Plastic Surgery's Obligation to the Transgender Community

Nicholas R. Jarvis, BS; Sumanas W. Jordan, MD, PhD; Michael A. Howard, MD; Chad M. Teven, MD


Plast Reconstr Surg Glob Open. 2022;10(9):e4502 

Debate regarding care for transgender individuals has recently intensified in the community, media, and government. Already in 2022, more than 150 bills increasing restrictions on transgender/nonbinary individuals have been proposed in state legislatures across the US.[1] These bills limit access to gender-affirming healthcare, remove discriminatory protection, and even prevent transgender youth from participating in gender-congruent sports. Conversely, only 40 bills protecting against these restrictions have been proposed in 2022.[1]

Although significant work has been done to destigmatize gender nonconformity, the transgender community continues to face frequent discrimination that negatively impacts physical and psychological well-being.[2] External pressures to conform to traditional gender norms are costly, with transgender individuals demonstrating higher rates of psychological distress, delay in seeking medical treatment, and suicidality.[2] These trends call for a paradigm shift on the individual, institutional, and national levels. Accomplishing this is challenging; however, plastic surgeons are uniquely positioned to support the transgender community.

As understanding of gender expression has expanded, so has gender-affirming healthcare, including surgical intervention. Gender-affirming surgery has evolved from a need to serve transgender patients. Given the myriad benefits of gender-affirming surgery, the number of operations will likely rise.[3,4] Average wait time to consult with plastic surgeons offering this care is similarly increasing. Thus, more plastic surgeons are likely to evaluate and potentially treat a rising number of transgender patients. As such, the plastic surgery community must advocate for trans-affirming practices across healthcare settings. Additionally, increased research and empiric data analysis would improve our understanding of the importance of trans-affirming interventions and their impact on care quality.

At a time when transgender individuals are targeted by society and its political leaders, the clinical domain must remain safe, comfortable, and apolitical. The recent increase in anti-transgender legislation risks restricting patients' access to comprehensive gender-affirming care as well as clinicians' ability to perform medically necessary interventions. Given the unique relationship between plastic surgeons and patients seeking gender-affirming surgery, it is crucial that the plastic surgery community continues to provide empathetic, equitable, and nonjudgmental care for this vulnerable population.[5] From initial evaluation to postoperative follow-up, plastic surgeons should provide care in a manner that is cognizant of the challenges that transgender individuals face. By and large, plastic surgeons are already doing so. However, shifting public sentiment and legislative restrictions jeopardize advancements in gender-affirming healthcare. Indeed, we believe such care is medically necessary, and decisions regarding its implementation are best made between patients and their providers and must not be politicized.

Given the many challenges that transgender individuals experience in daily life, plastic surgeons should continue to leverage our expertise to promote protection of gender-affirming care. Increased advocacy, research, and education in academic centers, community hospitals, and by professional societies would emphasize the necessity of such care and signal support for the transgender community. Finally, concrete steps to further benefit the transgender community include medical society statements highlighting the importance of access to appropriate medical care, required training in medical school and residency programs, and increased plastic surgery research funding targeting care of the transgender community.