more limited; liposuction to reduce fat in areas in which cisgender women i tend to carry it is one of the most commonly performed cosmetic procedures.
As surgical techniques improve, complication rates have fallen too. For instance, long-term complication risks for male-to-female reconstructive surgeries have fallen below 1 percent. Despite any complications, though, the overwhelming majority of people who've undergone surgical reconstruction report they're satisfied with the results [source: Jarolím ]. Other researchers have noted that people who complete their transition process show a marked improvement in mental health and a substantial decrease in substance abuse and depression. Compare these results to 2010 survey findings that revealed that 41 percent of transgender people in the U.S. attempted suicide, and you'll see that finally feeling comfortable in one's own skin can be an immensely positive experience [source: Moskowitz ].
It's difficult, though, to paint a complete picture of what life is like after people transition to a new gender, as many people move to a new place for a fresh start after their transition is complete. For that reason, many researchers, doctors and therapists have lost track of former patients. For some people, that fresh start is essential to living their new lives to the fullest, while others have found that staying in the same job, the same marriage or the same city is just as rewarding and fulfilling and vital to their sense of acceptance.
In many ways, the process of gender affirmation is ongoing. Even after the surgeries and therapies are complete, people will still have to deal with these discrimination issues. Transgender people are often at high risk for hate crimes. Regular follow-ups will be necessary to maintain both physical and mental health, and many people continue to struggle with self-acceptance and self-esteem after struggling with themselves for so long. Still, as more people learn about gender reassignment, it seems possible that that these issues of stigma and discrimination won't be so prevalent.
As many as 91 percent Americans are familiar with the term "transgender" and 76 percent can correctly define it; 89 percent agree that transgender people deserve the same rights, privileges and protections as those who are cisgender [source: Public Religion Research Institute ]. But that's not to say that everything becomes completely easy once a person transitions to his or her desired gender.
Depending upon where you live, non-discrimination laws may or may not cover transgender individuals, so it's completely possible to be fired from one's job or lose one's home due to gender expression. Some people have lost custody of their children after divorces and have been unable to get courts to recognize their parental rights. Historically, some marriages were challenged — consider, for example, what happens when a man who is married to a woman decides to become a woman; after the surgery, if the two people decide to remain married, it now appears to be a same-sex marriage, which is now legalized in the U.S. Some organizations and governments refuse to recognize a person's new gender unless genital reconstructive surgery has been performed, despite the fact that some people only pursue hormone therapy or breast surgery [sources: U.S. Office of Personnel Management , Glicksman ].
Author's note: stages of gender reassignment.
It's interesting how our terminology changes throughout the years, isn't it? (And in some cases for the better.) What we used to call a sex change operation is now gender realignment surgery. Transsexual is now largely replaced with transgender. And with good reason, I think. Knowing that sex, sexuality and gender aren't interchangeable terms, updating "sex change" to "gender reassignment" or "gender affirmation" and "transsexual" to "transgender" moves the focus away from what sounds like something to do with sexual orientation to one that is a more accurate designation.
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Female-to-male gender reassignment surgery (FTM GRS) is a complex and irreversible genital surgery for female transsexual who is diagnosed with gender identity disorder and has a strong desire to live as male. The procedure is to remove all female genital organs including the uterus, ovaries, and vagina with the construction of male genitalia composed of the penis and scrotum.
The patient who is fit for this surgery must strictly follow the standard of care set by the World Professional Association of Transgender Healthcare (WPATH) or equivalent criteria; Express desire or live in another gender role (Female gender) long enough, under hormonal replacement therapy, evaluated and approved by a psychiatrist or other qualified professional gender therapist.
Apart from genital surgery, the patient would seek other procedures to allow them to live as males smoothly such as breast amputation, facial surgery, body surgery, etc.
Interested in having this procedure?
Ensure you consider all aspects of a procedure. You can speak to your surgeon about these areas of the surgery in more detail during a consultation.
The surgery is very complicated and only a handful of surgeons are able to perform this procedure. It is a multi-staged procedure, the first stage is the removal of the uterus, ovary, and vagina. The duration of the procedure is 2-3 hours. The second and later stages are penis and scrotum reconstruction which is at least 6 months later. There are several techniques for penile reconstruction depending on the type of tissue such as skin/fat of the forearm, skin/fat of the thigh, or adjacent tissue around the clitoris. This second stage of surgical time is between 3-5 hours. A penile prosthesis can be incorporated simultaneously or at a later stage. The scrotal prosthesis is also implanted later.
The procedure is done under general anesthesia and might be combined with spinal anesthesia for faster recovery by reducing the usage of anesthetic gas.
The patient will be hospitalized as an in-patient for between 5-7 days for each stage depending on the technique and surgeon. The patient will have a urinary catheter at all times in the hospital.
What are the risks.
The most frequent complication of FTM GRS is bleeding, wound infection, skin flap or graft necrosis, urinary stenosis and fistula, unsightly scar, etc. The revision procedure is scar revision, hair transplant, or tattooing to camouflage unsightly scars.
During hospitalization, the patient must be restricted in bed continuously or intermittently for several days between 3-5 days. After release from the hospital, the patients return to their normal lives but not having to do physical exercise during the first 2 months after surgery. The patient will have a urinary catheter continuously for several weeks to avoid a urinary fistula. If the patient has a penile prosthesis, it would need at least 6 months before sexual intimacy.
With good surgical technique, the result is very satisfying with an improved quality of life. The patient is able to live in a male role completely and happily either on their own or with their female or male partners.
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by JACKSON WALKER | The National Desk
WASHINGTON (TND) — The House Oversight Committee on Tuesday announced it has launched a probe into the Department of Health and Human Services over its push to remove age restrictions for a variety of transgender procedures.
Documents released in June show that when the World Professional Association for Transgender Health (WPATH) was updating its guidelines, officials within the Department of Health and Human Services (HHS) feared a minimum age requirement for breast removals, genital surgeries and other procedures could invite political backlash. Emails included in the documents reveal Assistant Secretary for Health Rachel Levine, a transgender woman, advocated for WPATH to remove proposed age limits from the guidelines.
In one included email, Levine's then-chief of staff Sarah Boateng said both the assistant secretary and the Biden administration as a whole worried the inclusion of "specific ages" would affect access to health care for transgender youth. Boateng now serves as HHS's principal deputy assistant secretary for health.
Rep. Lisa McClain, R-Mich., wrote to Secretary of Health and Human Services Xavier Becerra to press for answers. She noted the House Oversight Committee is concerned the department "inappropriately applied pressure for changes to international pediatric medical standards."
“Considering the Biden administration’s recently concocted defense that ‘the Administration does not support surgery for minors,’ it is alarming that HHS would advocate for these policies in its communications with WPATH,” the letter reads . “The reality that WPATH caved to make changes to child patient care recommendations based on blatant political motivations is a stain on the credibility of WPATH and its guidelines.”
READ MORE | Detransitioner sues Planned Parenthood, other doctors over hormone therapy, breast removal
The representative closed the letter by calling for a slew of documents from HHS leaders and communications with WPATH. She included a deadline of Sept. 10.
A spokesperson for HHS did not respond to a request for comment from The National Desk (TND) Tuesday.
Former President Donald Trump’s campaign indicated last week he would call to instate felonies for doctors who perform surgeries on minors without parental consent. Prepared rally remarks of Trump also touched on introducing the death penalty for child rapists and the return of “stop and frisk” policing.
Follow Jackson Walker on X at @_jlwalker_ for the latest trending national news. Have a news tip? Send it to [email protected].
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Gender reassignment and the role of the laboratory in monitoring gender-affirming hormone therapy.
3. gender development, genesis of gender incongruence, 4. guidelines for gaht, 4.1. adolescent gi, 4.2. adult gi, 5. laboratory tests in transgender afab/amab individuals, 5.1. red blood cell indices, 5.2. renal function, 5.3. liver enzymes, 5.4. lipids, 5.5. cardiac biomarkers, 5.6. reproductive hormones, 5.7. ferritin, 5.8. prostate specific antigen.
Laboratory Tests | Comments | Reference | ||
---|---|---|---|---|
Estradiol treatment | Testosterone treatment | Estradiol GAHT shifts haemoglobin, haematocrit to lower values in line with cisgender women’s reference intervals. Testosterone GAHTshifts reference intervals to higher levels in line with cisgender men’s reference intervals | [ ] | |
RBC | Decrease | Increase | ||
Hemoglobin | Decrease | Increase | ||
Hematocrit | Decrease | Increase | ||
Creatinine | Decrease | Increase | The most reno protective calculated GFR either male/female is suggested; 24h creatinine clearance if indicated | [ ] |
High sensitivity troponin I | Report a reference range that would allow critical results to be appropriately followed; an approach of least harm to the patient is suggested | [ ] | ||
Ferritin | Laboratories use dual reference ranges for cisgender individuals. Interpretation is based on clinical presentation (e.g., pregnancy) in combination with full blood count, liver function test, and markers of inflammation, e.g., CRP. Iron overload: If secondary causes excluded, investigation for primary haemochromatosis gene may be indicated | [ ] | ||
Reproductive hormones | Testosterone, Estradiol | Following stabilisation of treatment with gender-affirming hormones, guidelines suggest treatment goals are physiological levels of the affirmed gender identity cisgender adults. The time of measurement of the hormone is dependent on the method of administration as well as formulation of the GAHT | [ ] | |
Reproductive hormones | LH, FSH, AMH, and DHEAS are variable in a transgender population and are interpreted with clinical information | [ , ] | ||
PSA | Data for reference ranges in transgender AMAB people and from screening for prostatic cancer is not available | [ ] | ||
Renal function/liver function/lipid profile | Guidelines suggest monitoring of liver function/renal function and lipids during GAHT treatment. Sex-specific reference ranges are not ordinarily stated for the measurements | [ ] |
6. electronic medical record systems (emr), 7. gaht and other laboratory markers, 7.1. risk of venous thromboembolism in amab people, 7.2. hyperprolactinemia, 7.3. other sex hormone dependent tumours, 7.4. bone mineral density, 8. gaht, vascular health and cardiovascular disease, and impact of aging in transgender adults, 9. conclusions, 10. future directions, conflicts of interest.
Click here to enlarge figure
Tanner Stage | Pubic Hair (Male and Female) | Breast Development (Females) | Testicular Volume (Males) |
---|---|---|---|
1 | No hair | No glandular breast tissue palpable | Testicular volume < 4 mL or long axis < 2.5 cm |
2 | Downy hair | Breast bud palpable under the areola (1st pubertal sign in females) | 4–8 mL (or 2.5 to 3.3 cm long), 1st pubertal sign in males |
3 | Scant terminal hair | Breast tissue palpable outside areola; no areolar development | 9–12 mL (or 3.4 to 4.0 cm long) |
4 | Terminal hair that fills the entire triangle overlying the pubic region | Areola elevated above the contour of the breast, forming a “double scoop” appearance | 15–20 mL (or 4.1 to 4.5 cm long) |
5 | Terminal hair that extends beyond the inguinal crease onto the thigh | Areolar mound recedes into single breast contour with areolar hyperpigmentation, papillae development, and nipple protrusion | >20 mL (or >4.5 cm long) |
Guidelines | Society of Endocrinology | The World Professional Association for Transgender Health (WPATH) | Australian Professional Association for Trans Health (AusPATH) |
---|---|---|---|
Evaluation of prospective patients | Clinicians can add gender-affirming hormones after multidisciplinary team (MDT) team has confirmed the persistence of GI and sufficient mental capacity to give informed consent to treatment. The clinicians and mental health practitioners must be trained to diagnose GI. | Health care professionals have competencies in the assessment of transgender and gender diverse people wishing gender-related medical treatment and consider the role of social transition together with the individual. Liaise with professionals from different disciplines within the field of transgender health prior to gender-affirming treatment | |
Treatment | Unless there is agreement among the parents, the adolescent, and medical practitioner regarding competence, diagnosis, and treatment, a Family Court order is required for access to gender-affirming puberty blockers, hormone treatment, and surgery for adolescents under 18 years old. | ||
Puberty Induction Regimen | Transgender AMAB people: Increasing doses of oral or transdermal 17β-estradiol, until adult dosage is reached. In postpubertal transgender AMAB people, the dose is increased more rapidly. Transgender AFAB people: Increasing doses of testosterone until adult values are reached. In postpubertal males, the dose is increased more rapidly. Adult maintenance dose is to mimic physiological adult levels. | In eligible youth who have reached the early stages of puberty, the aim is to delay further pubertal progression with GnRHas until an appropriate time when GAHT can be introduced. In these cases, pubertal suppression is considered medically necessary. | |
Treatment of transgender AFAB/AMAB people | Transgender AFAB people: treatment with both parenteral and transdermal testosterone Transgender AMAB people: Oral, transdermal or parenteral oestrogen. Antiandrogens: spironolactone, cyproterone acetate, GnRH agonist. Estradiol and testosterone are maintained at premenopausal female levels. Gender-affirming hormones are maintained at normal adult ranges | Transgender AFAB people: Masculinising treatment, usually with testosterone. Transgender AMAB people: treatment is usually with oestrogen and androgen-lowering medication. | Transgender AFAB people: masculinising treatment is with different formulations of testosterone Transgender AMAB people: Feminising treatment includes oestrogen and androgen blockers. It is usual to start with low doses and titrate upwards. |
Monitoring | Periodic monitoring of hormone levels, metabolic parameters, and assessment of prostate gland, gonads, and uterus as well as bone density | Hormone levels are measured during gender-affirming treatment to ensure endogenous sex steroids are lowered and administered sex steroids are maintained at levels appropriate for the treatment goals of transgender people according to the Tanner stage. | For masculinising treatment, total testosterone levels are maintained at the lower male reference range, and for feminising treatment, estradiol is aimed to be within the female reference range. |
Reference | [ ] | [ ] | [ , ] |
Clinical Chemistry Tests | Other Tests | |
---|---|---|
LH, FSH, E2/T, 25(OH)D | Anthropometry: height, weight, blood pressure, Tanner stages | |
Suggested Interval | 6–12 months | 3–6 months |
Bone density using DXA | ||
Suggested Interval | 1–2 years | |
Reference | [ ] |
Laboratory Tests | Other Tests | |
---|---|---|
Transgender AFAB people | T | Monitor for virilization |
Suggested Interval | 3 monthly until levels within adult range | Every 3 months the first year and then one or two times per year |
Haematocrit or haemoglobin | Screening for osteoporosis, cervical screening (if cervical tissue present), breast cancer screening as recommended | |
Suggested Interval | 3 monthly for first year then one/two times per year | |
Lipids at regular intervals | ||
Transgender AFAM people | Serum T and estradiol | Feminisation |
Suggested Interval | Every 3 months | Every 3 months the first year and then one or two times per year |
If treated with spironolactone, electrolytes | Routine cancer screening and bone density | |
Every 3 months the first year and then annually | ||
Reference | [ ] |
The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
Ramasamy, I. Gender Reassignment and the Role of the Laboratory in Monitoring Gender-Affirming Hormone Therapy. J. Clin. Med. 2024 , 13 , 5134. https://doi.org/10.3390/jcm13175134
Ramasamy I. Gender Reassignment and the Role of the Laboratory in Monitoring Gender-Affirming Hormone Therapy. Journal of Clinical Medicine . 2024; 13(17):5134. https://doi.org/10.3390/jcm13175134
Ramasamy, Indra. 2024. "Gender Reassignment and the Role of the Laboratory in Monitoring Gender-Affirming Hormone Therapy" Journal of Clinical Medicine 13, no. 17: 5134. https://doi.org/10.3390/jcm13175134
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IMAGES
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COMMENTS
Actually, some veterinarians, like Christie Cornelius of Houston, do talk about "sex change" operations for cats. The surgery, says Cornelius, of Last Wishes, is not a true "sex reassignment ...
A pet owner has gained viral attention after revealing the procedure her cat had that is often likened to human gender-reassignment surgery. In a video shared on June 5 on TikTok, which has ...
An "intersex" dog born with male and female genitals has made a full recovery after having rare gender reassignment surgery. Molly, a Jack Russell puppy, was taken to a vet when her owners, Mary ...
The surgery was performed after a bladder stone was preventing Piglet from being able to pass water. Piglet has made a miraculous recovery after undergoing radical 'gender reassignment ...
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Support trulyindependent journalism. An intersex dog born with both male and female genitals has successfully recovered from a rare gender reassignment surgery. Molly, a Jack Russell terrier puppy ...
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. ... Complications, subjective satisfaction and sexual experience by gender reassignment surgery in male-to-female transsexuality [Article in German] Lowenberg H, Lax H, Rossi Neto R, Krege S. Z Sex Forsch.
Here's how gender reassignment works: Converting male anatomy to female anatomy requires removing the penis, reshaping genital tissue to appear more female and constructing a vagina. An incision ...
During this period, 214 patients underwent penile inversion vaginoplasty. Results: Results demonstrate that the average age at the time of surgery was 32.2 years (range, 18-61 years); the average of operative time was 3.3 h (range 2-5 h); the average duration of hormone therapy before surgery was 12 years (range 1-39).
Several mentioned that even though the video shows people being eaten alive by animals, as well as real footage of murder and suicide, the hardest segment to watch is that of a "male-to-female sex change" operation. ... Elektra sees a pamphlet on the wall about "sex reassignment surgery." Not only do we get to see actual medical ...
Original research and review studies whose abstracts addressed the following topics were included for full-text review: gender-affirming surgery, sex reassignment, patient satisfaction, detransition, regret. A total of 163 abstracts were reviewed and a total of 21 articles were closely read for the relevant discussion of regret and satisfaction.
Individuals who desire surgical procedures who have not been part of the Comprehensive Gender Services Program should contact the program office at (734) 998-2150 or email [email protected]. We will assist you in obtaining what you need to qualify for surgery. University of Michigan Comprehensive Gender Services Program brings ...
Gender affirmation surgery, also known as gender confirmation surgery, is performed to align or transition individuals with gender dysphoria to their true gender. A transgender woman, man, or non-binary person may choose to undergo gender affirmation surgery. The term "transexual" was previously used by the medical community to describe people ...
Male to female (MTF) gender reassignment surgery is also known as sex reassignment surgery (SRS), genital construction, and generally as Gender Confirmation Surgery. These procedures are used to remove and alter male genitalia into traditional female genitalia. Plastic surgeons will remove the scrotum, perform a penile inversion to create the ...
The bill, signed into law by Gov. Henry McMaster in May, also made it a felony to perform gender reassignment surgery on those under the age of 18, as well as banning the South Carolina Medicaid ...
Gender dysphoria—a condition in which an individual has a severe discontent with the gender they were born with—can be treated with gender reassignment surgery. In this article, Selvaggi and ...
His confidence in this new approach is the result of nearly three decades of expertise and innovation in SRS and urogenital reconstructive surgery, which includes 600 male-to-female vaginoplasties, 900 female-to-male metoidioplasties, 300 female-to-male phalloplasties, and the co-development of a penile disassembly technique for epispadias repair.
1 of 15. Emmie Smith texts with her family and friends the night before she will undergo gender reassignment surgery. She and her mother, Kate Malin, stayed in a hotel near the small Pennsylvania ...
Double incision. With this procedure, incisions are typically made at the top and bottom of the pectoral muscle and the chest tissue is removed. The skin is pulled down and reconnected at the ...
The findings of the studies permit the conclusion that sex reassignment surgery beneficially affects emotional well-being, sexuality, and quality of life in general. In other categories (e.g., "freedom from pain", "fitness", and "energy"), some of the studies revealed worsening after the operation. All of the studies were judged to ...
Not all who identify with a gender different than their birth sex suffer from gender dysphoria or go on to seek surgery. Transgender people who do want gender reassignment surgery, however, must follow the standards of care for gender affirmation as defined by the World Professional Association for Transgender Health (WPATH).
Female-to-male gender reassignment surgery (FTM GRS) is a complex and irreversible genital surgery for female transsexual who is diagnosed with gender identity disorder and has a strong desire to live as male. The procedure is to remove all female genital organs including the uterus, ovaries, and vagina with the construction of male genitalia ...
There is no explicit authoritative Catholic teaching on gender reassignment surgery (GRS). Catholic bioethicists have debated the origin of gender dysphoria and the effectiveness of GRS. A further ethical question is whether some forms of GRS involve "mutilation in the strict sense.". The principle of totality does not apply to GRS as the ...
WASHINGTON (TND) — The House Oversight Committee on Tuesday announced it has launched a probe into the Department of Health and Human Services over its push to remove age restrictions for a variety of transgender procedures. Documents released in June show that when the World Professional Association for Transgender Health (WPATH) was updating its guidelines, officials within the Department ...
Transgender people experience distress due to gender incongruence (i.e., a discrepancy between their gender identity and sex assigned at birth). Gender-affirming hormone treatment (GAHT) is a part of gender reassignment treatment. The therapeutic goals of the treatment are to develop the physical characteristics of the affirmed gender as far as possible. Guidelines have been developed for GAHT ...