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Khanijow K, Neira PM, Streed CG. Considerations for adult transgender patients in the hospital setting. J Hosp Med 2024. [PMID: 38923287 DOI: 10.1002/jhm.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Keshav Khanijow
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paula M Neira
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, Maryland, USA
| | - Carl G Streed
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- GenderCare Center, Boston Medical Center, Boston, Massachusetts, USA
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Rifkin WJ, Parker A, Bluebond-Langner R. Use of Tranexamic Acid in Gender-Affirming Mastectomy Reduces Rates of Postoperative Hematoma and Seroma. Plast Reconstr Surg 2024; 153:1002e-1010e. [PMID: 37399532 DOI: 10.1097/prs.0000000000010892] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND The established safety and efficacy of tranexamic acid (TXA) in minimizing perioperative blood loss has led to increased interest within plastic surgery. Prior studies have demonstrated decreased edema and ecchymosis and reduced rates of postoperative collection with administration of TXA; however, its use has not been reported in gender-affirming mastectomy. This represents the first study to evaluate the effects of TXA on postoperative outcomes in patients undergoing gender-affirming mastectomy. METHODS A single-center cohort study was performed analyzing all consecutive patients undergoing gender-affirming mastectomy with the senior author (R.B.-L.) between February of 2017 and October of 2022. Beginning in June of 2021, all patients received 1000 mg of TXA intravenously before incision and 1000 mg at the conclusion of the procedure. Patients were stratified according to intraoperative administration of TXA, with demographic characteristics, surgical characteristics, and postoperative outcomes compared between groups. RESULTS A total of 851 patients underwent gender-affirming mastectomy. Of these, 646 cases were performed without TXA, and 205 patients received intravenous TXA intraoperatively, as described previously. Patients who received TXA had significantly lower rates of seroma (20.5% versus 33.0%; P < 0.001) and hematoma (0.5% versus 5.7%; P = 0.002). There was no difference in rates of surgical-site infection ( P = 0.74). TXA use was not associated with increased rates of venous thromboembolism ( P = 0.42). CONCLUSIONS Intraoperative administration of TXA in patients undergoing gender-affirming mastectomy may safely reduce the risk of postoperative seroma and hematoma without increased risk of thromboembolic events. Additional data collection and prospective studies are warranted to corroborate these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- William J Rifkin
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Augustus Parker
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
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Hung YC, Assi PE, Park BC, Nemani SV, Chaker SC, Williams TD, Drolet BC, Kassis SA. Patterns of Perioperative Hormone Therapy for Gender-Affirming Surgery. Ann Plast Surg 2024; 92:442-446. [PMID: 38319916 DOI: 10.1097/sap.0000000000003820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
INTRODUCTION There is no consensus regarding perioperative hormone replacement therapy (HRT) for gender-affirming surgery (GAS). Common concerns for continuing perioperative HRT included risk of deep vein thrombosis (DVT) or hematoma. However, discontinuing HRT is not risk free and may cause mood swing or increased anxiety. Our study aimed to investigate current patterns of HRT before GAS worldwide. METHODS The first stage of Delphi technique was implemented by sending a 27-item survey to all surgeons (total n = 150; 94 plastic surgeon, 35 urologist, and 21 gynecologists) of the World Professional Association for Transgender Health who perform GAS. Survey themes included the hormone type, duration, and usage of DVT prophylaxis. RESULTS Overall survey response rate was 34% (total n = 51; 8 urologists, 35 plastic surgeons, and 8 gynecologists). The majority of surgeons are US-based (n = 39, 76%). The most common HRTs are in injection form (n = 28, 55%). The majority of surgeons do not stop HRT before GAS and do provide DVT prophylaxis to all patients <1 week after GAS. The most common procedure that surgeons discontinue HRT is feminizing bottom surgery (43%). For surgeons who discontinue HRT before GAS, there is a wide variation on discontinuation schedule. CONCLUSIONS There is considerable variation in perioperative HRT patterns for GAS. Further research is needed to develop a data-driven consensus guideline to provide high quality of care for transgender and nonbinary patients.
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Affiliation(s)
| | - Patrick E Assi
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Sriya V Nemani
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Sara C Chaker
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Salam A Kassis
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
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Skorochod R, Rysin R, Wolf Y. Gender affirming surgery in non-binary patients: The importance of patient-centered care. J Plast Reconstr Aesthet Surg 2023; 84:176-181. [PMID: 37331039 DOI: 10.1016/j.bjps.2023.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Gender-affirming mastectomies are a growing necessity for transgender and gender-diverse patients. The preoperative evaluation and surgical outcome must be tailored to the individual, taking into consideration previous medical history, medications, hormonal therapy, patient anatomy, and expectations. Although non-binary patients constitute a significant portion of patients referring for gender-affirming mastectomies, current literature rarely acknowledges them as a separate patient category from trans-masculine patients. METHODS Retrospective cohort, demonstrating the single-surgeon experience with gender-affirming mastectomies over the course of 2 decades. RESULTS A total of 208 patients were included in this cohort, patients identifying as "non-binary" in gender accounted for 30.8% of the cohort. Non-binary patients were found to be younger (P value<0.001) at the time of surgery, at the time of HRT initiation (P value<0.001), at the first feeling of gender dysphoria, coming out to society, and use of non-female pronouns (P value = 0.04,<0.001 and<0.001, accordingly). In the non-binary patient group, a shorter period of time passed from the first feeling of gender dysphoria to initiation of HRT and surgery (P value<0.001 and<0.001, accordingly). However, the average time from HRT initiation to surgery and from the first use of non-female pronouns to HRT initiation or surgery did not statistically differ (P value= 0.34, 0.06, and 0.08, accordingly). CONCLUSION Non-binary patients demonstrate a significantly different timeline from trans-masculine patients in terms of gender development. In order to accommodate their needs, caregivers must take the information into consideration and develop appropriate guidelines and courses of action.
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Affiliation(s)
- Ron Skorochod
- Hillel Yaffe Medical Center, Plastic Surgery Unit, Hadera, Israel; The Technion, Rappaport Faculty of Medicine, Haifa, Israel.
| | - Roman Rysin
- Hillel Yaffe Medical Center, Plastic Surgery Unit, Hadera, Israel; The Technion, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoram Wolf
- Hillel Yaffe Medical Center, Plastic Surgery Unit, Hadera, Israel; The Technion, Rappaport Faculty of Medicine, Haifa, Israel
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Klein DA, Schvey NA, Baxter TA, Larson NS, Roberts CM. Caring for Military-Affiliated Transgender and Gender-Diverse Youths: A Call for Protections. Am J Public Health 2023; 113:251-255. [PMID: 36480769 PMCID: PMC9932380 DOI: 10.2105/ajph.2022.307163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/13/2022]
Affiliation(s)
- David A Klein
- David A. Klein is with the Departments of Family Medicine and Pediatrics, Uniformed Services University, Bethesda, MD, and the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Natasha A. Schvey is with the Department of Medical and Clinical Psychology, Uniformed Services University. Thomas A. Baxter is with the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Noelle S. Larson is with the Department of Pediatrics, Uniformed Services University, and the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda. Christina M. Roberts is with the Division of Adolescent Medicine, Children's Mercy Kansas City, and the Department of Pediatrics, University of Missouri-Kansas City School of Medicine. Note. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of Uniformed Services University (USU), the Department of the Air Force, the Department of the Army, the US Department of Defense, or the US Government
| | - Natasha A Schvey
- David A. Klein is with the Departments of Family Medicine and Pediatrics, Uniformed Services University, Bethesda, MD, and the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Natasha A. Schvey is with the Department of Medical and Clinical Psychology, Uniformed Services University. Thomas A. Baxter is with the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Noelle S. Larson is with the Department of Pediatrics, Uniformed Services University, and the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda. Christina M. Roberts is with the Division of Adolescent Medicine, Children's Mercy Kansas City, and the Department of Pediatrics, University of Missouri-Kansas City School of Medicine. Note. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of Uniformed Services University (USU), the Department of the Air Force, the Department of the Army, the US Department of Defense, or the US Government
| | - Thomas A Baxter
- David A. Klein is with the Departments of Family Medicine and Pediatrics, Uniformed Services University, Bethesda, MD, and the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Natasha A. Schvey is with the Department of Medical and Clinical Psychology, Uniformed Services University. Thomas A. Baxter is with the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Noelle S. Larson is with the Department of Pediatrics, Uniformed Services University, and the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda. Christina M. Roberts is with the Division of Adolescent Medicine, Children's Mercy Kansas City, and the Department of Pediatrics, University of Missouri-Kansas City School of Medicine. Note. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of Uniformed Services University (USU), the Department of the Air Force, the Department of the Army, the US Department of Defense, or the US Government
| | - Noelle S Larson
- David A. Klein is with the Departments of Family Medicine and Pediatrics, Uniformed Services University, Bethesda, MD, and the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Natasha A. Schvey is with the Department of Medical and Clinical Psychology, Uniformed Services University. Thomas A. Baxter is with the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Noelle S. Larson is with the Department of Pediatrics, Uniformed Services University, and the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda. Christina M. Roberts is with the Division of Adolescent Medicine, Children's Mercy Kansas City, and the Department of Pediatrics, University of Missouri-Kansas City School of Medicine. Note. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of Uniformed Services University (USU), the Department of the Air Force, the Department of the Army, the US Department of Defense, or the US Government
| | - Christina M Roberts
- David A. Klein is with the Departments of Family Medicine and Pediatrics, Uniformed Services University, Bethesda, MD, and the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Natasha A. Schvey is with the Department of Medical and Clinical Psychology, Uniformed Services University. Thomas A. Baxter is with the Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, CA. Noelle S. Larson is with the Department of Pediatrics, Uniformed Services University, and the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda. Christina M. Roberts is with the Division of Adolescent Medicine, Children's Mercy Kansas City, and the Department of Pediatrics, University of Missouri-Kansas City School of Medicine. Note. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of Uniformed Services University (USU), the Department of the Air Force, the Department of the Army, the US Department of Defense, or the US Government
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Rysin R, Skorochod R, Wolf Y. Implications of Testosterone Therapy on Wound Healing and Operative Outcomes of Gender-Affirming Chest Masculinization Surgery. J Plast Reconstr Aesthet Surg 2023; 81:34-41. [PMID: 37084532 DOI: 10.1016/j.bjps.2022.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/09/2022] [Accepted: 11/29/2022] [Indexed: 02/11/2023]
Abstract
The increased awareness of the transgender population and their medical needs has given rise to a wide array of gender-affirming surgeries and hormonal therapies. To better understand the implication of testosterone therapy on female-to-male gender-affirming mastectomies, we conducted a retrospective cohort study based on the medical histories of 170 transgender males operated on by a single surgeon over 18 years. One hundred and one (59.4%) patients received hormonal therapy. The average age of patients in the testosterone treatment group was 20.6 ± 5.3 (range 14-49) years. The median weight of resected breast tissue was 318 g (IQR 221-515) and 311.5 g (IQR 223-480) in patients treated with testosterone, compared to 380 g (IQR 225-735) and 370 g (IQR 240-700) in patients without testosterone treatment (for the right and left breast, respectively). Supplementary liposuction was performed in 35 patients, of whom 23 (64%) were treated with testosterone. Fifty-four patients (31.7%) experienced surgical complications, and 55.6% of complications were recorded in the group treated with testosterone. Forty-nine patients (28.8%) recorded their satisfaction using the Likert satisfaction scale; the average satisfaction was 4.86 ± 0.35 in the non-testosterone group and 4.63 ± 0.69 in the testosterone group. Opposing previous cohorts, we did not find a statistically significant association between testosterone and increased surgical complications in gender-affirming mastectomies. Possible explanations include our practice of avoiding testosterone therapy several weeks before the operation and vigorous hemostasis methods.
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