Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience

  • Allison C. Hu (Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine) ;
  • Mengyuan T. Liu (Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine) ;
  • Candace H. Chan (Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine) ;
  • Saloni Gupta (Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine) ;
  • Brian N. Dang (Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine) ;
  • Gladys Y. Ng (Department of Urology, University of California, Los Angeles, David Geffen School of Medicine) ;
  • Mark S. Litwin (Department of Urology, University of California, Los Angeles, David Geffen School of Medicine) ;
  • George H. Rudkin (Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine) ;
  • Amy K. Weimer (UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine) ;
  • Justine C. Lee (Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine)
  • Received : 2022.01.25
  • Accepted : 2022.06.30
  • Published : 2023.01.15
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Abstract

Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth (n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs (n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5±3.6 years, primarily estrogen (n = 39). Most patients (n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy (n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery (n = 15, 22%), vaginoplasty (n = 15, 22%), mastectomy (n = 11, 16%), and orchiectomy (n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB weremore likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021). Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy.

Keywords

Acknowledgement

This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (J.C.L.) and the Jean Perkins Foundation (J.C.L.). J.C.L. is additionally supported by the National Institutes of Health/NIDCR R01 DE028098.

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