Plastic surgeons' group identifies top transition treatments
By Maureen Salamon
MONDAY, May 22, 2017 (HealthDay News) -- Until Gearah Goldstein fully transitioned her gender, being female housed in a male body felt like a hunger she couldn't satisfy.
A vital part of Goldstein's transition involved multiple gender confirmation surgeries several years ago that aligned her appearance with the person she's always felt like inside.
Goldstein's experience highlights a growing trend among transgender people in the United States, who increasingly opt for various surgeries not only to alter their genitalia, but other sex-specific features, such as chest and facial contours.
The American Society of Plastic Surgeons (ASPS) reports a nearly 20 percent jump in transgender-related surgeries in the first two years of collecting data on these procedures.
"The findings highlight how important this type of corrective surgery really is," said Goldstein, 49, who lives in Chicago and works as an advocate for transgender youth.
"For me, it was absolutely required to feel like I was living in a body that correctly matched the identity I live every day," she added. "It truly was lifesaving and I never approached it as cosmetic."
More than 3,200 gender confirmation surgeries of all types were performed in 2016, the plastic surgeons' group reports. That represents a rise of nearly 20 percent from 2015.
About 1.4 million adults in the United States, or about 0.6 percent of the adult population, identify as transgender, according to a 2016 analysis by the Williams Institute at University of California, Los Angeles School of Law.
Experts attribute the increase in gender confirmation surgeries to more widespread insurance coverage, as well as growing discussion and acceptance surrounding transgender people.
"With the ACA [Affordable Care Act] and some legislation that bars discrimination against transgender people, those patients are now having their surgeries covered by their insurance plans, resulting in quite an increase in numbers requesting surgery," said Dr. Debra Johnson, president of the plastic surgeons' society.
"So part of it was that [surgeries] are now covered, and there was a pent-up demand, if you will, of patients who once couldn't afford to have surgery who now can," she said.
Gender confirmation surgeries range from sex "reassignment" -- altering a patient's genitals -- to breast augmentation or reduction, facial and neck contouring, and even hair transplants.
Comprehensive care surrounding gender transition may also involve hormone therapy and psychological counseling.
"We felt we needed to have a handle on how many patients are having this surgery, so we could help educate [ASPS] members and patients," Johnson explained.
Dr. Loren Schechter is a plastic surgeon in Chicago whose practice specializes in gender reassignment. He said the 20 percent recorded rise in transgender-related surgeries nationally between 2015 and 2016 seems low, considering his practice has "seen an exponential growth" in these procedures.
Schechter's patients have ranged from teenagers to those in their 70s. High-profile transitions among public figures, such as Caitlyn Jenner (formerly Bruce Jenner), have helped fuel the upward swing in numbers.
"The Jenner story is important [as] she's been able, because of her notoriety, to raise awareness and bring it into mainstream discussion," Schechter said. "In spite of all the frenzy around it, I think she's done quite a bit to raise awareness. But these issues have been around for millennia -- the question is how society is now addressing them."
Regardless of which type of gender confirmation surgery is chosen, it's not cheap. Schechter and Johnson said costs can range from $6,000 to $10,000 for breast procedures; $20,000 to $30,000 for vaginoplasty to construct a vagina for a transgender woman; and $50,000 to $60,000 for phalloplasty to construct a penis for a transgender man.
Johnson noted that the majority of transgender patients are primarily interested in so-called "top surgery" -- either breast augmentation or mastectomy to achieve a more female- or male-appearing chest. Altering genitalia is next in popularity, followed by changing facial features -- such as the nose, chin or forehead -- to soften or strengthen their prominence.
"There's no one-size-fits-all -- there are many different procedures," Schechter said. "Surgery is not for everyone. It's one component, and often a very dramatic one, but it's also related to cultural norms, and some people are able to find relief from gender dysphoria without surgery."
The American Society of Plastic Surgeons' report was released May 22.
The World Professional Association for Transgender Health offers a list of transgender resources.
SOURCES: Debra Johnson, M.D., president, American Society of Plastic Surgeons; Loren Schechter, M.D., plastic surgeon, Chicago; Gearah Goldstein, Chicago; May 22, 2017, report, American Society of Plastic Surgeons
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