Barriers To Finding A Gender Affirming Surgeon

Abstract

Background: Gender affirmation surgery is increasingly prevalent; however, finding a surgeon continues to be difficult. Additionally, the majority of transgender patients utilize the internet for information before elective surgery. Therefore, it is imperative to explore potential online barriers in finding a gender affirming surgeon.

Aims: The authors sought to use the Internet to search for gender affirming surgeons practicing in the USA, and therefore, reflect the process that patients potentially undergo. We highlight the barriers to information and care that we encountered.

Methods: We conducted a comprehensive review of public online transgender surgery directories for currently practicing surgeons that provide facial feminization, facial masculinization, breast augmentation, chest masculinization, vaginoplasty, metoidioplasty, and/or phalloplasty in the USA. Each surgeon's name, surgical specialty, the current practice's name, state, and zip code, and procedures provided were recorded. Chi-square analysis was used for comparisons of categorical variables.

Results: There are currently 660 gender affirmation surgeons in the USA, with most specializing in plastic surgery, followed by otolaryngology and urology. In total, 30.5% of surgeons practice in the West, 25.6% in the Northeast, 25.3% in the South, and 18.6% in the Midwest. The most common surgery provided was chest masculinization (70.2%), followed by facial feminization (42.7%) and chest feminization (42.6%).

Conclusion: Plastic surgeons are most likely to perform gender affirmation surgery compared to other specialties. Geographic distribution of surgeons, does not, however, match the distribution of patients. Additionally, we encountered significant hardship in confirming that a surgeon performs the procedure listed in their profile on popular online gender affirmation surgeon directories.

Level of evidence: V.

Keywords: Access to care; Gender affirmation surgery; Gender confirmation surgery; Plastic surgery; Transgender; Transgender surgery.