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Gender Reassignment Surgery: A Review of the Clinical Evidence and Guidelines

Last updated: July 23, 2014
Project Number: RC0568-000
Product Line: Rapid Response
Research Type: Other Diagnostics
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
Gender Identity Disorder (GID), also known as gender dysphoria, is a condition in which a male or female feels a strong identification with the opposite sex. A person with GID often experiences great distress about his or her actual anatomic gender and gender role. GID, a rare disorder affecting children and adults, is more common in males, although the overall prevalence is uncertain. Management of GID may include hormone therapy, gender reassignment surgery, and psychotherapy and mental health support.

Technology
Gender reassignment surgery alters the physical appearance and function of the penis or vagina to resemble that of the opposite sex. It is usually the last step in the treatment process for GID in transsexuals who wish to live fully in the desired sex. Adult male-to-female (MtF) individuals may receive vaginoplasty, labiaplasty, orchiectomy, breast augmentation and breast implants, while phalloplasty, urethral extension, scrotoplasty, metaiodoplasty and mastectomy are treatment options for female-to-male (FtM) transexuals.

Issue
A review of the clinical evidence on long-term patient outcomes as well as a review of the evidence-based guidelines on the physical and mental health care needs of patients who have undergone the procedures will help guide decisions about gender reassignment surgery.

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 525 citations, 29 of which were deemed potentially relevant. An additional 2 articles were identified from other sources. Of these 31 reports, 4 met the criteria for inclusion in this review: 1 systematic review, 1 population-based cohort study, 1 case control study, and 1 clinical practice guideline.

Key Messages
Following gender reassignment surgery for GID or Gender Dysphoria:

  • FtM and MtF patients appear to be satisfied with surgical outcomes and functioning.
  • Long-term quality of life is uncertain.
  • A clinical practice guideline suggests cardiovascular risks and bone mineral density be evaluated regularly.
  • Screening for breast and prostate cancer is also recommended.
  • High-quality evidence is limited.

Question

  1. What is the clinical evidence regarding the long-term patient outcomes following gender reassignment surgery?
  2. What are the evidence-based guidelines regarding the physical and mental health care of individuals who have undergone gender reassignment surgery?

Key Message

The evidence from a systematic review comprised mostly of case series and case reports suggested that, following gender reassignment surgery, both female-to-male and male-to-female GRS patients were satisfied with surgical outcomes and functioning. In one non-RCT, treatment with GRS was associated with a higher risk of death and psychiatric hospitalizations compared to the general population. These findings must be interpreted with caution given the lower level of evidence. One clinical practice guideline suggested that cardiovascular risks and bone mineral density be evaluated regularly. Cancer screening for prostate and breast cancer were recommended.