Gender Self-Identification: Opinions About Transgender Women from a National Online Survey in Taiwan.

Gender self-identification (transgender) is not permitted in most Asian countries. In Taiwan, individuals recognized as transgender must meet requirements mandated by the Gender Recognition Act. Currently, lifting the requirement for proof of sex-reassignment surgery is pending. The aim of this study was to survey a large sample of Taiwanese to gain a better understanding of the general population's attitudes toward gender self-identification. A self-report survey, entitled "Opinions of Gender Self-Identification," collected demographic information and responses (agree = 1, disagree = 0) to 14 statements about transgender women and women's safety, personal rights, and the law; one statement discussed rights of transgender men to give birth; total scores ranged from 0 to 14. The online survey was distributed to non-government organizations across Taiwan and the Taiwanese islands and was available between April 16 and 30, 2022. Most of the 10,158 respondents were female (77.4%); ages of respondents ranged from 15 to > 65 years. The mean total score was 0.95 ± 2.27, indicating respondents strongly disagreed with support for transgender females; 91.56% disagreed with all statements. Although there were significant differences in scores between parents and non-parents, and those ≤ 35 years versus ≥ 36 years (p < .01), all strongly disagreed with gender self-identification. Given the majority of respondents were females, survey findings should be regarded with caution. Public acceptance of gender self-identification requires support from its residents. Our findings suggest that gender self-identification has not begun to approach even a moderate level of public support among survey respondents.

Frequency and Characteristics of Postoperative Neuropathy in Individuals on Gender-Affirming Hormone Therapy Undergoing Gender Affirmation Surgery: A Retrospective Cohort Study.

Introduction Gender affirmation surgery includes procedures of the face, larynx, chest, reproductive system, external genitalia, and adipose tissue performed to ameliorate incongruence between gender identity and phenotype. The annual number of gender affirmation surgeries performed in the United States has increased significantly. There have been no investigations into the frequency of peripheral neuropathy after gender affirmation surgery, which is an important topic, given transgender individuals are at increased risk for delaying necessary medical care. After appreciating a number of cases of postoperative neuropathy in our clinical practice, we hypothesized that gender affirmation surgery is a high-risk procedure for postoperative neuropathy.  Methods We conducted a one-year, monocentric, retrospective cohort study utilizing clinical data of individuals on gender-affirming hormone therapy undergoing gender-affirmation surgery under general anesthesia. The study included transgender women, assigned male at birth, receiving antiandrogen, progesterone, or estrogen therapy (target range plasma estradiol concentration 90-200 pg/ml) and transgender men, assigned female at birth, receiving antiestrogen or testosterone therapy (target range plasma testosterone concentration 320-1000 ng/dl). The primary objective was to estimate the incidence of postoperative peripheral neuropathy, defined as new numbness, paresthesia, neuropathic pain, or muscle weakness occurring in a peripheral innervation territory. Secondary objectives were to summarize the clinical presentation of neuropathy and investigate for associations between procedure characteristics and neuropathy. Results We identified nine cases of postoperative peripheral nerve injury in 232 consecutive gender affirmation procedures establishing an incidence of 3.9%. All injuries were associated with surgery longer than six hours and were characterized by sensory deficits including numbness 89% (8/9) and tingling 56% (5/9), which were diagnosed by postoperative day one. Conclusions Our results suggest that gender affirmation surgery is a high-risk procedure for postoperative neuropathy, with an incidence similar to other high-risk procedures, and an incidence that is higher than the general surgical population. However, given this has not been previously reported and our study includes a heterogenous population from a single institution, our results should be considered hypothesis generating. Additional studies that include multiple institutions are needed to confirm our findings and identify modifiable risk factors for postoperative neuropathy.

[Ethical issues of gender reassignment surgery]. / Enjeux éthiques de la chirurgie de réassignation sexuelle.

Gender reassignment raises complex ethical issues. It questions gender identity and the right to self-determination. Some highlight the right to access the medical care necessary to live according to one's perceived gender. Others worry about the potential rush into major medical decisions, especially among minors. The need for a medical diagnosis of gender dysphoria can be seen as pathologizing. The requirement for surgery for marital status change, while not mandatory in many places, remains controversial. The balance between informed consent and access to treatment, as well as stigma and discrimination, contribute to the complexity of ethical issues. Finally, the issues surrounding the competence of health professionals, the quality of care and the integration of individual needs make these decisions particularly sensitive from an ethical point of view.

Sociodemographics of Patient Populations Undergoing Gender-Affirming Surgery: A Systematic Review of All Cohort Studies.

Importance: Sociodemographic and health characteristics of patients undergoing gender-affirming surgery (GAS) are currently unknown. Understanding these patient characteristics is vital to optimizing patient-centered care for transgender patients. Objective: To determine sociodemographic characteristics for the transgender population undergoing GAS. Collected sociodemographic information included the following: age, race/ethnicity, body metrics, hormone replacement therapy administration and duration, substance use, psychiatric comorbidities, and medical comorbidities. Evidence Review: A search of seven electronic databases (PubMed, PsycINFO, Embase, CINAHL, Web of Science, Cochrane, and Gender Studies) was used to find all articles on GAS from inception through May 2019. The 15,190 articles were then subjected to two levels of screening, and articles unrelated to gender-affirming care, unavailable in English, n<5, and with no outcomes reporting were excluded. Textbook chapters and letters were also excluded. Findings: A total of 406 studies were fully extracted, with 307 studies reporting age (n=22,727 patients), 19 reporting race/ethnicity (n=1184), 74 reporting body metrics (body mass index [BMI] n=6852, height n=416, and weight n=475), 58 reporting hormone therapies (n=5104), 56 reporting substance use (n=1146), 44 reporting psychiatric comorbidities (n=574), and 47 reporting medical comorbidities (n=573). From the 406 studies, 80 were done in the United States. Regarding U.S. studies, 59 studies reported age (n=5365), 10 reported race/ethnicity (n=709), 22 reported body metrics (BMI n=2519), 18 reported hormone therapies (n=3285), 15 reported substance use (n=478), 44 reported psychiatric comorbidities (n=394), and 47 reported medical comorbidities (n=293). Age was the most reported characteristic, reported in 75.62% of studies (73.75% of U.S. studies). Race/ethnicity was the least commonly reported data, reported in 4.68% of studies (12.50% of U.S. studies). Conclusions and Relevance: The type of sociodemographic information reported by GAS studies is inconsistently reported. To improve patient-centered care for transgender patients, further work is needed to create a standardization of collected sociodemographic information.

Masculinizing and defeminizing gender-affirming surgery.

Transmasculine transgender and gender-diverse individuals may request gender-affirming surgery, standalone or in addition to other interventions. The choices and preferred outcomes of surgery can be highly individual. Besides surgeons' technical skills and patient physique, professionals in this field should be able to cooperate with other disciplines and with patients. The most requested surgery is masculinizing chest surgery, aiming to create a masculine chest with minimal scarring. For genital surgery, metoidioplasty refers to the procedure where the hypertrophic clitoris is released and possibly a scrotum is created from local labia flaps, whereas phalloplasty refers to a procedure in which a neophallus is created from a flap. Possible other surgeries include hysterectomy/oophorectomy, colpectomy, and the implants of scrotal or erection prostheses. In order to guide patients and clinicians, standardized outcome measures as well as evidence-based decision aids have been developed. Such aids, in combination with collaborative medical and psychosocial care, may further leverage the long-term outcomes of these surgeries.

Comparison Between two Surgical Techniques for Increasing Vocal Pitch by Endoscopic Shortening of the Vocal Folds.

OBJECTIVE: To compare two surgical techniques, the Wendler glottoplasty (GP) and its modification, the vocal fold shortening, and retrodisplacement of the anterior commissure (VFSRAC) associated with laser assisted voice adjustment (LAVA) cordotomy, used to feminize the voice of transgender women by increasing the fundamental frequency (F0). METHODS: A retrospective study of 22 trans-women (20-62 years-old) was carried out. 12 of them were treated with GP and 10 with the VFSRAC+LAVA technique. They were evaluated before surgery and 6 months after surgery and the postoperative speech therapy. Laryngostroboscopy examination, F0 measurements, Transgender Woman Voice Questionnaire (TWVQ) assessment and the perceptual assessment using a visual analog scale (PA-VAS) were obtained from all patients. RESULTS: Laryngostroboscopic findings showed normal vocal folds before surgery and a shortening of the vocal folds, due to the anterior glottic synechia, after surgery. Significant increases of F0 were found in both groups but they were higher in the VFSRAC+LAVA group (47.75Hz in GP group vs 69.70Hz in VFSRAC+LAVA group). TWVQ scores showed a significant decrease in both groups although the difference was greater in the VFSRAC+LAVA group. Similarly, PA-VAS scores lowered significantly in both groups but VFSRAC+LAVA group presented the biggest decreases. CONCLUSION: Both surgical techniques produce the shortening of the vocal folds through an endoscopic approach and result in voices with higher vocal pitch. Of the two techniques presented, the VFSRAC+LAVA produces better results although when compared with previous studies it seems that the LAVA technique may not significantly contribute to the postoperative results. So, the VFSRAC technique followed by postoperative speech therapy could be recommended for trans-women who wish to feminize their voice.

Winning The Battle - A Success Story Of Managing Gender Dysphoria.

The DSM 5 defines Gender Dysphoria (GD) as a marked incongruence between one's biological gender and experienced gender. Individuals with GD face increased discrimination in the form of decreased job opportunities, healthcare facilities and increased violence. The definitive treatment for GD is sex reassignment surgery (SRS). The case we present follows a 24-year-old biological male, self-identifying as a female. His experience seeking treatment made him a target for misdiagnoses and mistreatment by healthcare professionals (including psychiatrists, endocrinologists and plastic surgeons) and family resulting in mental agony. After struggling for a long time, he was able to move abroad for SRS. Upon her return to Pakistan as a female she presented as being finally content with her gender and life. The article places emphasis on creating inclusive healthcare plans for individuals with GD and raising awareness among healthcare professional and general population regarding the issue.

Applications of three-dimensional surgical planning in facial feminization surgery: A systematic review.

BACKGROUND: Despite some reports that have shown an increase in safety, efficiency, and accuracy during feminizing craniofacial procedures utilizing three-dimensional (3D) technology, there are no reports summarizing the available evidence on this matter for facial feminization surgery (FFS). Here, we aimed to systematically review the application of 3D technology on FFS. METHODS: We conducted a comprehensive search across PubMed, SCOPUS, Ovid MEDLINE®, Web of Science, and ScienceDirect looking for studies reporting the use of 3D surgical planning in the setting of FFS following the PRISMA guidelines. We extracted data on photographic assessment, imaging, surgical application, and surgical technique and outcomes. RESULTS: This review included 10 studies comprising 1473 transgender female patients and 50 cadaveric cranial specimens. Four studies employed virtual surgical planning (VSP) and the concomitant use of prefabricated cutting guides. One study reported the implementation of 3D VSP using a female skull as a reference. One study used computer-aided design cutting guides and custom plates for FFS. Standardized incorporation of 3D printed models allowed for preoperative planning in three studies. Three studies reported VSP using 3D reconstruction of CT images, but without the use of 3D printing. Three studies used 3D photography with specialized camera technology to enrich clinical documentation and provide a comprehensive facial analysis of soft tissue. Accuracy ranged from 85.7% to 97%. Morbidity ranged from 0% to 12.5%. CONCLUSION: Based on this data, we believe 3D VSP has promising outcomes in terms of accuracy and low morbidity, encouraging its implementation in FFS. However, further prospective double-arm cohort studies are required.

The Importance of Surgical Sex Reassignment in TheOpinion of Female-To-Male Transsexuals.

<br><b>Introduction:</b> The term transsexualism determines people whose gender identity is contrary to their genetic sex and physical features. This condition leads to a discrepancy between the psychological gender preferred by transsexuals and their biological sex. Transsexuals experience a feeling of being incarcerated in a foreign body and therefore wish to alter their sex by hormone therapy and surgical treatment.</br><br><b>Aim:</b> The aim of this study is to describe the opinions of female-to-male transsexuals concerning sex reassignment surgery with selecting the most important stage.</br><br><b>Method:</b> The questionnaire studies were performed among a group of 82 female-to-male transsexuals with a mean age 25.2 years. Patients were at different stages of treatment. Results: More than 90% of the questionnaired transsexuals expect to complete their treatment with hope. For 86.6% of transsexuals, the most important stage in surgical treatment is the phalloplasty, the second panhysterectomy (70.7%), and the third breast reduction (69.5%).</br><br><b>Conclusions:</b> Phalloplasty is the most important stage in sex reassignment surgery in the opinion of transsexuals. Each stage of treatment improves the mental comfort of female-to-male transsexuals.</br>.

Evaluation of Mental Health and Satisfaction Following Transfeminine Gender-Affirming Surgery in Thailand.

Purpose: Although many studies have shown that transgender women (TW) tend to have more depressive symptoms compared with the general population, the exact prevalence of major depressive disorder and contributing risk factors have not yet been studied, especially in those who have undergone gender-affirming genital surgery (GAS). Methods: Every TW aged 20-60 years attending transgender clinics in the Thai Red Cross Society for postoperative checkup were invited to complete a self-report questionnaire, including (1) demographic data, (2) the Thai Patient Health Questionnaire 9 (PHQ-9), (3) satisfaction with psychosocial factors (relationship in family, friends, and society), sexual experiences and outcomes of gender-affirming treatments before and after GAS, and (4) contributing factors to depressive symptoms. Correlations between demographic data and depressive scores were tested. Paired t-test was used to compare pre- and post-GAS data. Results: A total of 97 TW were analyzed, with 22.7% considered to have "major depression" (PHQ-9≥9) after GAS. Postoperative improvement in satisfaction with psychosocial factors and gender-affirming treatment outcomes were observed, especially in sexual experience. Depression severity was found to be negatively correlated with age and sexual satisfaction. Notably, presence of male characteristics before surgery, poor social support and understanding, and postoperative surgical complications were greatly considered as factors contributing to depressive symptoms. Conclusion: Compared with non-GAS TW, depression among those who underwent GAS in Thailand was lower but still significant and was linked to younger age and poor postoperative sexual experiences. These findings were supported by the number of qualitative assessments in the psychosexual domain and postoperative treatment outcomes. Clinical Trial Registration Number - TCTR20190904003.

Quality of Life and Perceived Social Support Before and After Sex Reassignment Surgery.

This study aimed to explore the pre- and postoperative differences in quality of life and perceived social support of Female-to-Male transsexual patients who underwent mastectomy and complete hysterectomy. Sixty-three Female-to-Male female individuals who underwent complete hysterectomy and mastectomy between November 2019 and November 2020 were included in this study. Data were collected using the Personal Information Form, Multidimensional Scale of Perceived Social Support, and the World Health Organization Quality of Life Scale Short Form. The pre- and postoperative perceived social support mean scores of patients were 57.2 ± 9.0 and 74.9 ± 7.3, respectively. The pre- and postoperative quality of life mean scores of patients were 76.9 ± 8.3 and 107.8 ± 10.1, respectively. There were statistically significant differences between the measurements (p < .05). In addition, the patients whose education level was primary school, whose income was less than their expenditure, whose father was a primary school graduate, whose family had a strict family opinion on sexuality, whose family had a traditional view, and who had a high body mass index were found to have higher postoperative social support perceptions and quality of life. The patients' postoperative quality of life and perceived social support improved after sex reassignment surgery.

Investigation of body image perception, self-esteem, and self-confidence in female-to-male transsexuals before and after sex reassignment surgery.

PURPOSE: The study was aimed at investigatting the changes in body image perception, self-esteem, and self-confidence of female-to-male transsexuals (FtM) after sex reassignment surgery (SRS). DESIGN AND METHODS: The quasi-experimental study was conducted with the female individuals who undergo FtM SRS between May 2018 and May 2019. The study data were collected using the Personal Information Form, Body Image Scale, Coopersmith Self-Esteem Inventory, and Self-Confidence Scale. FINDINGS: It was observed that the patients' postoperative body image perception, self-esteem, and self-confidence improved. As their postoperative body image perception was higher than was their preoperative body image perception, their postoperative self-esteem and self-confidence levels were also higher. In addition, as their self-esteem increased, so did their self-confidence. PRACTICE IMPLICATIONS: It was found that the patients' postoperative body image perception, self-esteem, and self-confidence improved.

How Early in Life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for Patients, Providers, and for Our Healthcare System.

INTRODUCTION: The age at which transgender women (TW) and men (TM) first experience gender dysphoria (GD) has not been reported in a U.S. population of adults seeking genital gender-affirming surgery (gGAS). Because gender is an innate part of identity, we hypothesized that untreated GD would be a part of individuals' earliest memories. Understanding GD onset can help guide providers with when and how to focus care to patients not yet identified as "transgender AIM: (i) Determine the age at which transgender adults seeking gGAS first experience GD (ii) Determine the number of life-years that transgender adults spend living with untreated GD METHODS: During initial consultation for gGAS, we asked patients the earliest age at which they experienced GD and the age at which they had their earliest episodic memory. We also queried history of anxiety, depression, and suicide attempt. MAIN OUTCOME MEASURES: Patients self-reported their earliest recollections of experiencing GD, earliest memories in general, and history of anxiety, depression, and suicide attempt. RESULTS: Data from 155 TW (mean age 41.3; SD 16.3) and 55 TM (mean age 35.4; SD 10.8) were collected. Most patients (TM: 78%; TW: 73%) reported experiencing GD for the first time between ages 3 and 7 years.  For TM the mean age of onset was 6.17 years; for TW it was 6.71 years. A total of 81% of TW and 80% of TM described their first recollection of GD as one of their earliest memories. Mean years of persistent GD before the start of gender transition were 22.9 (TM) and 27.1 (TW). Rates of depression, anxiety, and suicide ideation decreased following gender transition. CONCLUSION: Our findings suggest that GD typically manifests in early childhood and persists untreated for many years before individuals commence gender transition. Diagnosis and early management during childhood and adolescence can improve quality of life and survival. Zaliznyak M, Yuan N, Bresee C, et al. How Early in Life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for Patients, Providers, and for Our Healthcare System. Sex Med 2021;9:100448.

Mastectomia masculinizadora para redesignação de gênero de transexuais masculinos / Masculinizing mastectomy for male transsexual's gender reassignment

■ RESUMO Introdução: A mastectomia masculinizadora é geralmente o primeiro, o mais importante e muitas vezes o único procedimento cirúrgico na readequação de gênero em transexuais masculinos. O objetivo é descrever e sistematizar os passos da técnica utilizada pelo autor da mastectomia com dupla incisão associado ao enxerto livre de complexo areolopapilar. Métodos: Revisão retrospectiva de 26 pacientes submetidos a mastectomias masculinizadoras (total de 52 mamas), realizadas pela técnica utilizada pelo autor, entre novembro de 2013 e janeiro de 2018. Resultados: 84,6% dos pacientes sofreram a cirurgia com cicatriz final horizontal no sulco inframamário e 15,4% evoluíram com cicatriz final em "T" invertido. A taxa de complicações maiores foi de 3,8%. Houve uma reoperação (3,8%) no período de acompanhamento. O peso médio das mamas foi de 1.136 gramas, a idade média de 27 anos e 9 meses, índice de massa corporal médio de 26,6kg/m2 e 73% dos pacientes receberam terapia com hormônio masculino previamente à cirurgia. Conclusão: A mastectomia masculinizadora é um procedimento seguro, com boa reprodutibilidade e traz resultados estéticos satisfatórios.

■ ABSTRACT Introduction: Masculinizing mastectomy is generally the first, most important and often the only surgical procedure for gender reassignment in male transsexuals. The objective is to describe and systematize the steps of the technique used by the author of the double-incision mastectomy associated with a free graft from the nipple-areola complex. Methods: Retrospective review of 26 patients who underwent masculinizing mastectomies (total of 52 breasts), performed using the technique used by the author, between November 2013 and January 2018. Results: 84.6% of patients had surgery with a final horizontal scar in the inframammary fold, and 15.4% evolved with a final inverted "T" scar. The rate of major complications was 3.8%. There was one reoperation (3.8%) in the follow-up period. Mean breast weight was 1,136 grams, mean age was 27 years and nine months, mean body mass index was 26.6 kg/m2, and 73% of patients received male hormone therapy before surgery. Conclusion: Mastectomy is a safe procedure, with good reproducibility and brings satisfactory aesthetic results.

The Bioethical Dilemma of Gender-Affirming Therapy in Children and Adolescents.

Since the establishment of the first transgender clinic in the United States in 2007, over sixty clinics associated with children's hospitals have opened across the nation and are seeing very young children and adolescents with a diagnosis of gender dysphoria (GD). Once known as gender identity disorder, GD has been redefined by the latest version of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) not as a mental illness but as the distress experienced by individuals related to their biological sex. The widely accepted practice of gender-affirming therapy (GAT) to treat a vulnerable population despite the associated health risks, the lack of supportive scientific evidence for the pharmacological and surgical interventions, along with the unqualified claim that these interventions will decrease the rate of suicide in these individuals presents a significant bioethical dilemma. The growing trend of GD not only impacts the individuals diagnosed but also society, culture, and the integrity of the profession of medicine. This article utilizes the five-box method, an ethical decision-making framework, to address the implications of the proposed treatment. Once applied, it becomes clear that the hormonal and surgical approaches used are not scientifically or ethically justified. The patient's autonomy and preferences should be respected, yet constrained, if there exists a considerable risk to the well-being of the individual without proven benefits. The quality of life of those receiving this treatment has not been shown to be significantly improved long term, and the mental, physical, and spiritual health of individuals with GD is not thoroughly addressed in these clinics. The important social and contextual factors, on both microcosmic and macrocosmic scales, are minimized in favor of promoting an ideology. Ultimately, Catholic moral teaching reveals that this widely recommended treatment violates the body-soul union, disregards the principle of totality and integrity, and debases the dignity of humanity. SUMMARY: This article examines GAT, the paradigm used in treating individuals identifying as transgender, through the lens of an EDMF. Each stage of this widely proposed treatment - social affirmation, pubertal blockade, administration of cross-sex hormones, and sex reassignment surgery - poses harms and risks that are not fully disclosed to minors and families, creating a bioethical dilemma. Dialogue utilizing science and reasoning must be encouraged to assist individuals who experience a gender identity that rejects their biological sex. This approach would also contribute to the well-being of society.

Treatment of Urethral Strictures in Transmasculine Patients.

BACKGROUND: Urethral strictures are a common complication after genital gender-affirming surgery (GGAS) in transmasculine patients. Studies that specifically focus on the management of urethral strictures are scarce. The aim of this systematic review is to collect all available evidence on the management of urethral strictures in transmasculine patients who underwent urethral lengthening. METHODS: We performed a systematic review of the management of urethral strictures in transmasculine patients after phalloplasty or metoidioplasty (PROSPERO, CRD42021215811) with literature from PubMed, Embase, Web of Science and Cochrane. Preferred Reporting Items for Systematic reviews and Meta-Analysis-(PRISMA) guidelines were followed, and risk of bias was assessed for every individual study using the 5-criterion quality appraisal checklist. RESULTS: Eight case series were included with a total of 179 transmasculine patients. Only one study discussed the management of urethral strictures after metoidioplasty. Urethral strictures were most often seen at the anastomosis between the fixed and pendulous urethra. For each stricture location, different techniques have been reported. All studies were at a high risk of bias. The current evidence is insufficient to favor one technique over another. CONCLUSIONS: Different techniques have been described for the different clinical scenarios of urethral stricture disease after GGAS. In the absence of comparative studies, however, it is impossible to advocate for one technique over another. This calls for additional research, ideally well-designed prospective randomized controlled trials (RCTs), focusing on both surgical and functional outcome parameters.

[Masculinizing mastectomy with nipple-areola graft autotransplantation for female-to-male transsexualism]. / Maskuliniziruyushchaya mammoplastika s autotransplantatsiei areol pri lechenii yadernoi formy zhenskogo transseksualizma.

OBJECTIVE: To develop the method of masculinizing mammoplasty with nipple grafting female-to-male transsexuals with BMI >30 kg/m2, large breast volume and severe ptosis. MATERIAL AND METHODS: There were 114 mastectomies in 57 patients with nipple grafting technique. The methods of areola grafting and scar design were modified to improve aesthetic results. Inclusion criteria were BMI >30 kg/m2, breast size B+ and severe ptosis (Regnault grade ≥2). Anonymous survey for evaluation of aesthetic outcome and quality of life was performed a year after surgery. RESULTS: Postoperative complications included hematoma (5.2%), seroma (7.9%), tangential graft necrosis (9.6%), wound dehiscence (0.8%), ligature-induced inflammation (1.7%), scar hypertrophy (12.2%). Three patients (5.2%) developed nipple hypersensivity in long-term postoperative period. Three patients (5.2%) required redo urgent surgery for hematoma. Additional surgical correction of scar hypertrophy was performed in 4 patients (7%). In a year after surgery, patients rated aesthetic postoperative result as 4.45 out of 5 scores. CONCLUSION: Masculinizing mammoplasty with areola autotransplantation is preferable for FtM transsexuals with large breast volume and severe ptosis. This surgery ensures a good aesthetic result with minimal secondary corrections and complication rate.

Masculinizing gender-affirming surgery for trans men and non-binary individuals: what you should know.

Gender dysphoria, the discordance between one's gender identity and anatomy, affects nearly 25 million people worldwide, and the prevalence of transgender and non-binary identities is increasing because of greater acceptance and awareness. Because of the improved accessibility to gender-affirming surgery (GAS), many providers will care for patients during and after gender transition. For trans men (female-to-male), GAS represents a combination of procedures rather than a single surgery. The particular combination of masculinizing procedures is chosen on the basis of informed patient-provider discussions regarding the patient's goals and anatomy and implemented through a multidisciplinary team approach. In this review, we describe the common procedures comprising masculinizing GAS to improve delivery of specialized care for this patient population.