Archives of Plastic Surgery

  • 제50권1호
  • /
  • Pages.63-69
  • /
  • 2023
  • /
  • 2234-6163(pISSN)
  • /
  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
권호 표지
DOI QR코드

DOI QR Code

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)
  • 투고 : 2022.01.25
  • 심사 : 2022.06.30
  • 발행 : 2023.01.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

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.

키워드

과제정보

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.

참고문헌

  1. James S, Herman J, Rankin S, Keisling M, Mottet L, Anafi Ma. The Report of the 2015 U.S. Transgender Survey; 2016 
  2. Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet 2016;388(10042):390-400  https://doi.org/10.1016/S0140-6736(16)00683-8
  3. Esmonde N, Heston A, Jedrzejewski B, et al. What is "Nonbinary" and What Do I Need to Know? A primer for surgeons providing chest surgery for transgender patients. Aesthet Surg J 2019;39(05):NP106-NP112  https://doi.org/10.1093/asj/sjy166
  4. Clark BA, Veale JF, Townsend M, Frohard-Dourlent H, Saewyc E. Non-binary youth: access to gender-affirming primary health care. Int J Transgenderism 2018;19:158-169  https://doi.org/10.1080/15532739.2017.1394954
  5. Kuper LE, Nussbaum R, Mustanski B. Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals. J Sex Res 2012;49(2-3):244-254  https://doi.org/10.1080/00224499.2011.596954
  6. Koehler A, Eyssel J, Nieder TO. Genders and individual treatment progress in (non-)binary trans individuals. J Sex Med 2018;15(01):102-113  https://doi.org/10.1016/j.jsxm.2017.11.007
  7. Padula WV, Heru S, Campbell JD. Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: a cost-effectiveness analysis. J Gen Intern Med 2016;31(04):394-401  https://doi.org/10.1007/s11606-015-3529-6
  8. Schechter LS, Cohen M. Gender confirmation surgery: a new frontier in plastic surgery education. Plast Reconstr Surg 2016;138(04):784e-785e  https://doi.org/10.1097/PRS.0000000000002594
  9. Morrison SD, Chong HJ, Dy GW, et al; Transgender Educational Study Group. Educational exposure to transgender patient care in plastic surgery training. Plast Reconstr Surg 2016;138(04):944-953  https://doi.org/10.1097/PRS.0000000000002559
  10. Scandurra C, Mezza F, Maldonato NM, et al. Health of non-binary and genderqueer people: a systematic review. Front Psychol 2019;10:1453 
  11. Monro S. Non-binary and genderqueer: an overview of the field. Int J Transgenderism 2019;20(2-3):126-131  https://doi.org/10.1080/15532739.2018.1538841
  12. Gray R, Nguyen K, Lee JC, et al. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Plast Reconstr Surg 2019;144(05):1159-1168  https://doi.org/10.1097/PRS.0000000000006166
  13. Miller TJ, Wilson SC, Massie JP, Morrison SD, Satterwhite T. Breast augmentation in male-to-female transgender patients: technical considerations and outcomes. JPRAS Open 2019;21:63-74  https://doi.org/10.1016/j.jpra.2019.03.003
  14. Boas SR, Ascha M, Morrison SD, et al. Outcomes and predictors of revision labiaplasty and clitoroplasty after gender-affirming genital surgery. Plast Reconstr Surg 2019;144(06):1451-1461  https://doi.org/10.1097/PRS.0000000000006282
  15. Dunford C, Bell K, Rashid T. Genital reconstructive surgeryinmale to female transgender patients: a systematic review of primary surgical techniques, complication profiles, and functional outcomes from 1950 to present day. Eur Urol Focus 2021;7(02):464-471  https://doi.org/10.1016/j.euf.2020.01.004
  16. Bared A, Epstein JS. Hair transplantation techniques for the transgender patient. Facial Plast Surg Clin North Am 2019;27(02):227-232  https://doi.org/10.1016/j.fsc.2018.12.005
  17. Marks DH, Awosika O, Rengifo-Pardo M, Ehrlich A. Dermatologic surgical care for transgender individuals. Dermatol Surg 2019;45(03):446-457  https://doi.org/10.1097/DSS.0000000000001718
  18. Kailas M, Lu HMS, Rothman EF, Safer JD. Prevalence and types of gender-affirming surgery among a sample of transgender endocrinology patients prior to state expansion of insurance coverage. Endocr Pract 2017;23(07):780-786 https://doi.org/10.4158/EP161727.OR