CC BY-NC-ND 4.0 · Arch Plast Surg 2023; 50(01): 063-069
DOI: 10.1055/s-0042-1758383
Gender Affirmation Surgery
Original Article

Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience

1   Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
,
Mengyuan T. Liu
1   Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
,
1   Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
,
1   Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
,
1   Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
,
2   Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
3   UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
,
2   Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
3   UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
,
George H. Rudkin
1   Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
3   UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
,
Amy K. Weimer
3   UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
4   Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
,
1   Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
3   UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
› Author Affiliations
Funding This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (J.C.L.) and the Jean Perkins Foundation (J.C.L.). J.C.L. is additionally supported by the National Institutes of Health/NIDCR R01 DE028098.

Abstract

Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients.

Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed.

Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth (n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs (n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5 ± 3.6 years, primarily estrogen (n = 39). Most patients (n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy (n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery (n = 15, 22%), vaginoplasty (n = 15, 22%), mastectomy (n = 11, 16%), and orchiectomy (n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB were more likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021).

Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy.

Authors' Contribution

A.C.H.: Conceptualization, methodology, validation, formal analysis, validation, investigation, writing - original draft, writing – review and editing; M.T.L.: investigation, writing – review and editing; C.H.C.: investigation, writing – review and editing; S.G.: investigation, writing – review and editing; B.N.D.: investigation, writing – review and editing; G.Y.N.: methodology, writing – review and editing; M.S.L.: methodology, writing – review and editing; G.H.R.: methodology, writing – review and editing; A.K.W.: methodology, writing – review and editing; J.C.L.: Conceptualization, methodology, validation, resources, writingreview and editing, supervision, funding acquisition.


Ethical Approval

This study was approved by University of California, Los Angeles Institutional ReviewBoard #19-001482 and#001571.




Publication History

Received: 25 January 2022

Accepted: 30 June 2022

Article published online:
06 February 2023

© 2023. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 James S, Herman J, Rankin S, Keisling M, Mottet L, Anafi Ma. The Report of the 2015 U.S. Transgender Survey; 2016
  • 2 Winter S, Diamond M, Green J. et al. Transgender people: health at the margins of society. Lancet 2016; 388 (10042): 390-400
  • 3 Esmonde N, Heston A, Jedrzejewski B. et al. What is “Nonbinary” and What Do I Need to Know? A primer for surgeons providing chest surgery for transgender patients. Aesthet Surg J 2019; 39 (05) NP106-NP112
  • 4 Clark BA, Veale JF, Townsend M, Frohard-Dourlent H, Saewyc E. Non-binary youth: access to gender-affirming primary health care. Int J Transgenderism 2018; 19: 158-169
  • 5 Kuper LE, Nussbaum R, Mustanski B. Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals. J Sex Res 2012; 49 (2-3): 244-254
  • 6 Koehler A, Eyssel J, Nieder TO. Genders and individual treatment progress in (non-)binary trans individuals. J Sex Med 2018; 15 (01) 102-113
  • 7 Padula WV, Heru S, Campbell JD. Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: a cost-effectiveness analysis. J Gen Intern Med 2016; 31 (04) 394-401
  • 8 Schechter LS, Cohen M. Gender confirmation surgery: a new frontier in plastic surgery education. Plast Reconstr Surg 2016; 138 (04) 784e-785e
  • 9 Morrison SD, Chong HJ, Dy GW. et al; Transgender Educational Study Group. Educational exposure to transgender patient care in plastic surgery training. Plast Reconstr Surg 2016; 138 (04) 944-953
  • 10 Scandurra C, Mezza F, Maldonato NM. et al. Health of non-binary and genderqueer people: a systematic review. Front Psychol 2019; 10: 1453
  • 11 Monro S. Non-binary and genderqueer: an overview of the field. Int J Transgenderism 2019; 20 (2-3): 126-131
  • 12 Gray R, Nguyen K, Lee JC. et al. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Plast Reconstr Surg 2019; 144 (05) 1159-1168
  • 13 Miller TJ, Wilson SC, Massie JP, Morrison SD, Satterwhite T. Breast augmentation in male-to-female transgender patients: technical considerations and outcomes. JPRAS Open 2019; 21: 63-74
  • 14 Boas SR, Ascha M, Morrison SD. et al. Outcomes and predictors of revision labiaplasty and clitoroplasty after gender-affirming genital surgery. Plast Reconstr Surg 2019; 144 (06) 1451-1461
  • 15 Dunford C, Bell K, Rashid T. Genital reconstructive surgery in male to female transgender patients: a systematic review of primary surgical techniques, complication profiles, and functional outcomes from 1950 to present day. Eur Urol Focus 2021; 7 (02) 464-471
  • 16 Bared A, Epstein JS. Hair transplantation techniques for the transgender patient. Facial Plast Surg Clin North Am 2019; 27 (02) 227-232
  • 17 Marks DH, Awosika O, Rengifo-Pardo M, Ehrlich A. Dermatologic surgical care for transgender individuals. Dermatol Surg 2019; 45 (03) 446-457
  • 18 Kailas M, Lu HMS, Rothman EF, Safer JD. Prevalence and types of gender-affirming surgery among a sample of transgender endocrinology patients prior to state expansion of insurance coverage. Endocr Pract 2017; 23 (07) 780-786