Gender Confirmation Surgery

What is gender identity?

One’s basic sense of self as a man or woman.

What is gender dysphoria?

A term introduced by Fisk in 1973, gender dysphoria refers to distress resulting from conflicting gender identity and sex of assignment. It has replaced the term Gender Identity Disorder in the Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5), which was implemented in 2014. This revision of the DSM-4’s Gender Identity Disorder was intended to avoid the stigmatizing effect of the previous diagnostic term without jeopardizing access to effective treatment options.

What are the diagnostic criteria for gender dysphoria according to the DSM-5?

There must be marked difference between the individual’s expressed gender and the gender others would assign him or her. This must continue for at least 6 months. The critical element is the presence of clinically significant impairment in social, occupational, or other important areas of functioning.

What is transsexualism?

A term coined by Magnus Hirschfield in 1923, a transsexual is an individual who desires to live permanently in the social role of the opposite gender, and wants to undergo sex reassignment. In 1994, the DSM-4 committee replaced the diagnostic term Transsexualism with Gender Identity Disorder, which has since been replaced by Gender Dysphoria. The International Classification of Diseases-10 (ICD-10) continues to use Transsexualism as a diagnostic term under the heading of Gender Identity Disorders.

What are the diagnostic criteria for transsexualism according to the ICD-10?

There are three criteria: (1) the desire to live and be accepted as a member of the opposite sex; (2) the transsexual identity has been present persistently for at least 2 years; and (3) the disorder is not a symptom or another mental disorder or a chromosomal abnormality.

What is the prevalence of gender dysphoria?

The DSM-5 reports a range from 1 in 20,000 up to 1 in 10,000 biological men and a range from 1 in 50,000 up to 1 in 30,000 biological women.

Is gender dysphoria a disorder of sex development (DSD)?

No, DSD is a distinct entity representing congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical.

What are the Standards of Care for the Health of Transsexual?

Previously known as the Harry Benjamin International Gender Dysphoria Association Guidelines for Diagnosis and Treatment, the Standards of Care is a publication of the World Professional Association for Transgender Health (WPATH). It is intended to provide flexible clinical guidelines to meet the diverse health care needs of individuals with gender dysphoria. The most current set, Version 7, was published in 2011.

What are the mechanisms of feminization through hormone therapy?

Feminization is achieved by two mechanisms: androgen suppression using medications such as spironolactone or finasteride, and induction of female characteristics using estrogen.

What are the effects of feminization hormone therapy?

Within the first 6 months there is redistribution of fat, decreased muscle mass, softening of the skin, and decreased libido. Breast growth may be expected after 3 to 6 months of therapy and may continue for over 2 years.

What are the effects of masculinization hormone therapy?

Testosterone therapy results in increased muscle mass, decreased fat mass, increased facial hair and acne, male pattern baldness, and increased libido. In female-to-male individuals, testosterone therapy results in clitoromegaly, temporary or permanent decreased fertility, deepened voice, vaginal atrophy, and cessation of menses.

Why use the term “Gender Confirmation Surgery” as opposed to “Sex Change” or “Gender Reassignment Surgery”?

The latter two phrases suggest that a person is making a choice to switch genders. Gender confirmation surgery should be seen as a therapeutic tool to enable a person to feel comfortable as their gendered self.

What are the anatomic differences between the male and female chest that are relevant in top surgery?

The male chest is wider than the female chest, and the male pectoral muscle is usually more developed. The male areola is smaller than the female areola, and the distance between the nipple and inframammary crease is shorter in males.

What are the methods of top surgery performed for female-to-male individuals?