Loren Schechter

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

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Human Services decided that its 1981 exclusion of transsexual surgical treatments from Medicare coverage was based on outdated, incomplete, and biased science and did not reflect current evidence or standards of care, and the exclusion was therefore lifted.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.

Gender Confirmation Surgery: Guiding Principles

BACKGROUNDnAt this time, no formal training or educational programs exist for surgeons or surgery residents interested in performing gender confirmation surgeries.nnnAIMnTo propose guiding principles designed to aid with the development of formal surgical training programs focused on gender confirmation surgery.nnnMETHODSnWe use expert opinion to provide a first of its kind framework for training surgeons to care for transgender and gender nonconforming individuals.nnnOUTCOMESnWe describe a multidisciplinary treatment model that describes an educational philosophy and the institution of quality parameters.nnnRESULTSnThis article represents the first step in the development of a structured educational program for surgical training in gender confirmation procedures.nnnCLINICAL IMPLICATIONSnThe World Professional Association for Transgender Health Board of Directors unanimously approved this article as the framework for surgical training.nnnSTRENGTHS AND LIMITATIONSnThis article builds a framework for surgical training. It is designed to provide concepts that will likely be modified over time and based on additional data and evidence gathered through outcome measurements.nnnCONCLUSIONnWe present an initial step in the formation of educational and technical guidelines for training surgeons in gender confirmation procedures. Schechter LS, DArpa S, Cohen MN, etxa0al. Gender Confirmation Surgery: Guiding Principles. J Sex Med 2017;14:852-856.

The Surgeon's Relationship with the Physician Prescribing Hormones and the Mental Health Professional: Review for Version 7 of the World Professional Association for Transgender Health's Standards of Care

ABSTRACT With advances in psychological, medical, and surgical treatment of transgendered individuals, a multidisciplinary approach has been postulated to improve overall patient care. Because no single discipline can meet all the needs of this patient population, a close working relationship between the surgeon, behavioral scientist, and medical physician responsible for hormonal therapy is important in providing the highest level of patient care. Moreover, the surgeon must assume an active role in understanding the patients diagnosis and medical and hormonal therapies.

Abstract: A Survey Study of Surgeons’ Experience with Regret and/or Reversal of Gender-Confirmation Surgeries

CONCLUSION: A skin flap lined urethra is, in our experience, the best option for urethral reconstruction in ALT phalloplasty. When this cannot be accomplished with the same ALT flap with the tube-in-tube technique due to excess flap thickness our first choices are the SCIAP or the RFF flaps. Due to the high stricture rates, flap prelamination has been abandoned. When there is existing penile skin, like in cases of an unsatisfactory previous phalloplasty, the penile skin could be tubed in to reconstruct the urethra.

Letter to the EditorResponse to Letter to the Editor: “Gender Confirmation Surgery: Guiding Principles”

Thank you for your insightful commentary regarding our proposal for formalized training programs in transgender care. We agree with you that current residency training in transgender care is inadequate and highly variable. Furthermore, your point about objectively exploring doctorpatient interactions to determine whether our care meets the expectations of our patients is critical. Patient involvement will be an invaluable tool to guide us to best serve our patients, and our team is beginning a pilot study to assess patient-reported outcome measures.