Gender affirmation surgery: surgical techniques, evaluation of the surgical outcomes, and patients’ Quality of Life

More specifically, the projects aim:

1. - to define the role of some surgical procedures (e.g. facial feminization surgery and chondrolaryngoplasty)
2. to improve an algorithm for choosing the most appropriate surgical technique for mastectomy in trans men, to define the risk of breast cancer in trans men following mastectomy, and to define the role of radiological examinations
3. to assess the results of the facial feminization surgery, chondrolaryngoplasty, mastectomy, and clitoro-labio-vaginoplasty in trans persons, and the impact of these surgeries in the patients’  Quality of Life.

Background

Description of the condition Gender Dysphoria

Description of the condition Gender Dysphoria describes the discomfort or distress caused by a discrepancy between a person’s gender identity and that assigned at birth along with the associated gender role and/or primary and secondary sex characteristics. This condition is named “Transsexualism” in the ICD-10, and “Gender Dysphoria” in the Diagnostic Statistical Manual of Mental Disorders (DSM-V). Eventually, on 18 June 2018 the World Health Organization released the ICD-11, where the term “gender incongruence” has been introduced, and replaced the old term “transsexualism”. Following the original Harry

Benjamin’s diagnostic criteria for transsexualism, the “World Professional Association for Transgender Health” has developed the Standards of Care.

Gender affirmation surgery (GAS)

The term GAS refers to all genital, facial and body procedures required to create a feminine or masculine appearance. Genital procedures, such as vaginoplasty, clitorolabioplasty, penectomy and orchidectomy in trans women and penile and scrotal reconstruction after hysterosalpingo-ophorectomy and mostly vaginectomy in trans men, are the main procedures in GAS. Non-genital procedures, such as breast enlargement, chest contouring mastectomy (CCM), facial feminisation surgery (FFS), voice surgery, and other procedures, complete the surgical treatment available.

In 2015, The Swedish National Board of Health and Welfare (Socialstyrelsen) published the “Good Care of Adults with Gender Dysphoria” (God vård av vuxna med könsdysfori, Nationellt kunskapsstöd) with guidelines for health care professionals in order to improve the care of transgender patients in Sweden [10]. According to this text the Swedish health care regions are advised to offer GAS for people with gender dysphoria. A national quality register for gender dysphoria, supported by SALAS (SKR - formerly called SKL)), started inclusion of patients in 2018.

Aim and goals

A recent HTA (Health Technology Assessment ) report presented a lack of long-term data on the results of GAS in relation to patient reported outcomes, meeting pre-operative patients´ expectations, rate of complications and its impact on patients´ health, QoL and mental health.

Thus, there is an urge for research studies on GAS. The aim of these projects is to improve the knowledge about benefits and risks of FFS, CCM and vaginoclitorolabioplasty, and to improve patients’ Quality of Life.

More specifically, scope of the FFS project is: to develop a protocol for FFS on the basis of patient’s goals. Expectations of the patients’ and the effectiveness of the FFS regarding the impact on Quality of Life (QoL) and Gender Dysphoria will be examined.

Scope of the CCM project is: to assess the impact of mastectomy on patients’ QoL; to report on complication rates, specifically for each type of mastectomy performed; to improve the decision making process when selecting a specific CCM technique; to find out the value of histopathological examination of the removed breast tissue at the time of CCM, as well as what is the role of radiological screening for breast cancer in this group of patients.

Scope of the clitoro-vaginoplasty project is to assess the results of the surgery, and to examine patients’ QoL