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Tuesday, May 23, 2017

DAYS OF LOT: First ever data on US transgender surgeries reveals huge surge in demand

DAYS OF LOT: First ever data on US transgender surgeries reveals huge surge in demand
Warning: Sensitive Material
 
The first ever data on gender reassignment surgeries in the United States shows demand is skyrocketing.
The American Society of Plastic Surgeons found a nearly 20 percent increase in vaginoplasties, phalloplasties, top surgery and contouring operations in just the first year of reporting.
In 2016, more than 3,200 surgeries were performed to help transgender patients feel more like themselves.
Surgeons in the field claim that figure is a conservative estimate - and would likely three times higher if all hospitals had a uniform way of documenting such surgeries.
And they believe celebrity transitions have been a driving force in this shift.


It’s only in the last couple of years that we’ve seen this dramatic increase in demand for procedures, it’s certainly a subject that’s more talked about,’ Dr Loren Schechter a board-certified plastic surgeon who’s been practicing gender-reassignment surgery for two decades, told Daily Mail Online.
‘It’s really the reason why the society is recognizing and collecting data.

‘This is the first time that the ASPS is formally collecting the numbers and they’re probably a conservative estimate of procedures. I wouldn’t be surprised if it was double or triple.’
Increasingly, insurance companies are offering coverage for surgery for patients with gender dysphoria - a disconnect between how an individual feels and what their anatomic characteristics are.
Gender confirmation procedures can include everything from facial and body contouring to reassignment surgeries.
As Chicago-based Dr Schechter explains, ‘there is no one-size-fits all treatment’.
Gender transitions usually include more than just surgery.
Plastic surgeons often partner with other experts to provide comprehensive care, such as doctors who specialize in hormone therapy or urology and with mental health professionals who help patients through the emotional aspects of their transition.
Male to female genital surgery is called vaginoplasty; female to male genital surgery is called phalloplasty. There are various techniques and ways to perform each procedure.

But before 2014, Dr Schechter says, there were just six board-certified plastic surgeons trained in performing both male to female genital surgery and female to male.
‘Our surgical society is trying to not only meet the patient demand but also the surgeon demand,’ he explains.

‘Up until recently, there were only about half a dozen surgeons who offered both [vaginoplasties and phalloplasties].
‘The numbers are increasing, but one of the barriers is that there’s been no formal training program.
‘A few years ago it wasn’t very easy to find a hospital which would let them perform these procedures - be it for religious reasons or lack of insurance coverage, which makes it very expensive...’
Despite the lack of provisions, surgeons and research, Dr Schechter insists the landscape has changed for patients with gender dysmorphia.
‘Not that it’s easy to transition at this point, but it’s certainly different,’ he said.
‘Access to care has dramatically improved here in the states thanks to more insurance coverage - and societal attitudes have changed.
‘They don’t necessarily feel as isolated or alone as they might have done years ago.’
Members of the American Society of Plastic Surgeons undergo intense training to help these patients address the incongruity between their bodies and the gender they know themselves to be.
 ‘Surgical therapy is one component of the overall care of the individual,’ said Dr. Schechter. ‘It takes a team of experts across different disciplines working together to provide comprehensive care. I often partner with doctors who may prescribe treatments such as hormone therapy and mental health professionals who help patients through their transitions.’
Choosing a team of experts can be a difficult path to navigate. ASPS President Debra Johnson, MD, a board-certified plastic surgeon in Sacramento, California, says it is crucial to choose a surgeon who is certified by the American Board of Plastic Surgery to ensure the highest safety and training standards.
‘Board-certified plastic surgeons undergo rigorous training that is designed to not only provide the safest and best quality care, but also give patients a variety of options when it comes to gender affirming surgeries,’ said Dr. Johnson. ‘Our goal as plastic surgeons is to help get transgender patients to a place where they feel the most comfortable.’

Dr Johnson added: ‘I haven't been surprised by the increase in gender confirmation surgery. These potential surgical patients have always existed, but previously they had to pay out of pocket for their care, which some just could not afford. After new federal legislation was passed, health plans had to offer these surgeries as part of their coverage plans. So patients who couldn't previously afford surgery are finally able to gain access.’

A vaginoplasty is a far less costly and far more successful procedure than the female to male procedure.
In the surgery, the testicles and most of the penis are removed while the urethra is shortened.
The skin of the penis is then inverted and used to create a vagina.
In some procedures a neoclitoris is also created with that skin from the tip of the penile glans which allows for sensation.
The prostate meanwhile is not removed during the surgery, though it does shrink because of the hormones that are taken during the transition process.
After the surgery, patients spent three days in the hospital and must not do any strenuous activities for two weeks.
Initial recovery time is between four and six weeks for most patients, and after 12 weeks the patient is fully recovered.
Dilation must be performed by the patient multiple times a day for at least 12 weeks after the surgery for 15 minutes at a time, and at least once a week after that for the rest of their life.
Some doctors recommend daily dilation for life with the largest dilator or dildo the patient can comfortably fit into their new vagina.
At 12 weeks, the patient can have sex again and in most cases those who have had the surgery report that they are able to experience orgasms.
The procedure can cost anywhere from $5,000 to $100,000, with the average US surgery cost $20,000.
Bleeding, swelling and vaginal discharge are among the common side effects after surgery.