Claire Dawson
Gender-affirming surgery, also known as gender confirmation surgery, is a term for surgical procedures that help align a person's body with their gender identity. These procedures are becoming more widely available across the world, with more hospitals offering them and insurance companies adding coverage. In the US, the Centers for Medicare and Medicaid Services started covering transgender-related procedures in 2014, and the number of health system encounters for gender identity disorder rose from 13,855 in 2016 to 38,470 in 2020. This increase in services has been life-saving for many transgender people, and it is important that these procedures are provided with compassionate and comprehensive care. While there is no specific data on the number of hospitals offering these procedures, notable hospitals in the US that do so include Johns Hopkins Medicine, Rush University Medical Center, and Boston Children's Hospital.
| Characteristics | Values |
|---|---|
| Number of hospitals offering gender-affirming surgeries | Limited data but an increasing number |
| Examples of hospitals offering gender-affirming surgeries | Johns Hopkins Medicine, Rush hospitals in Chicago, Boston Children's Hospital |
| Procedures offered | Vaginoplasty, metoidioplasty, phalloplasty, chest reconstruction, breast augmentation, facial feminization and masculinization, body sculpting, liposuction, lipofilling |
| Insurance coverage | Varies, but more companies are adding coverage and Medicare now covers surgery |
| Hospital stay | 3-7 days for bottom surgery, 5-10 days for vaginoplasty, 1 week for phalloplasty |
| Post-operative care | Close follow-up for several weeks, soft or liquid diet, walking encouraged after a week |
| Surgery destinations | Bangkok, Phuket, Istanbul |
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What You'll Learn
Hospitals offering gender-affirming surgery
Gender-affirming surgery is a term for a variety of surgical procedures that help align a patient's gender identity with their physical appearance. These procedures include breast and chest surgery, facial and cosmetic interventions, and genital reconstruction.
In the United States, hospitals offering gender-affirming surgery include UCLA Health, which provides a wide range of services, including hormone therapy, voice therapy, behavioural health services, and surgical procedures such as facial reconstruction, chest/top surgery, and genital reconstruction.
Another option is Keck Medicine of USC, whose surgeons are highly experienced in gender-affirming surgery. Their specialties include chest procedures (top surgery), genital procedures (bottom surgery), hysterectomies, and facial surgery, such as facial feminization and masculinization. They also offer a multidisciplinary care team that includes speech therapists, physical therapists, and occupational therapists.
While some hospitals have been criticized for providing gender-affirming care to minors, it is important to note that the focus of this controversy is on youth patients, and hospitals like Stanford Medicine and NYU Langone have only halted such procedures for those under 18 or 19.
The availability of gender-affirming surgery can vary by region, and it is always recommended to contact hospitals directly to understand their specific offerings and eligibility criteria.
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The increase in gender-affirming surgeries
Gender-affirming surgery, also known as gender confirmation surgery, is a term used to describe a variety of surgical procedures that align an individual's gender identity with their physical appearance. These procedures can include breast and chest surgery, genital reconstructive surgery, and facial feminization or masculinization. In recent years, there has been an increase in the number of hospitals offering these procedures, as well as in the number of individuals seeking them.
Previously, transgender individuals faced significant barriers in accessing gender-affirming surgeries, due to a lack of medical institutions offering these procedures and limited insurance coverage. However, since 2014, there has been a notable increase in hospitals providing gender-affirming surgeries in the United States. This change occurred when the U.S. government's Centers for Medicare and Medicaid Services began covering transgender-related procedures. As a result, more hospitals have added their names to the list of providers, expanding the options available to transgender Americans.
The increase in the number of hospitals offering gender-affirming surgeries is a positive step towards improving access to these life-saving treatments for the transgender community. According to Mara, the director of the National Center for Lesbian Rights, "Access to these treatments is lifesaving for many transgender people." Despite this progress, there is still a need for comprehensive and compassionate care, as stated by Goldstein of NBC News.
The demand for gender-affirming surgeries has also increased, with the number of procedures nearly tripling from 2016 to 2019, according to a recent study. This increase is likely due to expanded insurance coverage for transgender care and efforts by the Obama administration to discourage discrimination based on gender identity. The study found that breast and chest surgery was the most common procedure, particularly among younger patients, followed by genital reconstructive procedures, which increased with age.
While the number of gender-affirming surgeries dipped slightly in 2020 due to the pandemic, it is clear that the overall trend is towards greater accessibility and acceptance of these procedures. This is reflected in the growing number of hospitals offering these surgeries and the increasing demand from patients. As a result, more individuals are able to access the treatments they need to affirm their gender identity and improve their quality of life.
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Types of gender-affirming surgery
Gender-affirming surgery (GAS) is a surgical procedure or series of procedures that alter a person's physical appearance and sexual characteristics to align with their gender identity. While it is most often associated with transgender healthcare, many such treatments are also pursued by cisgender individuals.
There are several types of gender-affirming surgery, including:
- Top surgery: This refers to surgeries on the chest and can include breast augmentation, breast reduction, and chest contouring or reconstruction.
- Bottom surgery: This refers to surgeries on the genitals and can include vaginoplasty (construction of a vagina), vulvoplasty (construction of a vulva), penectomy (removal of the penis), orchiectomy (removal of the testes), and phalloplasty (construction of a penis).
- Facial feminization and masculinization: These procedures can include a range of surgeries to enhance and adjust facial features to create more feminine or masculine appearances, such as reshaping the nose, chin, cheeks, and jaw, brow lifts, Adam's apple reduction, and jaw augmentation.
- Other procedures: Some other procedures that may be part of a gender affirmation surgery plan include hysterectomy (removal of the uterus), oophorectomy (removal of the ovaries), scrotoplasty (creation of a scrotum), and body sculpting procedures such as liposuction and lipofilling.
It is important to note that not all transgender individuals seek or require surgery, and the specific procedures undertaken will depend on the individual's unique needs and goals. Additionally, many gender-affirming surgeries require comprehensive aftercare, and patients should discuss their surgical options and potential risks with their doctor beforehand.
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Aftercare for gender-affirming surgery
Gender-affirming surgery is a broad term for surgical procedures that help transgender, non-binary, and gender-diverse people transition. These procedures include facial surgery, top surgery, and bottom surgery. Before undergoing gender-affirming surgery, patients must go through multiple discussions with mental health providers and physicians to determine if surgery is the appropriate course of action.
Before surgery, patients should receive guidance from their care team on what to expect in the days, weeks, and months following their procedure. This includes information on potential post-surgical complications, which, while rare, can occur. For example, bottom surgery, which involves transforming and reconstructing the genitals, typically requires a hospital stay of around three to seven days, followed by close follow-up care for several weeks.
To optimise aftercare, patients may require additional mental health support, assistance with wound care and pain management, and help with activities of daily living during their recovery. It is important to tailor aftercare plans to the unique needs of each patient, taking into account their specific surgical procedures and individual circumstances.
In addition to medical aftercare, patients may also benefit from support groups or counselling services to help them navigate the social and emotional aspects of their transition. These services can provide valuable guidance and community as individuals adjust to their affirmed gender identities.
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The cost of gender-affirming surgery
Some healthcare providers offer payment plans directly or through lenders that allow patients to pay off medical bills over time. Patients might also take out a personal loan or a medical loan to cover expenses related to gender-affirming care or surgery.
There are also costs associated with gender-affirming surgery that may not be covered by insurance. These include the cost of psychiatric care or therapy, which is usually required before surgery, with an hour of therapy ranging from $65 to $250. There is also the cost of time off work, with bottom surgery requiring six weeks of recovery time and top surgery requiring around two weeks. Finally, there are miscellaneous goods that will help with recovery, such as a shower stool, waterproof bed sheets, cheap underwear, and sanitary towels.
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Frequently asked questions
The exact number of hospitals is unclear, but there has been a notable increase in hospitals offering gender-reaffirming surgeries since 2014. Some hospitals that offer these procedures include Rush hospitals in Chicago, Boston Children's Hospital, Johns Hopkins Medicine, and Weiss Memorial Hospital in Chicago.
The increase is partly due to changes in federal and state laws mandating coverage of gender-affirming surgery, as well as advocacy by organizations like the National Center for Lesbian Rights and the Transgender Legal Defense and Education Fund.
Common procedures include vaginoplasty, metoidioplasty, phalloplasty, chest reconstruction, breast augmentation, facial feminization, masculinization, and body sculpting.
The recovery process can vary depending on the specific procedure. For example, a vaginoplasty generally requires a hospital stay of five to ten days, while a phalloplasty may require a hospital stay of at least a week. Early recovery for facial surgery typically ranges from two to three weeks, with final results taking six to twelve months. Proper post-operative care is essential to ensure successful healing and minimize complications.
