The Use of Plastic Surgery in Treating Gender Dysphoria

Defining Gender Dysphoria

It is difficult to apply a precise Gender Dysphoria definition that satisfies both the transgender community and the medical and support professionals who care for them. For any discussion of gender confirming plastic surgery, it is advisable to first explore the often confusing terminology employed by both professionals and the general population to describe a condition that is now medically referred to as Gender Dysphoria, or the various more outdated terms like Gender Identity Disorder, Gender Distress, Gender Conflict, or Transsexualism.

Activists for reform in the standards of diagnosis and treatment of transgender and gender non-conforming people question the validity of categorizing transgender individuals as having a mental disorder  for the purpose of establishing insurance approval for hormone therapy or plastic surgery. Dr. Mosser chooses to frame the process of gender transition as gender confirmation.

A Gender Dysphoria diagnosis may be made according to various criteria, not always standard, although attempts have been made to standardize both diagnostic guidelines as well as treatment and care procedures. Gender Dysphoria as a medical condition is described by the World Professional Association for Transgender Health (WPATH) in their Standards of Care (SOC).

WPATH is an international organization which articulates a professional consensus regarding the psychiatric, psychological, medical, and surgical management of gender transition. WPATH published their 7th Version of Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC) in September 2011. (ref.1) The SOC is an important reference to assist both individuals experiencing Gender Dysphoria and those in medical and other support roles who seek to understand the many and varied aspects of gender transition in order to reach a Gender Dysphoria diagnosis.

Many reforms and positive changes have taken place over the years regarding social acceptance and access to treatment for individuals with Ggender Dysphoria as clinical research has brought increased understanding. One important change in the 7th Version of the SOC was redefining Gender Identity Disorder (GID) as Gender Dysphoria.

Current Medical Standards

When individuals dissatisfied with the sex and gender they were designated at birth exhibit behavior described in the criteria as laid out in one of two official nomenclatures–the ICD-10 (International Classification of Diseases-10, published by the WHO-World Health Organization) or the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association)–they may be formally diagnosed as having a Gender Dysphoria.

The DSM provides several separate diagnoses for gender identity conflicts in an effort to provide guidelines for research and treatment, but some combinations of symptoms in any one individual could defy categorization. Updates to the DSM are made regularly.

Gender Dysphoria instead of ‘GID’

It maybe misleading to term all gender conflicts as ‘disorders’ as some transgender issues may be resolved as the subject matures (in the case of childhood dysphoria) or the level of the individual’s personal distress does not persist or is alleviated by living comfortably as their self-perceived gender identity either with or without hormone therapy or plastic surgery. Gender non-conforming individuals may not see themselves as disordered but rather disagree with cultural beliefs about the binary nature of sex and gender, celebrating diversity in these arenas.

Awareness of the clinical uncertainties and limitations of knowledge in the area of setting standards for making a diagnosis of Gender Dysphoria should be recognized by both transgender and gender non-conforming individual and those offering treatment. The ultimate goal of setting standards of diagnosis and treatment should always be the comfort and well-being of the transgender individual.

A practical definition of “transsexualism” (a lay term and not a medical one) which could be applied to a majority of cases would be the presence in the individual of a persistent and lasting state of distress and discomfort over the disparity between the sex and gender they were designated at birth and their own sex and gender identification. When the level of distress prevents the individual from living with an expectation of personal fulfillment, the condition rises to the level of Gender Dysphoria.

Treating Gender Dysphoria

Since each patient has a unique anatomic, social, and psychological situation, such guidelines are naturally subject to modification and interpretation. Treatment or management of Gender Dysphoria generally falls into 3 phases, or categories: psychological or psychiatric counseling, medical treatment with hormone therapy and/or sexual reassignment surgery, and social adjustment–a period of social interaction to test the altered physical identity. Not all individuals diagnosed with Gender Dysphoria require or desire all 3 phases. Only some individuals diagnosed with Gender Dysphoria seek a surgical transformation of their bodies.

Plastic Surgery in Treating Gender Dysphoria

A patient seeking chest reconstruction or breast augmentation surgery has special needs and expectations that require not only specialized skills and experience on the part of the surgeon but an understanding of the patient’s emotional motivation and goals. Transgender patients often require a broad range of social support and a coordinated effort that may include a surgeon, a primary care physician, a psychologist and a social worker or support group, as well as the usual network of family and friends. The decision to undergo a FTM or MTF top surgery may be the first or the only step in medical transition to support a change in gender identification.

Whatever their reasons for seeking plastic surgery, patients will find an understanding, compassionate and non-judgmental physician in Dr. Mosser who, together with his welcoming staff of professionals, will work together to achieve their personal goals and explore gender confirmation surgery options at his San Francisco practice. Patient communication, comfort, and confidentiality are hallmarks of Dr. Mosser’s plastic surgery practice.