Masculinizing and defeminizing gender-affirming surgery

• Published in: Best practice & research. Clinical obstetrics & gynaecology 2023-06, Vol.88, p.102323-102323, Article 102323
• Main Author: van de Grift, Tim C.
• Format: Article
• Language: English
• Subjects: Female; Humans; Hysterectomy; Male; Quality of healthcare; Sex reassignment surgery; Sex Reassignment Surgery - methods; Shared decision-making; Subcutaneous mastectomy; Surgical Flaps - surgery; Transgender Persons; Transsexualism - surgery
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2023.102323

Transmasculine transgender and gender-diverse individuals may request gender-affirming surgery, standalone or in addition to other interventions. The choices and preferred outcomes of surgery can be highly individual. Besides surgeons’ technical skills and patient physique, professionals in this field should be able to cooperate with other disciplines and with patients. The most requested surgery is masculinizing chest surgery, aiming to create a masculine chest with minimal scarring. For genital surgery, metoidioplasty refers to the procedure where the hypertrophic clitoris is released and possibly a scrotum is created from local labia flaps, whereas phalloplasty refers to a procedure in which a neophallus is created from a flap. Possible other surgeries include hysterectomy/oophorectomy, colpectomy, and the implants of scrotal or erection prostheses. In order to guide patients and clinicians, standardized outcome measures as well as evidence-based decision aids have been developed. Such aids, in combination with collaborative medical and psychosocial care, may further leverage the long-term outcomes of these surgeries. •A significant increase in the diversity of masculinizing/defeminizing gender-affirming surgical approaches is observed.•Chest masculinization surgery aims to masculinize the chest wall while minimizing scarring.•To adequately counsel prior to genital gender-affirming surgery, multidisciplinary teams with significant experience in this care are recommended.•The heterogeneity of studies makes aggregated outcome analyses and direct comparisons of studies impossible.•Clinicians should support patients in their decision-making by providing necessary information and assist in weighing different options.