Management of the patient requesting transgender surgery
Urologist’s role may include orchiectomy, treatment of voiding dysfunction
Transgender individuals make up an estimated 0.6% of the U.S. population (Flores et al. How Many Adults Identify as Transgender in the United States? Los Angeles: The Williams Institute, 2016) and have been the subject of increasing mainstream media attention in recent years. A growing number of insurance providers and health care systems, including Medicare and the Veterans Health Administration, now offer coverage for certain aspects of medical and surgical gender transition.
As surgeons of the genitourinary tract, urologists are likely to see increased demand from transgender patients both for general urologic care and for needs specific to surgical transition.
Gender-confirming surgery, previously described as sex reassignment surgery, includes procedures that alter an individual’s body to resemble that of their identified gender. Urologists may be involved in providing surgical castration, genital reconstruction, or in managing complications of genital reconstruction. Beyond gender-confirming surgeries, transgender patients may have unique urologic needs as a result of hormonal therapy or prior reconstruction.
In this article, we will provide an overview of the urologist’s role in caring for patients undergoing gender transition as well as urologic concerns of transgender men and women.
First, it is helpful to understand relevant terminology. “Transgender” is an umbrella term for individuals who do not identify with the physical sex to which they were assigned at birth. A transgender woman (male-to-female; MtF) is an individual who was assigned male at birth and has a female gender identity; a transgender man (female-to-male; FtM) is an individual who was assigned female at birth and has a male gender identity.
“Gender nonconforming” or “gender variant” individuals may identify with neither male nor female gender identity. Providers should ask gender nonconforming patients about their preferred pronoun (he, she, they) during the initial clinic visit and address them accordingly.
Gender identity development is thought to reflect a complex interplay of biologic, environmental, and cultural factors, with emerging evidence of a neurologic basis. A patient’s gender identity, biological sex, and sexual orientation or sexual preference may be distinct from one another. A subset of transgender patients develop “gender dysphoria,” or severe distress caused by a discrepancy between a person’s gender identity and their sex assigned at birth.