Overview of gender-affirming treatments and procedures

Supporting evidence for providing gender-affirming treatments and procedures

Transgender people may seek any one of a number of gender-affirming interventions, including hormone therapy, surgery, facial hair removal, interventions for the modification of speech and communication, and behavioral adaptations such as genital tucking or packing, or chest binding. All of these procedures have been defined as medically necessary by the World Professional Association for Transgender Health.[1] Lower quality research has found improvements in a range of psychosocial measures after gender-affirming treatments such as hormones or surgery.[2-5] Sevelius' Model of Gender Affirmation describes the ways in which denial of access to gender affirmation is associated with high risk behaviors and increased rates of HIV infection.[6] Conversely, not all transgender people seek all interventions, and some may seek none. In contrast to past practices in which a set pathway involved a requirement of psychological assessment → hormones → genital surgery, the current standard of care is to allow each transgender person to seek only those interventions which they desire to affirm their own gender identity.[7]

Medical interventions

Gender-affirming hormone therapy is the primary medical intervention sought by transgender people. Such treatment allows the acquisition of secondary sex characteristics more aligned with an individual's gender identity.

Surgical interventions

A wide range of gender-affirming surgeries are available to transgender people. These include surgeries specific to gender affirmation, as well as procedures commonly performed in non-transgender populations.

Surgeries specific to transgender populations:

• Feminizing vaginoplasty
• Masculinizing phalloplasty / scrotoplasty
• Metoidioplasty (clitoral release/enlargement, may include urethral lengthening
• Masculinizing chest surgery ("top" surgery)
• Facial feminization procedures
• Reduction thyrochondroplasty (tracheal cartilage shave)
• Voice surgery

Surgeries not specific to transgender populations:

• Augmentation mammoplasty
• Hysterectomy / oophorectomy
• Orchiectomy
• Vaginectomy

Other interventions:

Other interventions include:

• Facial hair removal
• Voice modification
• Genital tucking and packing, and chest binding

References

1. WPATH Clarification on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage for Transgender and Transsexual People Worldwide WPATH. Transgender Health Information Program. [cited 2014 Jan 21].
2. Gómez-Gil E, Zubiaurre-Elorza L, Esteva I, Guillamon A, Godás T, Cruz Almaraz M, et al. Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology. 2012 May;37(5):662-70.
3. Meier SLC, Fitzgerald KM, Pardo ST, Babcock J. The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. J Gay Lesbian Ment Health. 2011;15(3):281-99.
4. Newfield E, Hart S, Dibble S, Kohler L. Female-to-male transgender quality of life. Qual Life Res. 2006 Jun 7;15(9):1447-57.
5. White Hughto JM, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health. 2016 Jan 13;1(1):21-31.
6. Sevelius JM. Gender Affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013 Jun 1;68(11-12):675-89.
7. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgenderism. 2012;13(4):165-232.