Gender-Affirming Care: A Primer

In this episode of BackTable Urology, Dr. Aditya Bagrodia and Dr. Jen Anger from UCSD Urology about care for transgender patients and gender-affirming surgery.

Firstly, Dr. Bagrodia and Dr. Anger discuss the importance of gender-affirming terminology and using the correct pronouns for transgender and gender-fluid patients. Dr. Anger encourages healthcare providers to always ask patients how they would like to be addressed before making assumptions based on anatomy and past history.

Next, Dr. Anger describes her workup for patients initially seeking gender-affirming pelvic reconstructive (“bottom”) surgery. Most patients seeking bottom surgery will have already started hormonal therapy and puberty blockade. In concordance with national regulations, Dr. Anger only performs gender-affirming pelvic reconstruction surgery if a patient has already lived as their preferred gender and undergone hormonal therapy for at least a year and has secured 2 letters from mental health providers stating support for their transition. For adolescents, there is an additional requirement involving the consent of two parents.

Dr. Anger emphasizes that transgender care is a multidisciplinary field. She works closely with many other physicians, such as the patient’s primary care provider, endocrinologists, mental health providers, other urologists, plastic surgeons, dermatologists, and fertility specialists. She notes that, although more attention, research, and resources have been directed towards transgender healthcare, it is still not widely available to the entire population. Thus, many patients are still seeking gender-affirming surgery in other countries, potentially exposing them to higher complication rates. Thus, she advocates for more research and advocacy in the United States for transgender patients and their medical/surgical needs.