gender reassignment surgery cleveland clinic

More U.S. Hospitals Offering Gender-Affirming Surgeries

A boon is underway at medical institutions from coast to coast, aimed at helping transgender Americans who suffer gender dysphoria because of the mismatch between their bodies and their gender identity.

Gender-transition services and surgeries are becoming more widely available across the nation, and more insurance companies are adding coverage to help the more than one million Americans who identify as transgender.

“Access to these treatments is lifesaving for many transgender people,” said Kate Kendell, executive director at the National Center for Lesbian Rights, one of the nation’s strongest legal advocates for LGBTQ Americans. “The recent sea change among insurers and state Medicaid programs is long overdue, and we must be vigilant about protecting and expanding these protections.”

“Half of the respondents to the 2011 National Transgender Discrimination Survey said they had to educate their health care providers on how to treat them appropriately,” Mara Keisling, executive director of the National Center for Transgender Equality (NCTE), told NBC OUT. “Too few providers are sufficiently trained in how to treat transgender patients, and even fewer have the expertise to offer critical transition-related services. It is heartening that an increasing number of medical institutions and providers are learning about the importance of competency around transgender issues and transition-related procedures.”

The Cleveland Clinic, Boston Medical Center, Oregon Health and Science University in Portland and Mount Sinai Hospital in New York City are among the latest medical centers to provide gender-affirming procedures.

“At Mount Sinai, we are offering the full array of services for transgender people regardless of whether they have already accomplished their transition,” Zil Goldstein, a nurse practitioner and program director at Mount Sinai’s Center for Transgender Medicine and Surgery , told NBC OUT. “We want people to know that these treatments are available, and also that our staff are prepared to serve and care for the transgender community with sensitivity.”

This month an institution with a controversial history regarding transgender health care added its name to the list: Johns Hopkins Medicine. Johns Hopkins made history in 1965 as the first academic institution to offer gender-affirming surgeries, but it stopped in 1979 and never resumed. However, in a letter posted earlier this month , it reaffirmed its "commitment to the LGBT community” and announced it will resume gender-reassignment surgeries in 2017.

“We have committed to and will soon begin providing gender-affirming surgery as another important element of our overall care program, reflecting careful consideration over the past year of best practices and the appropriate provision of care for transgender individuals," the letter stated.

Even though not every transgender individual seeks or qualifies for surgery -- because of personal reasons, their health or insurance coverage -- demand is high. The increase in services has ramped-up since 2014, when the U.S. government’s Centers for Medicare and Medicaid Services started covering transgender-related procedures, which have been indelicately called “sex change operations.” A more common name is sex reassignment surgery, or SRS, and a more popular name within the trans community is gender confirmation surgery, or GCS.

"Despite the recent improvements in institutions offering these lifesaving transgender health services, there is still an unmet need for compassionate and comprehensive care,” Goldstein told NBC News.

“This is life-affirming and, in many cases, lifesaving treatment that is recognized as medically necessary by the medical profession,” Jillian Weiss, executive director of the Transgender Legal Defense and Education Fund , said. “It is crucial that we have a cadre of medical professionals across the county and around the world who have the training and experience to provide health care to the millions of transgender people who require it."

Right now, 12 states and the District of Columbia offer Medicaid programs covering transition-related care, according to the NCTE. But that leaves 38 states with none.

“No one should be denied medically necessary care because of who they are, and yet, that has been the reality for most transgender people for decades,” Kendell of NCLR told NBC OUT. “These positive changes are long overdue, and they are already under attack by anti-LGBT groups. We must be vigilant about defending and protecting them.”

Dawn Ennis is an award-winning journalist who was the first to transition in a network TV newsroom. She is now a freelance writer, producer and editor, as well as a widow, a single parent of three children, and the subject of an award-winning documentary, Before Dawn/After Don . Ennis is also on YouTube , on Twitter and blogging at lifeafterdawn.com

Follow NBC OUT on Twitter , Facebook and Instagram .

Daniel A. Medalie, M.D.

Board certified plastic and cosmetic surgeon.

Transgender

Welcome! You have made the right choice in choosing Dr. Medalie for your Gender Confirming Surgery. If you would like to schedule an evaluation of your chest to determine what type of operation may be necessary, please e-mail front and side photos to Valerie at [email protected] . Before you contact her please download the history form , and send it along with the photos. She can also answer most of your logistical questions. Typical fees for “top surgery” are $7500-8500 (this includes anesthesia and facility fees and all post operative care).

All correspondence, forms and pictures should be scanned and e-mailed to Valerie at

[email protected]

Assessing Gender-Affirming Chest Surgery Outcomes: Does Gender Identity Alter Gaze?

Affiliations.

• 1 Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.
• 2 Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
• 3 Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA. [email protected].
• 4 Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA. [email protected].
• 5 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Hospital and Clinics, Palo Alto, CA, USA.
• 6 Align Surgical Associates, San Francisco, CA, USA.
• PMID: 34114074
• DOI: 10.1007/s00266-021-02378-1

Background: Outcomes of gender-affirming chest surgery can be variable. Placement of nipple-areolar complexes and orientation of scars can drastically affect the aesthetic outcomes of these procedures, as may observer gender identity. Here, we compared attention and perception of outcomes following gender-affirming chest surgery between laypersons, based on gender identity.

Methods: Transgender and cisgender participants were enrolled and shown images of surgery naïve chests and postoperative masculinized and feminized chests, blinded to the gender identity of the photographed subject. Gaze data were captured using the Tobii X2 60 eye-tracking device. Participants scored the perceived gender and aesthetic appearance of each image.

Results: Eighteen cisgender and 14 transgender participants were enrolled. When viewing male chests, transgender participants spent significantly longer fixated on the nipples (naïve: 802 vs. 395 ms; p = 0.02, masculinized: 940 vs. 692 ms, p = 0.002). For masculinized chests, cisgender participants spent significantly longer fixated on the inframammary scar (483 vs. 391 ms; p = 0.04). On images of feminized chests, transgender participants spent longer viewing the nipples when compared to cisgender participants (1017 vs. 847 ms; p = 0.04). Cisgender viewers spent longer fixating on the postoperative scar on feminized chests (113 vs. 59 ms; p = 0.02) and also viewed feminized chests as significantly more masculine and masculinized chests as more feminine, when compared to transgender participants (p < 0.05).

Conclusions: This is the first study to use eye-tracking to assess how laypersons assess chests for gender determination. The findings suggest that observer gender identity has an effect on areas of focus and gender perception of chests that underwent gender-affirmation surgery.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Keywords: Chest surgery; Eye-tracking; Gender-affirming; Top-surgery; Transgender.

© 2021. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.

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Gender Affirmation Surgery and Compassionate Care for Individuals with Gender Dysphoria

Gender dysphoria is a medical term used to describe a condition in which a person’s gender identity – an internal and innate sense of oneself as being male or female – is incompatible with the external sexual characteristics present at birth. For example, a person born with female genitals who feels essentially male in every other way and identifies with that gender; or a person born with male genitals, yet feels essentially female in every other way and identifies with that gender. Both may be said to have gender dysphoria – a state of mind that can lead to depression, social anxiety, social isolation and a general state of emotional distress.

In recent years, recognition and acceptance of gender dysphoria as a legitimate diagnosis has spurred efforts in the medical community to offer compassionate support along with medical and surgical options to help people reconcile their outward appearance and sexual functioning with their internal self-perceptions.

A diagnosis of gender dysphoria is made by a healthcare provider after a thorough and careful evaluation has been done by a team of medical and psychological professionals. The next steps will depend on the individual’s goals and expectations.

What Is Gender Affirmation Surgery?

Any surgical procedure designed to align a person’s internal sense of self with their external physical and sexual characteristics is known as gender affirmation surgery. This is sometimes called gender confirmation surgery as well. Older terms such as gender reassignment or sex reassignment surgery have fallen out of favor.

While some may opt for hormone therapy only, for some transgender, transsexual or gender non-conforming patients it is medically and psychologically necessary to change their physical body to reduce gender dysphoria and improve their quality of life.

Some individuals may choose to undergo “top surgery” to alter their anatomy to be more in-line with their gender identity – male to female  transgender individuals (transfemales or transwomen) may take female hormones to promote breast development with or without breast implants. Furthermore, some transwomen undergo facial feminization, Adam’s Apple reduction, or vocal cord surgery as well. Female to male  transgender individuals (transmen or transmales) may have their breasts surgically removed (bilateral mastectomy) in addition to taking male hormones to increase muscle mass, lower their tone of voice and promote the growth of body and facial hair.

Genital Gender Affirmation Surgeries

Some people will choose to complete their transition with genital gender affirmation surgery or “bottom surgery” – a surgical procedure (or procedures) by which the genital organs are altered to physically resemble and function like those that are associated with their identified gender. Prior to genital gender affirmation surgery, patients must have been on hormones for at least a year while living consistently as the gender to which they are transitioning.

UH reconstructive urologist, Shubham Gupta, MD, FACS offers male to female and female to male genital reconstruction surgeries, including:

• Vaginoplasty (male to female)
• Phalloplasty and metoidioplasty (female to male)

Eligibility Requirements for Gender Affirmation Surgery

All gender transition surgeries result in permanent, physical transformation so patients must meet certain eligibility requirements before proceeding. To be eligible, patients must:

• Be of legal age (age 18 in the United States)
• Complete 12 months of continuous hormone therapy (HT)
• Successfully complete 12 months of living full-time as the gender with which they identify
• Undergo a mental health assessment and participate in psychotherapy
• Demonstrate knowledge and understanding of the surgeries (including cost), potential complications, recovery and rehabilitation.

The Region’s Only Comprehensive Program

Gender transition surgeries require the expertise of multiple specialists, including reconstructive urologists, plastic surgeons and otolaryngologists (ENT) to achieve optimal cosmetic and functional outcomes. The surgeons at University Hospitals work as a team to offer patients a wide variety of procedures to help them complete their gender transition journey.

University Hospitals is the only health system in the region to offer these complex and highly specialized gender affirmation surgeries that are not widely available in the United States. As a result, thousands of individuals now have access to these life-changing services that have the potential to improve their quality of life and decrease depression and social anxiety.

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Transgender Surgery

Stanford Medicine is proud to be a leader in providing gender-affirming surgery, including vaginoplasty and orchiectomy. Our team is specially trained to offer surgical and post-operative care for penile-inversion vaginoplasty and postoperative conditions including vaginal stenosis, pelvic floor disorders, and vaginal dilation issues.

Click here to learn more about vaginoplasty →

Click here to learn more about orchiectomy →

We work hand-in-hand with healthcare providers at the Stanford LGBTQ+ Health Program as well as a team of experts in pelvic floor physical therapy. We are committed to providing specialized and personalized care, and to research in these important areas.

We routinely collaborate with other specialists including coordination of other surgeries.

For a new appointment, please contact the LGBTQ+ Health Program to see Dr. Kavita Mishra at (650) 724-8844.

Our surgical and postoperative care team includes Dr. Kavita Mishra , a nurse practitioner, a registered nurse, 3 pelvic floor physical therapists, and a surgical coordinator. We work closely with your primary care and mental health providers before, during, and after surgery. We believe in multidisciplinary and supportive care to provide you with the best postoperative outcome.

Dr. Kavita Mishra is a female pelvic medicine and reconstructive surgeon who was the first graduate of Cleveland Clinic’s Transgender Surgery & Medicine fellowship program, training with Dr. Cecile Ferrando. Dr. Mishra attended Brown University for her undergraduate studies and the University of California, San Francisco, for medical school. She completed a four-year residency in obstetrics and gynecology at Brown University/Women & Infants Hospital. She then completed a three-year fellowship in Urogynecology (Female Pelvic Medicine & Reconstructive Surgery) at Brown University, specializing in minimally invasive surgery and pelvic floor disorders. She practiced at the University of California, San Francisco, before joining the department at Stanford. Dr. Mishra is enthusiastic about connecting with her patients, supporting them in their journey, and educating the next generation of physician leaders.

Why Choose Stanford for Gender Affirming Surgery?

Our team believes that you and only you get to decide how your identity is expressed. We are experts in helping people meet their goals and specialize in care ranging from routine medical visits to the physical transition process. We have spent the last few years actively expanding surgical services at Stanford.

World Professional Association for Transgender Health (WPATH) Guidelines

Our team follows the World Professional Association for Transgender Health (WPATH) guidelines to ensure patients are appropriate surgical candidates. We require patients live full time as their self-affirmed gender for more than one year, that they have undergone cross-sex hormone therapy for at least one year (if appropriate), that they have letters of support for surgical transition from two mental health professionals who are well-versed in transgender patient care. Patients who have met these criteria are deemed appropriate surgical candidates. They cannot be smokers or be excessively overweight, and they must be medically optimized for surgery if they have medical comorbidities.

Click here to read additional information about WPATH guidelines.

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Ohio judge blocks ban on gender-affirming care for transgender minors—for now

A n Ohio judge on Tuesday temporarily blocked an impending law that would restrict medical care for transgender minors in the Buckeye State.

The decision came weeks after the American Civil Liberties Union filed a lawsuit challenging the state on behalf of two transgender girls and their families. The measure prevents doctors from prescribing hormones, puberty blockers, or gender reassignment surgery before patients turn 18.

Attorneys contend the law violates the state Constitution , which gives Ohioans the right to choose their health care.

“Today’s ruling is a victory for transgender Ohioans and their families,” said Harper Seldin, staff attorney for the ACLU. “Ohio’s ban is an openly discriminatory breach of the rights of transgender youth and their parents alike and presents a real danger to the same young people it claims to protect.”

The legislation was set to take effect on April 24 after House and Senate Republicans  voted to override  Gov. Mike DeWine’s veto. Proponents of the bill contend it will protect children, but critics say decisions about transition care should be left to families and their medical providers.

The suit in Ohio mirrors efforts in other states to challenge laws that restrict gender-affirming care for minors. A federal judge struck down a  similar policy in Arkansas , arguing it violates the constitutional rights of transgender youth and their families. The state is appealing that decision.

“We protect children with various restrictions that do not apply to adults − from signing legal contracts to buying alcohol and tobacco and more,” Attorney General Dave Yost posted on X , formerly known as Twitter, after the lawsuit was filed. “As I promised during the veto override, my office will defend this constitutional statute.”

What does the Ohio bill do?

The bill allows Ohioans younger than 18 who are already receiving hormones or puberty blockers to continue as long as doctors determine stopping the prescription would cause harm. Critics say that’s not enough to protect current patients because health care providers could be wary of legal consequences.

The legislation does not ban talk therapy, but it requires mental health providers to get permission from at least one parent or guardian to diagnose and treat gender dysphoria.

More: 6 jurors selected to serve in Donald Trump's hush money trial: Latest Trump trial news

The bill also bans transgender girls and women from playing on female sports teams in high school and college. It doesn’t specify how schools would verify an athlete’s gender if it’s called into question. Players and their families can sue if they believe they lost an opportunity because of a transgender athlete.

The lawsuit doesn’t specifically challenge the athlete ban. But it argues the legislation flouts the constitution’s single-subject rule, which requires legislation to address only one topic. House Republicans introduced separate bills on gender-affirming care and transgender athletes before  combining them into one .

In Tuesday’s decision, Franklin County Judge Michael Holbrook indicated that the law could be tossed out because of a single-subject violation.

“It is not lost upon this Court that the General Assembly was unable to pass the (Saving Ohio Adolescents from Experimentation) portion of the Act separately, and it was only upon logrolling in the Saving Women’s Sports provisions that it was able to pass,” Holbrook wrote.

Panel clears ban on gender reassignment surgery for minors

Tuesday’s decision came one day after a legislative panel cleared the way for an administrative rule that will ban gender reassignment surgery for minors. Ohio health care providers say they do not perform that procedure on patients under 18.

The rule will take effect May 3.

More: Supreme Court, in an emergency order, lets Idaho enforce ban on transgender care

The measure was among several that DeWine proposed to regulate gender-affirming care after he vetoed the legislation. In testimony for Monday’s meeting, opponents argued that the rules overstep the administration’s authority and conflict with federal law.

“The proposed administrative rule changes are based on biased definitions, ignore well-established best practices, and restrict countless patients’ access to gender-affirming care,” said Mallory Golski, civic engagement and advocacy manager for Kaleidoscope Youth Center.

DeWine’s other proposals are still working their way through the rulemaking process. That includes a requirement for transgender minors to undergo at least six months of counseling before further treatment occurs. Another rule would require providers to report non-identifying data on gender dysphoria diagnoses and treatment.

Haley BeMiller is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

This article originally appeared on The Columbus Dispatch: Ohio judge blocks ban on gender-affirming care for transgender minors—for now

Gender Reassignments

Gender reassignment surgery.

Please note that Dr. Bram Kaufman does not currently provide genital reassignment surgery. Bodily surgeries, including facial feminization surgery, are available. Please see our surgical gender reassignment surgeries below.

Gender reassignment procedure aims to alter the physiological appearance of the patient in accordance with the gender they identify with. This procedure may be performed on individuals who are either male, but have been identified as female, or female, who have been identified as male.

Gender reassignment surgery can help patients who may have less developed or fully developed breasts. It allows for a change of breasts from one gender to another, depending on the patient’s actual sexual orientation. Following a diagnosis, the patient will have to undergo a three stage treatment program, involving hormone therapy, real life test, and sex reassignment surgery.

Hormone Therapy

Hormone therapy will involve androgen hormone delivery for biological females changing to male, and delivery of estrogen, progesterone, and testosterone blocking hormones for biological males changing to female. The therapy may continue for about 12 months, and is usually accompanied by a Real Life Test.

Patients may choose to receive cosmetic surgeries such as buttock and thigh lift, liposuction, and abdominoplasty.

Our practice is currently in the process of the developing a team to perform the “bottom” surgeries which will require collaboration between multiple departments such as gynecology, urology, plastic surgery and others. Cosmetic procedures we currently perform include  breast augmentatio n,  liposuction , rhinoplasty , facial bone construction, cheek implants, brow lift , lip augmentation , chin recontouring, jaw recontouring, and eyelid surgery .

Vocal cord surgery or voice training may also be a part of the elective procedures to accomplish an adequate gender transformation.

Impact of Hormone Therapy

With gender reassignment hormone therapy, biological males can expect breast growth, reduction of body hair and fat redistribution in certain areas. Biological females can expect an increase in body and facial hair, weight gain, heightened sexual appetite, and a heavier voice.

To learn more about  cosmetic treatment  and  procedures  or to schedule a consultation by Cleveland Ohio area plastic surgeon,  Dr. Bram Kaufman , please contact us at  1-216-778-2245 or  click here .