Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience

Allison C Hu; Mengyuan T Liu; Candace H Chan; Saloni Gupta; Brian N Dang; Gladys Y Ng; Mark S Litwin; George H Rudkin; Amy K Weimer; Justine C Lee

doi:10.1055/s-0042-1758383

Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience

Arch Plast Surg. 2023 Feb 6;50(1):63-69. doi: 10.1055/s-0042-1758383. eCollection 2023 Jan.

Authors

Allison C Hu¹, Mengyuan T Liu¹, Candace H Chan¹, Saloni Gupta¹, Brian N Dang¹, Gladys Y Ng^{2

3}, Mark S Litwin^{2

3}, George H Rudkin^{1

3}, Amy K Weimer^{3

4}, Justine C Lee^{1

3}

Affiliations

¹ Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
² Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
³ UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
⁴ Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.

Abstract

Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth ( n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs ( n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5 ± 3.6 years, primarily estrogen ( n = 39). Most patients ( n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy ( n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery ( n = 15, 22%), vaginoplasty ( n = 15, 22%), mastectomy ( n = 11, 16%), and orchiectomy ( n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB were more likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021). Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy.

Keywords: facial feminization surgery; gender dysphoria; gender-affirming surgery; nonbinary; reconstructive craniofacial surgery.

The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

Grants and funding

Funding This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (J.C.L.) and the Jean Perkins Foundation (J.C.L.). J.C.L. is additionally supported by the National Institutes of Health/NIDCR R01 DE028098.