From the Journals

Gender affirmation surgery has become more common

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Track outcomes to improve care

The study is thought provoking and suggests many areas for future study.

Gender-affirming surgery is the final step in a spectrum of treatments for gender identity disorders or transsexualism, including psychological counseling, hormonal therapies, and pubertal hormone blockers. Referrals for these treatments are increasing, and likely the demand for surgical treatment will also continue to increase.

A comprehensive database or other prospective tool to assess the comparative efficacy of these treatments, create quality metrics, and address long-term health or psychiatric outcomes should be pursued.

Future research must address cost effectiveness and cost burdens, given increased public funding for gender affirmation surgeries. Most longitudinal studies of patients who have undergone gender affirmation procedures have found high satisfaction rates with low rates of regret (less than 5%). However, when regret occurs, it can be surgically challenging and costly to reverse these procedures.

Marie Crandall , MD, is a professor of surgery at the University of Florida, Jacksonville. She made her comments in an editorial and had no industry disclosures (JAMA Surg. 2018 Feb 28. doi: 10.1001/jamasurg.2017.6232).



The number of gender-affirming surgeries is increasing annually in the United States, and private insurers and Medicare and Medicaid are covering more of them, according to a review of the National Inpatient Sample from 2000 to 2014.

“As coverage for these procedures increases, likely so will demand for qualified surgeons to perform them,” said investigators led by Joseph Canner, MHS, of Johns Hopkins University, Baltimore (JAMA Surg. 2018 Feb 28. doi: 10.1001/jamasurg.2017.6231).

The team sought to correct a glaring lack of demographic, hospital, and surgical data on transgender people, a problem due mainly to “the absence of routine, standardized collection and reporting of gender identity in health care settings,” the investigators said.

The Affordable Care Act banned gender identity discrimination, and state and federal governments – as well as private insurers – are expanding coverage of gender affirmation surgery and care. Given the trend, it’s essential that quality improvement agencies begin to “focus on adopting a new set of patient-centered measures to better monitor transgender care and identify opportunities for advancing transition-related services,” the researchers said.

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