For many transgender individuals, pursuing gender-affirming surgery (GAS) to minimize gender incongruence—commonly referred to as gender dysphoria—is a medically necessary element of comprehensive gender-affirming health care. Patients who undergo GAS report high postoperative satisfaction rates, and research indicates that GAS improves quality of life and emotional well-being, and eases gender dysphoria. This article is 1 of several articles in the current issue, summarizing the available surgical interventions for alleviating gender incongruence among transgender patients. This part briefly reviews and examines surgical aspects of masculinizing GAS for transmasculine patients. (J GYNECOL SURG 37:275)
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References
1.
ColemanE, BocktingW, BotzerM, et al.Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgenderism, 2012; 13:165.
2.
HessJ, NetoRR, PanicL, RübbenH, SenfW. Satisfaction with male-to-female gender reassignment surgery: Results of retrospective analysis. Dtsch Aerzteblatt Int, 2014; 111:795.
3.
van der SluisWB, BoumanM-B, de BoerNKH, et al.Long-term follow-up of transgender women after secondary intestinal vaginoplasty. J Sex Med, 2016; 13:702.
4.
SchulzSL. The informed consent model of transgender care: An alternative to the diagnosis of gender dysphoria. J Humanist Psychol, 2018; 58:72.
5.
LearmonthC, ViloriaR, LambertC, GoldhammerH, KeuroghlianAS. Barriers to insurance coverage for transgender patients. Am J Obstet Gynecol, 2018; 219:272.e1.
6.
PoteatT, GermanD, KerriganD. Managing uncertainty: A grounded theory of stigma in transgender health care encounters. Soc Sci Med, 2013; 84:22.
7.
RomanelliM, LindseyMA. Patterns of healthcare discrimination among transgender help-seekers. Am J Prev Med, 2020; 58:e123.
DeutschMP. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. University of San Francisco, California, Transgender Care. Online document at: https://transcare.ucsf.edu/guidelines Accessed February9, 2021.
12.
ReillyZP, FruhaufTF, MartinSJ. barriers to evidence-based transgender care: Knowledge gaps in gender-affirming hysterectomy and oophorectomy. Obstet Gynecol, 2019; 134:714.
13.
DefreyneJ, VanwonterghemY, ColletS, et al.Vaginal bleeding and spotting in transgender men after initiation of testosterone therapy: A prospective cohort study (ENIGI). Int J Transgender Health, 2020; 21:163.
14.
GrimstadFW, FowlerKG, NewEP, et al.Ovarian histopathology in transmasculine persons on testosterone: A multicenter case series. J Sex Med, 2020; 17:1807.
15.
GrimstadFW, FowlerKG, NewEP, et al.Uterine pathology in transmasculine persons on testosterone: A retrospective multicenter case series. Am J Obstet Gynecol, 2019; 220:257.e1.
16.
ChenI, NguyenV, HodgeM, et al.Surgical outcomes for transgender men undergoing hysterectomy. J Obstet Gynaecol Can, 2020; 42:25.
17.
Obedin-MaliverJ, LightA, de HaanG, JacksonRA. Feasibility of vaginal hysterectomy for female-to-male transgender men. Obstet Gynecol, 2017; 129:457.
18.
O'HanlanKA, DibbleSL, Young-SpintM. Total laparoscopic hysterectomy for female-to-male transsexuals. Obstet Gynecol, 2007; 110:1096.
19.
GrynbergM, FanchinR, DubostG, et al.Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population. Reprod Biomed Online, 2010; 20:553.
20.
LightAD, Obedin-MaliverJ, SeveliusJM, KernsJL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol, 2014; 124:1120.
21.
National Center for transgender Equality. 2015 U.S. Transgender Survey. Online document at: www.ustranssurvey.org Accessed February9, 2021.
22.
HembreeWC, Cohen-KettenisPT, GoorenL, et al.Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2017; 102:3869.
23.
WingoE, IngrahamN, RobertsSCM. Reproductive health care priorities and barriers to effective care for LGBTQ people assigned female at birth: A qualitative study. Womens Health Issues, 2018; 28:350.
24.
GoorenLJ. Care of transsexual persons. N Engl J Med, 2011; 364:1251.
25.
MeriggiolaMC, GavaG. Endocrine care of transpeople: Part I. A review of cross-sex hormonal treatments, outcomes and adverse effects in transmen. Clin Endocrinol (Oxf), 2015; 83:597.
26.
EvansEC, MattesonKA, OrejuelaFJ, et al.Salpingo-oophorectomy at the time of benign hysterectomy: A systematic review. Obstet Gynecol, 2016; 128:476.
27.
ChengPJ, PastuszakAW, MyersJB, GoodwinIA, HotalingJM. Fertility concerns of the transgender patient. Transl Androl Urol, 2019; 8:209.
28.
ArmuandG, DhejneC, OlofssonJI, Rodriguez-WallbergKA. Transgender men's experiences of fertility preservation: A qualitative study. Hum Reprod, 2017; 32:383.
29.
RowellEE, CorkumKS, LautzTB, et al.Laparoscopic unilateral oophorectomy for ovarian tissue cryopreservation in children. J Pediatr Surg, 2019; 54:543.
30.
MaxwellS, NoyesN, KeefeD, BerkeleyAS, GoldmanKN. Pregnancy outcomes after fertility preservation in transgender men. Obstet Gynecol, 2017; 129:1031.
31.
GroenmanF, NikkelsC, HuirneJ, van TrotsenburgM, TrumH. Robot-assisted laparoscopic colpectomy in female-to-male transgender patients: Technique and outcomes of a prospective cohort study. Surg Endosc, 2017; 31:3363.
32.
Al-TamimiM, PigotGL, van der SluisWB, et al.Colpectomy significantly reduces the risk of urethral fistula formation after urethral lengthening in transgender men undergoing genital gender affirming surgery. J Urol, 2018; 200:1315.
33.
MassieJP, MorrisonSD, WilsonSC, CraneCN, ChenML. Phalloplasty with urethral lengthening: Addition of a vascularized bulbospongiosus flap from vaginectomy reduces postoperative urethral complications. Plast Reconstr Surg, 2017; 140:551e.
34.
MedinaCA, FeinLA, SalgadoCJ. Total vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men. Int Urogynecology J, 2018; 29:1463.
35.
MonstreyS, CeulemansP, HoebekeP. Sex reassignment surgery in the female-to-male transsexual. Semin Plast Surg, 2011; 25:229.
36.
NikkelsC, van TrotsenburgM, HuirneJ, et al.Vaginal colpectomy in transgender men: A retrospective cohort study on surgical procedure and outcomes. J Sex Med, 2019; 16:924.
37.
HougenHY, DugiDD, BerliJU, SajadiKP. Outcomes of transperineal gender-affirming vaginectomy and colpocleisis. Female Pelvic Med Reconstr Surg, 2021; 27:300.
38.
ErgeneliMH, Hakan DuranE, ÖzcanG, ErdoganM. Vaginectomy and laparoscopically assisted vaginal hysterectomy as adjunctive surgery for female-to-male transsexual reassignment: Preliminary report. Eur J Obstet Gynecol Reprod Biol, 1999; 87:35.
39.
HageJJ, TorenbeekR, BoumanFG, BloemJJ. The anatomic basis of the anterior vaginal flap used for neourethra construction in female-to-male transsexuals. Plast Reconstr Surg, 1993; 92:102;discussion:109.
40.
FreyJD, PoudrierG, ChiodoMV, HazenA. Research disparities in female-to-male transgender genital reconstruction: The charge for high-quality data on patient reported outcome measures. Ann Plast Surg, 2017; 78:241.
41.
TerrierJ-É, CourtoisF, RuffionA, Morel JournelN. Surgical outcomes and patients' satisfaction with suprapubic phalloplasty. J Sex Med, 2014; 11:288.
42.
FreyJD, PoudrierG, ChiodoMV, HazenA. An update on genital reconstruction options for the female-to-male transgender patient: A review of the literature. Plast Reconstr Surg, 2017; 139:728.
CohanzadS. Extensive metoidioplasty as a technique capable of creating a compatible analogue to a natural penis in female transsexuals. Aesthetic Plast Surg, 2016; 40:130.
49.
DjordjevicML, BizicMR. Comparison of two different methods for urethral lengthening in female to male (metoidioplasty) surgery. J Sex Med, 2013; 10:1431.
50.
DjordjevicML, BizicM, StanojevicD, et al.Urethral lengthening in metoidioplasty (female-to-male sex reassignment surgery) by combined buccal mucosa graft and labia minora flap. Urology, 2009; 74:349.
51.
PerovicSV, DjordjevicML. Metoidioplasty: A variant of phalloplasty in female transsexuals. BJU Int, 2003; 92:981.
52.
FreyJD, PoudrierG, ChiodoMV, HazenA. A systematic review of metoidioplasty and radial forearm flap phalloplasty in female-to-male transgender genital reconstruction: Is the “ideal” neophallus an achievable goal?. Plast Reconstr Surg—Glob Open. 2016; 4:e1131.
53.
VukadinovicV, StojanovicB, MajstorovicM, MilosevicA. The role of clitoral anatomy in female to male sex reassignment surgery. Sci World J, 2014; 2014:437378.
54.
StojanovicB, BizicM, BencicM, et al.One-stage gender-confirmation surgery as a viable surgical procedure for female-to-male transsexuals. J Sex Med, 2017; 14:741.
55.
TerrellM, RobertsW, PriceCW, SlaterM, LoukasM, SchoberJ. Anatomy of the pedicled anterolateral thigh flap for phalloplasty in transitioning-males. Clin Anat, 2018; 31:160.
FeliciN, FeliciA. A new phalloplasty technique: The free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg, 2006; 59:153.
58.
van der SluisWB, SmitJM, PigotGLS, et al.Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction. Microsurgery, 2017; 37:917.
GarciaMM, ChristopherNA, De LucaF, SpilotrosM, RalphDJ. Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: The Institute of Urology, London U.K., experience. Transl Androl Urol, 2014; 3:156.
61.
LericheA, TimsitM-O, Morel-JournelN, BouillotA, DembeleD, RuffionA. Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism. BJU Int, 2008; 101:1297.
62.
RiegerUM, MajenkaP, WirthmannA, SohnM, BozkurtA, DjedovicG. Comparative study of the free microvascular groin flap: Optimizing the donor site after free radial forearm flap phalloplasty. Urology, 2016; 95:192.
63.
GaraffaG, ChristopherNA, RalphDJ. Total phallic reconstruction in female-to-male transsexuals. Eur Urol, 2010; 57:715.
64.
Van CaenegemE, VerhaegheE, TaesY, et al.Long-term evaluation of donor-site morbidity after radial forearm flap phalloplasty for transsexual men. J Sex Med, 2013; 10:1644.
65.
SalgadoCJ, NugentAG, MoodyAM, ChimH, PazAM, ChenH-C. Immediate pedicled gracilis flap in radial forearm flap phalloplasty for transgender male patients to reduce urinary fistula. J Plast Reconstr Aesthet Surg, 2016; 69:1551.
66.
SantucciRA. Urethral complications after transgender phalloplasty: Strategies to treat them and minimize their occurrence. Clin Anat, 2018; 31:187.
67.
AgarwalCA, ScheeferMF, WrightLN, WalzerNK, RiveraA. Quality of life improvement after chest wall masculinization in female-to-male transgender patients: A prospective study using the BREAST-Q and Body Uneasiness Test. J Plast Reconstr Aesthet Surg, 2018; 71:651.
68.
Owen-SmithAA, GerthJ, SineathRC, et al.Association between gender confirmation treatments and perceived gender congruence, body image satisfaction, and mental health in a cohort of transgender individuals. J Sex Med, 2018; 15:591.
69.
Bluebond-LangnerR, BerliJU, SabinoJ, ChopraK, SinghD, FischerB. Top surgery in transgender men: How far can you push the envelope?. Plast Reconstr Surg, 2017; 139:873e.
70.
FrederickMJ, BerhanuAE, BartlettR. Chest surgery in female to male transgender individuals. Ann Plast Surg, 2017; 78:249.
71.
CuccoloNG, KangCO, BoskeyER, et al.Masculinizing chest reconstruction in transgender and nonbinary individuals: An analysis of epidemiology, surgical technique, and postoperative outcomes. Aesthetic Plast Surg, 2019; 43:1575.
72.
de BlokCJM, WiepjesCM, NotaNM, et al.Breast cancer risk in transgender people receiving hormone treatment: Nationwide cohort study in The Netherlands. BMJ, 2019; 365:I1652.
73.
NolanIT, DaarDA, PoudrierG, MotoskoCC, CookTE, HazenA. Barriers to bottom surgery for transgender men. Plast Reconstr Surg, 2020; 145:667e.
74.
White HughtoJM, ReisnerSL, PachankisJE. Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med, 2015; 147:222.
