Treatment
18
Surgery for Sex Reassignment and Gender Confirmation
➤ ES recommends that a patient pursue genital gender-affirming surgery
only after the MHP and the clinician responsible for endocrine transition
therapy both agree that surgery is medically necessary and would benefit
the patient's overall health and/or well-being. (1|⊕⊕
)
➤ ES advises that clinicians approve genital gender-affirming surgery
only after completion of ≥1 year of consistent and compliant hormone
treatment, unless hormone therapy is not desired or medically
contraindicated. (UGPS)
➤ ES advises that the clinician responsible for endocrine treatment
and the primary care provider ensure appropriate medical clearance
of transgender individuals for genital gender-affirming surgery and
collaborate with the surgeon regarding hormone use during and after
surgery. (UGPS)
➤ ES recommends that clinicians refer hormone-treated transgender
individuals for genital surgery when: (1|⊕
)
1. The individual has had a satisfactory social role change
2. The individual is satisfied about the hormonal effects, and
3. The individual desires definitive surgical changes.
➤ ES suggests that clinicians delay gender-affirming genital surgery involving
gonadectomy and/or hysterectomy until the patient is ≥18 years old or legal
age of majority in his or her country. (2|⊕⊕
).
➤ ES suggests that clinicians determine the timing of breast surgery for
transgender males based upon the physical and mental health status of
the individual. There is insufficient evidence to recommend a specific age
requirement. (2|⊕
)
