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.
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.
‘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.
