Gender-affirming surgery
The phrase is most often associated with transgender health care and intersex medical interventions, though many such treatments are also pursued by cisgender and non-intersex persons.
In addition to gender-affirming surgery, patients may need to follow a lifelong course of masculinizing or feminizing hormone replacement therapy to support the endocrine system.
Sweden became the first country in the world to allow transgender people to change their legal gender after "reassignment surgery" and provide free hormone treatment, in 1972.
[9] As knowledge of non-binary genders expands in the medical community, more surgeons are willing to tailor operations to individual needs.
Gender nullification is the removal of all external genitalia except the urethral opening, typically pursued by people assigned male at birth.
Complications of penile inversion vaginoplasty are mostly minor; however, rectoneovaginal fistula (abnormal connection between the neovagina and the rectum) can occur in about 1–3% of patients.
For some trans women, facial feminization surgery, hair transplants, and breast augmentation are also aesthetic components of their surgical treatment.
[23] Adam's apple reduction surgery (chondrolaryngoplasty) or tracheal shaving is a procedure in which the most prominent part of the thyroid cartilage is reduced.
[25][better source needed] Reports of people seeking gender-confirming surgery (vaginoplasty) go back to the 2nd century, such as Roman Emperor Elagabalus.
[26][27] In the US in 1917, Alan L. Hart, an American tuberculosis specialist, became one of the first trans men to undergo hysterectomy and gonadectomy as treatment of what is now called gender dysphoria.
In June 1931, she underwent her fourth surgery, including an experimental uterine transplant and vaginoplasty, which she hoped would allow her to give birth.
[38] On 12 June 2003, the European Court of Human Rights ruled in favor of Carola van Kück, a German trans woman whose insurance company denied her reimbursement for sex reassignment surgery as well as hormone replacement therapy.
[39] In 2011, Christiane Völling won the first successful case brought by an intersex person against a surgeon for non-consensual surgical intervention described by the International Commission of Jurists as "an example of an individual who was subjected to sex reassignment surgery without full knowledge or consent".
[45] Some medical conditions, including diabetes, asthma, and HIV, can lead to complications with future therapy and pharmacological management.
[50] Fertility is also a factor considered in gender-affirming surgery, as patients are typically informed that if an orchiectomy or oöphoro-hysterectomy is performed, it will make them irreversibly infertile.
[51] Preferred treatments for children include puberty blockers, which are thought to have some reversible physical changes,[52] and sex hormones, which reduce the need for future surgery.
[56][57][58][citation needed] Milton Diamond at the John A. Burns School of Medicine, University of Hawaii recommended that physicians not perform surgery on children until they are old enough to give informed consent and to assign such infants in the gender to which they will probably best adjust.
In many regions, a person's pursuit of gender-affirming surgery is often governed, or at least guided, by documents called Standards of Care for the Health of Transgender and Gender Diverse People (SOC).
Some treatment may require a minimum duration of psychological evaluation and living as a member of the target gender full-time, sometimes called the real life experience (RLE) (sometimes mistakenly called the real life test [RLT]) before sex reassignment surgeries are covered by insurance.
[citation needed] Standards of Care usually give certain very specific "minimum" requirements as guidelines for progressing with treatment, causing them to be highly controversial and often maligned documents among transgender patients seeking surgery.
[64] In 2017, the United States Defense Health Agency for the first time approved payment for sex reassignment surgery for an active-duty U.S. military service member.
[68] Clinical research on long-term quality-of-life outcomes following surgery is limited and confounded by various factors, including small sample sizes, and baseline rates of mental health issues and suicide among transgender people compared to the general population.
[11] A 2024 systematic review found that genital surgeries significantly improved depression and dissociation, with "mixed results" for other mental health outcomes.
[73] A 2010 meta-analysis in Clinical Endocrinology noted the lack of randomization and control groups and reliance of self-reporting in the studies it reviewed, reaching the conclusion "Very low quality evidence suggests that hormonal therapies given to individuals with GID as a part of sex reassignment are likely to improve gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.
[76] Dhejne et al. (2011), in a study following 324 trans people who received gender-affirming surgery from 1973 to 2003, found that they "have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population"; concluding, "sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism".
[79][better source needed] During the process of gender-affirming surgery, transgender people may become victims of different social obstacles such as discrimination, prejudice and stigmatizing behaviours.
[83][84] Moreover, studies have also found that the critical procedure for genital sensitivity maintenance and achieving orgasm after phalloplasty is to preserve both the clitoral hood and the clitoris underneath the reconstructed phallus.
Transsexual individuals who have undergone gender-affirming surgery are more satisfied with their bodies and experienced less stress when participating in sexual activity.
The female-to-male trans individuals reported that they had been experiencing intensified and stronger excitements and orgasm while male-to-female persons have been encountering longer and more gentle feelings.
[85] The possible reasons for the difference in masturbation frequency could be associated with the surge of libido, which was caused by the testosterone therapies, or the withdrawal of gender dysphoria.
