The Northeastern Society of Plastic Surgeons

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Effects of Hormone Therapy in Patients who Underwent Male-To-Female Gender Confirmation Surgery
Trishul Kapoor, M.D., Joseph Banuelos, M.D., Todd B. Nippoldt, M.D., Pedro Ciudad, M.D., Oscar J. Manrique, M.D..
Mayo Clinic, Rochester, MN, USA.

BACKGROUND: An estimated 1.4 million transgender individuals currently reside in the United States and this patient population is increasing on an annual basis. Along with this census increase, there has also been an increasing number of gender confirmation surgeries being performed in the United States. Our primary objective was to study the effects of hormonal therapy on testicular volumetrics on transgender patients who underwent male-to-female (MtF) bottom gender confirmation surgery.
METHODS: Retrospective review of patients who underwent MtF bottom gender confirmation surgery. Based on World Professional Association for Transgender Health (WPATH) guidelines a minimum of one year of hormonal therapy was required in order to be included. Two groups were analyzed based on their hormone therapy regimen (estrogen and estrogen/progesterone). Demographics, comorbidities, Body Mass Index (BMI), medications (and length of use), testicular volumetrics (weight, length of spermatic cord, volume), and post-operative complications (dehiscence, seroma, hematoma, infection, return to the OR) were analyzed.
RESULTS: From 2017 to 2018, a total of 27 patients were analyzed. The mean age of the sample population was 35.4 years old. The mean difference in BMI before and after hormonal treatment was -0.19 (1.1) in the estrogen only group and +0.95 ( 1.2) in the estrogen/progesterone (combined) group (p= 0.060). The mean weight of surgical specimens in the estrogen only and in the combined group was 31.2 g ( 14.8) and 24 g (7.4), respectively (p= 0.001). Of all the patients, 11 presented with minor wound dehiscence of labia majora. Analysis of complications regarding to the type of hormonal therapy they received showed no difference among patients in the estrogen only and the combined group (p=0.451).
CONCLUSIONS: Hormone therapy is an integral aspect of a multidisciplinary approach to transgender medicine and surgery. Further studies are required to elucidate systemic effects in detail and evaluate outcomes in a postoperative setting.


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