Philadelphia, Pa.
From the Division of Plastic Surgery, University of Pennsylvania; Drexel University College of Medicine; and the College of Public Health, Temple University.
Plast Reconstr Surg. 2018 Mar;141(3):388e-396e. doi: 10.1097/PRS.0000000000004123.
The landscape of gender dysphoria has changed dramatically in recent years secondary to increased societal acceptance, legislative changes, and medical providers' increased awareness of the associated psychosocial burden associated with the diagnosis. National and global advocacy efforts, in conjunction with expanded third-party insurance coverage, have resulted in new health care opportunities for patients suffering from gender dysphoria. Delivering quality, streamlined health care to these patients requires a complex multidisciplinary approach, involving multiple medical and mental health disciplines, including plastic surgeons. To accommodate the expanding demand for gender-affirmation surgery, academic medical centers specializing in these procedures are gradually emerging. Advancing surgical techniques in the setting of rising patient demand encourage plastic surgeons to increasingly provide high-quality health care to this diverse patient population in an effort to optimize psychosocial functioning and minimize the burden of gender dysphoria. Although the current literature is replete with the evolving surgical and technical approaches to gender-affirming surgery, there remain critical gaps in the plastic surgery literature describing the delivery of comprehensive care to these patients. To address these gaps, the authors establish a framework that plastic surgeons can use to guide their management of patients with gender dysphoria to optimize surgical and psychosocial outcomes. First, the authors describe a timeline of events that have shaped present-day transgender medicine and characterize the current role of the plastic surgeon in the management of gender dysphoria. Subsequently, the authors discuss psychosocial and ethical considerations surrounding gender dysphoria. Finally, the authors discuss the future scope of transgender medicine.
近年来，由于社会接受度的提高、立法的改变以及医疗服务提供者对与诊断相关的社会心理负担的认识的提高，性别焦虑的景观发生了巨大变化。国家和全球的宣传努力，再加上第三方保险覆盖范围的扩大，为患有性别焦虑症的患者带来了新的医疗保健机会。为这些患者提供高质量、简化的医疗保健需要一个复杂的多学科方法，涉及多个医疗和心理健康学科，包括整形外科医生。为了满足对性别肯定手术的不断增长的需求，专门从事这些手术的学术医疗中心逐渐出现。在患者需求不断增加的情况下，推进手术技术鼓励整形外科医生为这一多样化的患者群体提供高质量的医疗保健，以优化社会心理功能并最大限度地减少性别焦虑症的负担。尽管目前的文献中充斥着不断发展的性别肯定手术的手术和技术方法，但在描述为这些患者提供全面护理的整形外科文献中仍存在关键空白。为了解决这些空白，作者建立了一个框架，整形外科医生可以使用该框架来指导他们管理患有性别焦虑症的患者，以优化手术和社会心理结果。首先，作者描述了塑造当今跨性别医学的一系列事件，并描述了整形外科医生在管理性别焦虑症中的当前角色。随后，作者讨论了性别焦虑症周围的社会心理和伦理问题。最后，作者讨论了跨性别医学的未来范围。
