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Gender Dysphoria & Its Association With Chronic Illness

Written by Leo Gorgatti, Edited by Olivia McCollum, Edited by Courtney Coleman


Gender dysphoria is defined as a form of psychological distress that may come with feelings of gender incongruence, often heightened during puberty as secondary sex characteristics begin to develop.₁ Gender incongruence is a marked and persistent conflict between an individual’s gender identity and assigned sex. It often produces a desire to transition (socially and/or medically) and be accepted as one’s experienced gender. Gender dysphoria most prominently affects transgender individuals, or people whose gender identity (an individual’s innate sense of their gender) differs from the one they were assigned at birth.₂ ₃ Based on data extracted from the Behavioral Risk Factor Surveillance Study (BRFSS), 0.5% of adults in the US identify as transgender.₄ In the past decade (2013-2023), reported gender dysphoria among young people has increased exponentially worldwide due to increased social acceptance and visibility of transgender individuals. This increase is a result of more widespread disclosure of gender dysphoria symptoms from transgender individuals to their healthcare providers and communities.₅ ₆ ₇ The 2017 Youth Risk Behavior Survey (YRBS) found that 1.8% of US high school students— across 10 states and 9 large urban areas— identified as transgender, while another 1.6% were unsure of their gender identity.₈

Gender dysphoria often highly impacts an individual’s mental health. It is also important to note that gender dysphoria— a psycho-emotional response to gender incongruence (a mismatch between one’s gender identity and assigned sex)— is exacerbated by discrimination, stigma, violence, and other adverse experiences.₉ Common mental health impacts of gender dysphoria include depression, suicidal ideation, anxiety, and overall low mood. Numerous studies show that gender-diverse individuals with high levels of gender incongruence are more likely to meet the diagnostic criteria for major depressive disorder.₁₀ Comorbidity studies in young people have shown that having gender dysphoria is associated with a higher likelihood of having a mental health disorder.₇ ₁₁ Another study analyzed medical data collected from the entire Swedish population over 10 years (2005-2015)— 2,679 of them having received a gender incongruence diagnosis. The analysis found that gender incongruence diagnosis was associated with a six times higher likelihood of having a mood/anxiety disorder, a three times higher likelihood of being prescribed antidepressants and antianxiety medications, and a six times higher likelihood of attempting suicide resulting in hospitalization (compared to the general population).₁₂

Some common physiological health impacts of gender dysphoria are activation of the hypothalamic-pituitary-adrenal axis, activation of the autonomic nervous system, and various pro-inflammatory responses.₁₃ ₁₄ Gender dysphoria may also increase stress, activating the central and peripheral nervous systems.₁₃ During chronic stress, the central nervous system is decoupled from the feedback loop that normally controls its activity, leading to chronic cortisol elevation.₁₂ ₁₅ Chronic cortisol elevation is additionally associated with abnormal development during childhood/adolescence, anxiety, anorexia, and sleep disturbances.₁₅ Chronic stress can cause the immune system to become dysregulated. Immune system dysregulation is attributed to the activation of cytokines and C-reactive proteins (CRP), working in combination to promote cardiovascular disease, growth suppression, hypogonadism, hypertension, and visceral fat accumulation.₁₆ ₁₇ ₁₈ Long-term, chronic stress may lead to osteoporosis, cardiovascular disease, obesity, and metabolic syndrome.₁₇ 

The standard treatment for gender dysphoria is gender-affirming care. The World Professional Association for Transgender Health (WPATH) Standards of Care Version 8 (2022) provides guidance on assessing gender dysphoria and determining eligibility for gender-affirming treatment. The guidance emphasizes that the assessor’s (psychologist, therapist, endocrinologist, surgeon, etc.) role in treating a patient presenting with gender dysphoria is not to determine their gender identity. The assessor is meant to identify the presence of gender dysphoria, assess any co-existing mental health concerns, offer information about gender-affirming treatments, support the patient in considering the risks/effects of the treatment/procedure, determine if the patient would likely benefit from the treatment/procedure, and verify if the patient is able to understand the treatment/procedure being offered.₁₉

The main forms of gender-affirming care include mental health care, hormone and surgical treatments, feminizing/masculinizing voice therapy, hair removal/transplant, and reproductive/sexual health care. Patients who would benefit from physically transitioning are linked to endocrinologists and mental health specialists to proceed with coordinated care. This ensures proper support of the patient’s psychosocial well-being and allows for individualized treatment that aligns with their corresponding gender identity.₁₉ 

Common medical interventions include puberty suppression, gender-affirming hormone therapy (GAHT), and gender-affirming surgeries. Puberty suppression is accomplished by gonadotropin-releasing hormone (GnRH) analogues. Adolescents experiencing gender dysphoria, but not yet undergoing GAHT, are recommended GnRH analogues to prevent/stall the development of secondary sex characteristics. Various circumstances may lead to the use of puberty suppression to treat gender dysphoria in place of or before GAHT. These include parental preferences, legislation/policies that restrict GAHT for adolescents, or the patient needing or wanting to further explore their gender identity with a mental health professional before deciding. For transfeminine people— those assigned male at birth who experience a feminine gender identity — estrogens, and sometimes progestins, are prescribed in feminizing hormone therapy. For transmasculine people — those assigned female at birth who experience a masculine gender identity — testosterone is prescribed as a masculinizing hormone therapy. Throughout these treatments, preliminary and ongoing monitoring are required to keep hormones at safe levels and ensure the patient is content with the physical and emotional developments induced by treatment.₁₉ Gender-affirming hormone therapy has been shown to reduce sexual distress, lower dysregulated cortisol levels to a normal range, alleviate distress/depression/anxiety, and improve quality of life.₂₀ ₂₁ ₂₂ ₂₃

There is a wide range of gender-affirming surgeries. Examples include genital reconstruction surgeries like vaginoplasty or phalloplasty and procedures such as voice feminization/masculinization surgeries. Again, each treatment is specific to the patient, and specific surgeries are recommended if they may alleviate a patient’s gender dysphoria. Multiple studies regarding gender-affirming mastectomy or breast reduction in transmasculine individuals have shown a consistent and direct increase in health-related quality of life, a significant decrease in gender dysphoria, and a consistent increase in satisfaction with body and appearance.₂₄₋₄₀ Studies regarding gender-affirming breast surgery in transfeminine individuals have shown consistent and direct improvement in patient satisfaction with body image.₃₉ ₄₁₋₄₄ Gender-affirming vaginoplasty, the construction of a vagina in transfeminine people, reported high levels of patient satisfaction and satisfaction with sexual function. It was also associated with a low incidence of patient regret.₃₈ ₃₉ ₄₂ ₄₅₋₆₇ In studies reporting post-gender-affirming facial surgeries, it was found that patients were very satisfied with their surgical results. Patients also reported being significantly more satisfied with the appearance of their faces than individuals who had not had gender-affirming facial surgery.₃₉ ₆₈₋₇₄

One of the main challenges in gender-affirming care today is inaccessibility/non-utilization of treatment. This is often caused by scarcity of trans-knowledgeable providers, untimely access, cost barriers, and previous stigmatizing experiences in healthcare. One of the main consequences of this challenge is the use of non-prescribed hormone therapy. Unregulated use of unprescribed hormone replacement can be dangerous because it can result in supratherapeutic doses and possibly unsafe injection practices; the latter holds a severe risk for exposure to blood-borne illness. Still, it is important to understand that the use of non-prescribed hormones is oftentimes a way to mitigate the burden of unmet gender-affirming medical needs. A harm-reduction lens may be required in addressing this medical challenge: people should not be expected to stop taking non-prescribed hormones if prescribed treatment isn’t made accessible to them. Two methods that have been used to improve accessibility to hormone therapy are decentralization of gender-affirming care in primary care settings and the establishment of telehealth services.₁₉

Gender dysphoria is a unique topic due to the hyper-politicization of transgender healthcare and the complicated history of classification and diagnosis. Though gender dysphoria is not a chronic illness itself, it can produce chronic illness, especially when left untreated. In the past decade, population trends have shown that reported gender dysphoria has increased substantially thanks to increased acceptance and visibility of transgender identities.₅₋₇ With more gender-diverse individuals seeking treatment for gender dysphoria, the need for advancement and expansion in gender-affirming care becomes all the more evident. With interdisciplinary gender-affirming interventions— mental health services, endocrinology, plastic surgery, fertility services, otolaryngology, etc.— the lives of individuals affected by gender dysphoria can be greatly improved. Still, to fully reinforce the health and well-being of gender dysphoric patients, policy, medicine, and society at large must continue progressing towards support for transgender individuals.₁₉


Works Cited

  1. American Psychiatric Association. Gender Dysphoria Diagnosis. Available at:,%2C%20medical%2C%20and%20surgical%20treatments. Accessed December 4, 2023.

  2. Li Y,  Zheng L. Validation of Two Measures of Gender Dysphoria/Incongruence in Transgender and Cisgender Populations in China. Archives of Sexual Behavior. 2023;52:1019–1030.

  3. World Health Organization. Gender Incongruence and Transgender Health in the ICD. Available at: Accessed December 4, 2023.

  4. Crissman HP, Berger MB, Graham LF, Dalton VK. Transgender Demographics: A Household Probability Sample of US Adults, 2014. American journal of public health. 2017;52:213-215. doi:10.2105/AJPH.2016.303571

  5. Aitken M, et al. Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. The journal of sexual medicine. 2015;12:756-63. doi:10.1111/jsm.12817

  6. Arnoldussen M, et al. Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals?. European child & adolescent psychiatry. 2020;29:803-811. doi:10.1007/s00787-019-01394-6

  7. McCallion S, et al. An appraisal of current service delivery and future models of care for young people with gender dysphoria. Eur J Pediatr. 2021;180:2969–2976. doi:10.1007/s00431-021-04075-2

  8. Johns MM, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students — 19 states and large urban school districts, 2017. Morbidity and Mortality Weekly Report. 2019;68:67–71. doi:10.15585/mmwr.mm6803a3

  9. Bränström R, Pachankis JE. Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. The American journal of psychiatry. 2020;177:727-734. doi:10.1176/appi.ajp.2019.19010080

  10. Chodzen G, Hidalgo MA, Chen D, Garofalo R. Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. J Adolesc Health. 2019;64:467–71. doi:10.1016/j.jadohealth.2018.07.006

  11. Connolly MD, et al. The Mental Health of Transgender Youth: Advances in Understanding. J Adolesc Health. 2016;59:489-495. doi:10.1016/j.jadohealth.2016.06.012

  12. Mason A, et al. Gender Dysphoria in Young People: A Model of Chronic Stress. Hormone research in paediatrics. 2023;96:54-56. doi:10.1159/000520361

  13. Chrousos G. Video Q & A: The impact of stress. An interview with George Chrousos. BMC medicine. 2014;12. doi:10.1186/1741-7015-12-102

  14. Glaser R, Kiecolt-Glaser JK. Stress-induced immune dysfunction: implications for health. Nature reviews. Immunology. 2015;5:243-251. doi:10.1038/nri1571

  15. Chrousos GP, Gold PW. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA. 1992;267:1244-52

  16. Kyrou I, et al. Stress, visceral obesity, and metabolic complications. Annals of the New York Academy of Sciences. 2006;1083:77-110. doi:10.1196/annals.1367.008

  17. Charmandari E, et al. Endocrinology of the Stress Response. Annual Review of Physiology. 2005;67:259-284. doi:10.1146/annurev.physiol.67.040403.120816

  18. Chrousos, GP. The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes. Int J Obes Relat Metab Disord. 2000;24:S50-S55. doi:10.1038/sj.ijo.0801278

  19. Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022;23(Suppl 1):S1-S259. Published 2022 Sep 6. doi:10.1080/26895269.2022.2100644

  20. Ristori J, Cocchetti C, Castellini G, et al. Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data. J Sex Med. 2020;17(1):142-151. doi:10.1016/j.jsxm.2019.10.008

  21. Allen LR, Watson LB, Egan AM, Moser CN. Well-being and suicidality among transgender youth after gender-affirming hormones. Clini Pract Pediatr Psychol. 2019;7(3):302–11.

  22. López de Lara D, Pérez Rodríguez O, Cuellar Flores I, Pedreira Masa JL, Campos-Muñoz L, Cuesta Hernández M, Ramos Amador JT. [Psychosocial assessment in transgender adolescents]. An Pediatr. 2020;93:41–8. Spanish. doi:10.1016/j.anpedi.2020.01.019

  23. Kuper LE, Stewart S, Preston S, Lau M, Lopez X. Body Dissatisfaction and Mental Health Outcomes of Youth on Gender-Affirming Hormone Therapy. Pediatrics. 2020;145. doi:10.1542/peds.2019-3006

  24. Agarwal CA, Scheefer MF, Wright LN, Walzer NK, Rivera A. Quality of life improvement after chest wall masculinization in female-to-male transgender patients: A prospective study using the BREAST-Q and Body Uneasiness Test. J Plast Reconstr Aesthet Surg. 2018;71(5):651-657. doi:10.1016/j.bjps.2018.01.003

  25. Frederick MJ, Berhanu AE, Bartlett R. Chest Surgery in Female to Male Transgender Individuals. Ann Plast Surg. 2017;78(3):249-253. doi:10.1097/SAP.0000000000000882

  26. Top H, Balta S. Transsexual Mastectomy: Selection of Appropriate Technique According to Breast Characteristics. Balkan Med J. 2017;34(2):147-155. doi:10.4274/balkanmedj.2016.0093

  27. van de Grift TC, Elaut E, Cerwenka SC, et al. Effects of Medical Interventions on Gender Dysphoria and Body Image: A Follow-Up Study. Psychosom Med. 2017;79(7):815-823. doi:10.1097/PSY.0000000000000465

  28. van de Grift TC, Kreukels BP, Elfering L, et al. Body Image in Transmen: Multidimensional Measurement and the Effects of Mastectomy. J Sex Med. 2016;13(11):1778-1786. doi:10.1016/j.jsxm.2016.09.003

  29. Bertrand B, Perchenet AS, Colson TR, Drai D, Casanova D. Chirurgie mammaire de réassignation vers le sexe masculin : étude rétrospective de la satisfaction des patients transsexuels après mastectomie [Female-to-male transgender chest reconstruction: A retrospective study of patient satisfaction]. Ann Chir Plast Esthet. 2017;62(4):303-307. doi:10.1016/j.anplas.2017.05.005

  30. Claes KEY, D'Arpa S, Monstrey SJ. Chest Surgery for Transgender and Gender Nonconforming Individuals. Clin Plast Surg. 2018;45(3):369-380. doi:10.1016/j.cps.2018.03.010

  31. Esmonde N, Heston A, Jedrzejewski B, et al. What is "Nonbinary" and What Do I Need to Know? A Primer for Surgeons Providing Chest Surgery for Transgender Patients. Aesthet Surg J. 2019;39(5):NP106-NP112. doi:10.1093/asj/sjy166

  32. Lo Russo G, Tanini S, Innocenti M. Masculine Chest-Wall Contouring in FtM Transgender: a Personal Approach. Aesthetic Plast Surg. 2017;41(2):369-374. doi:10.1007/s00266-017-0796-0

  33. Marinkovic M, Newfield RS. Chest reconstructive surgeries in transmasculine youth: Experience from one pediatric center. International Journal of Transgenderism. 2017;18(4):376-381. doi:10.1080/15532739.2017.1349706

  34. Poudrier G, Nolan IT, Cook TE, et al. Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study. Plast Reconstr Surg. 2019;143(1):272-279. doi:10.1097/PRS.0000000000005113

  35. Wolter A, Diedrichson J, Scholz T, Arens-Landwehr A, Liebau J. Sexual reassignment surgery in female-to-male transsexuals: an algorithm for subcutaneous mastectomy. J Plast Reconstr Aesthet Surg. 2015;68(2):184-191. doi:10.1016/j.bjps.2014.10.016

  36. Wolter A, Scholz T, Pluto N, Diedrichson J, Arens-Landwehr A, Liebau J. Subcutaneous mastectomy in female-to-male transsexuals: Optimizing perioperative and operative management in 8 years clinical experience. J Plast Reconstr Aesthet Surg. 2018;71(3):344-352. doi:10.1016/j.bjps.2017.09.003

  37. Olson-Kennedy J, Warus J, Okonta V, Belzer M, Clark LF. Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults: Comparisons of Nonsurgical and Postsurgical Cohorts. JAMA Pediatr. 2018;172(5):431-436. doi:10.1001/jamapediatrics.2017.5440

  38. Owen-Smith AA, Gerth J, Sineath RC, et al. Association Between Gender Confirmation Treatments and Perceived Gender Congruence, Body Image Satisfaction, and Mental Health in a Cohort of Transgender Individuals. J Sex Med. 2018;15(4):591-600. doi:10.1016/j.jsxm.2018.01.017

  39. van de Grift TC, Elaut E, Cerwenka SC, Cohen-Kettenis PT, Kreukels BPC. Surgical Satisfaction, Quality of Life, and Their Association After Gender-Affirming Surgery: A Follow-up Study. J Sex Marital Ther. 2018;44(2):138-148. doi:10.1080/0092623X.2017.1326190

  40. van de Grift TC, Elfering L, Greijdanus M, et al. Subcutaneous Mastectomy Improves Satisfaction with Body and Psychosocial Function in Trans Men: Findings of a Cross-Sectional Study Using the BODY-Q Chest Module. Plast Reconstr Surg. 2018;142(5):1125-1132. doi:10.1097/PRS.0000000000004827

  41. Weigert R, Frison E, Sessiecq Q, Al Mutairi K, Casoli V. Patient satisfaction with breasts and psychosocial, sexual, and physical well-being after breast augmentation in male-to-female transsexuals. Plast Reconstr Surg. 2013;132(6):1421-1429. doi:10.1097/01.prs.0000434415.70711.49

  42. Zavlin D, Schaff J, Lellé JD, et al. Male-to-Female Sex Reassignment Surgery using the Combined Vaginoplasty Technique: Satisfaction of Transgender Patients with Aesthetic, Functional, and Sexual Outcomes. Aesthetic Plast Surg. 2018;42(1):178-187. doi:10.1007/s00266-017-1003-z

  43. Fakin RM, Zimmermann S, Kaye K, Lunger L, Weinforth G, Giovanoli P. Long-Term Outcomes in Breast Augmentation in Trans-Women: A 20-Year Experience. Aesthet Surg J. 2019;39(4):381-390. doi:10.1093/asj/sjy143

  44. Kanhai RC, Hage JJ, Mulder JW. Long-term outcome of augmentation mammaplasty in male-to-female transsexuals: a questionnaire survey of 107 patients. Br J Plast Surg. 2000;53(3):209-211. doi:10.1054/bjps.1999.3298

  45. Buncamper ME, van der Sluis WB, de Vries M, Witte BI, Bouman MB, Mullender MG. Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft: To Graft or Not to Graft?. Plast Reconstr Surg. 2017;139(3):649e-656e. doi:10.1097/PRS.0000000000003108

  46. Cardoso da Silva D, Schwarz K, Fontanari AM, et al. WHOQOL-100 Before and After Sex Reassignment Surgery in Brazilian Male-to-Female Transsexual Individuals. J Sex Med. 2016;13(6):988-993. doi:10.1016/j.jsxm.2016.03.370

  47. Kanhai RC. Sensate Vagina Pedicled-Spot for Male-to-Female Transsexuals: The Experience in the First 50 Patients. Aesthetic Plast Surg. 2016;40(2):284-287. doi:10.1007/s00266-016-0620-2

  48. Mañero Vazquez I, García-Senosiain O, Labanca T, Gómez Gil E. Aesthetic Refinement in the Creation of the Clitoris, Its Preputial Hood, and Labia Minora in Male-to-Female Transsexual Patients. Ann Plast Surg. 2018;81(4):393-397. doi:10.1097/SAP.0000000000001532

  49. Papadopulos NA, Zavlin D, Lellé JD, et al. Male-to-Female Sex Reassignment Surgery Using the Combined Technique Leads to Increased Quality of Life in a Prospective Study. Plast Reconstr Surg. 2017;140(2):286-294. doi:10.1097/PRS.0000000000003529

  50. Tavakkoli Tabassi K, et al. Fold-back perineoscrotal flap plus penile inversion vaginoplasty for male-to-female gender reassignment surgery in circumcised subjects. Eur J Plast Surg. 2015;38:43-48. doi:10.1007/s00238-014-1038-1

  51. Wei SY, Li FY, Li Q, et al. Autologous Buccal Micro-Mucosa Free Graft combined with Posterior Scrotal Flap Transfer for Vaginoplasty in Male-To-Female Transsexuals: A Pilot Study. Aesthetic Plast Surg. 2018;42(1):188-196. doi:10.1007/s00266-017-0977-x

  52. Bouman MB, van der Sluis WB, van Woudenberg Hamstra LE, et al. Patient-Reported Esthetic and Functional Outcomes of Primary Total Laparoscopic Intestinal Vaginoplasty in Transgender Women With Penoscrotal Hypoplasia. J Sex Med. 2016;13(9):1438-1444. doi:10.1016/j.jsxm.2016.06.009

  53. Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BP, Mullender MG. Aesthetic and Functional Outcomes of Neovaginoplasty Using Penile Skin in Male-to-Female Transsexuals. J Sex Med. 2015;12(7):1626-1634. doi:10.1111/jsm.12914

  54. Hess J, Hess-Busch Y, Kronier J, Rübben H, Rossi Neto R. Modified Preparation of the Neurovascular Bundle in Male to Female Transgender Patients. Urol Int. 2016;96(3):354-359. doi:10.1159/000443281

  55. Jiang D, Witten J, Berli J, Dugi D 3rd. Does Depth Matter? Factors Affecting Choice of Vulvoplasty Over Vaginoplasty as Gender-Affirming Genital Surgery for Transgender Women. J Sex Med. 2018;15(6):902-906. doi:10.1016/j.jsxm.2018.03.085

  56. LeBreton M, Courtois F, Journel NM, et al. Genital Sensory Detection Thresholds and Patient Satisfaction With Vaginoplasty in Male-to-Female Transgender Women. J Sex Med. 2017;14(2):274-281. doi:10.1016/j.jsxm.2016.12.005

  57. Manrique OJ, Sabbagh MD, Ciudad P, et al. Gender-Confirmation Surgery Using the Pedicle Transverse Colon Flap for Vaginal Reconstruction: A Clinical Outcome and Sexual Function Evaluation Study. Plast Reconstr Surg. 2018;141(3):767-771. doi:10.1097/PRS.0000000000004122

  58. Massie JP, Morrison SD, Van Maasdam J, Satterwhite T. Predictors of Patient Satisfaction and Postoperative Complications in Penile Inversion Vaginoplasty. Plast Reconstr Surg. 2018;141(6):911e-921e. doi:10.1097/PRS.0000000000004427

  59. Morrison SD, Satterwhite T, Grant DW, Kirby J, Laub DR Sr, VanMaasdam J. Long-Term Outcomes of Rectosigmoid Neocolporrhaphy in Male-to-Female Gender Reassignment Surgery. Plast Reconstr Surg. 2015;136(2):386-394. doi:10.1097/PRS.0000000000001459

  60. Papadopulos NA, Lellé JD, Zavlin D, et al. Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery. J Sex Med. 2017;14(5):721-730. doi:10.1016/j.jsxm.2017.01.022

  61. Raigosa M, Avvedimento S, Yoon TS, Cruz-Gimeno J, Rodriguez G, Fontdevila J. Male-to-Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients. J Sex Med. 2015;12(8):1837-1845. doi:10.1111/jsm.12936

  62. Salgado CJ, Nugent A, Kuhn J, Janette M, Bahna H. Primary Sigmoid Vaginoplasty in Transwomen: Technique and Outcomes. Biomed Res Int. 2018. doi:10.1155/2018/4907208

  63. Seyed-Forootan K, Karimi H, Seyed-Forootan NS. Autologous Fibroblast-Seeded Amnion for Reconstruction of Neo-vagina in Male-to-Female Reassignment Surgery. Aesthetic Plast Surg. 2018;42(2):491-497. doi:10.1007/s00266-018-1088-z

  64. Sigurjónsson H, Möllermark C, Rinder J, Farnebo F, Lundgren TK. Long-Term Sensitivity and Patient-Reported Functionality of the Neoclitoris After Gender Reassignment Surgery. J Sex Med. 2017;14(2):269-273. doi:10.1016/j.jsxm.2016.12.003

  65. Simonsen RK, Giraldi A, Kristensen E, Hald GM. Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality. Nord J Psychiatry. 2016;70(4):241-247. doi:10.3109/08039488.2015.1081405

  66. Thalaivirithan BM, Sethu M, Ramachandran DK, Kandasamy M, Janardhanam J. Application of embryonic equivalents in male-to-female sex reassignment surgery. Indian J Plast Surg. 2018;51(2):155-166. doi:10.4103/ijps.IJPS_62_18

  67. Castellano E, Crespi C, Dell'Aquila C, et al. Quality of life and hormones after sex reassignment surgery. J Endocrinol Invest. 2015;38(12):1373-1381. doi:10.1007/s40618-015-0398-0

  68. Morrison SD, Capitán-Cañadas F, Sánchez-García A, et al. Prospective Quality-of-Life Outcomes after Facial Feminization Surgery: An International Multicenter Study. Plast Reconstr Surg. 2020;145(6):1499-1509. doi:10.1097/PRS.0000000000006837

  69. Bellinga RJ, Capitán L, Simon D, Tenório T. Technical and Clinical Considerations for Facial Feminization Surgery With Rhinoplasty and Related Procedures. JAMA Facial Plast Surg. 2017;19(3):175-181. doi:10.1001/jamafacial.2016.1572

  70. Capitán L, Simon D, Kaye K, Tenorio T. Facial feminization surgery: the forehead. Surgical techniques and analysis of results. Plast Reconstr Surg. 2014;134(4):609-619. doi:10.1097/PRS.0000000000000545

  71. Noureai SA, Randhawa P, Andrews PJ, Saleh HA. The role of nasal feminization rhinoplasty in male-to-female gender reassignment. Arch Facial Plast Surg. 2007;9(5):318-320. doi:10.1001/archfaci.9.5.318

  72. Raffaini M, Magri AS, Agostini T. Full Facial Feminization Surgery: Patient Satisfaction Assessment Based on 180 Procedures Involving 33 Consecutive Patients. Plast Reconstr Surg. 2016;137(2):438-448. doi:10.1097/01.prs.0000475754.71333.f6

  73. Simon D, Capitán L, Bailón C, et al. Facial Gender Confirmation Surgery: The Lower Jaw. Description of Surgical Techniques and Presentation of Results. Plast Reconstr Surg. 2022;149(4):755e-766e. doi:10.1097/PRS.0000000000008969

  74. Ainsworth TA, Spiegel JH. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Qual Life Res. 2010;19(7):1019-1024. doi:10.1007/s11136-010-9668-7


This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research is constantly evolving. This post contains information that was last updated on March 14, 2024.


Leo Gorgatti is a fourth year majoring in molecular cell biology with an emphasis in biochemistry at UC Berkeley.

Olivia McCollum is a second-year MPH student at the University of Washington (UW) in the Department of Epidemiology and a student in the UW’s Department of Environmental and Occupational Health Graduate Certificate Program.

Courtney Coleman is a master's degree candidate in biology at Harvard and Co-President of Students vs Pandemics.

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