gender reassignment surgery psychological evaluation

Type 2 Diabetes
Heart Disease
Digestive Health
Multiple Sclerosis
Diet & Nutrition
Supplements
Health Insurance
Public Health
Patient Rights
Caregivers & Loved Ones
End of Life Concerns
Health News
Thyroid Test Analyzer
Doctor Discussion Guides
Hemoglobin A1c Test Analyzer
Lipid Test Analyzer
Complete Blood Count (CBC) Analyzer
What to Buy
Editorial Process
Meet Our Medical Expert Board

Preparation and Procedures Involved in Gender Affirmation Surgeries

If you or a loved one are considering gender affirmation surgery , you are probably wondering what steps you must go through before the surgery can be done. Let's look at what is required to be a candidate for these surgeries, the potential positive effects and side effects of hormonal therapy, and the types of surgeries that are available.

Gender affirmation surgery, also known as gender confirmation surgery, is performed to align or transition individuals with gender dysphoria to their true gender.

A transgender woman, man, or non-binary person may choose to undergo gender affirmation surgery.

The term "transexual" was previously used by the medical community to describe people who undergo gender affirmation surgery. The term is no longer accepted by many members of the trans community as it is often weaponized as a slur. While some trans people do identify as "transexual", it is best to use the term "transgender" to describe members of this community.

Transitioning

Transitioning may involve:

Social transitioning : going by different pronouns, changing one’s style, adopting a new name, etc., to affirm one’s gender
Medical transitioning : taking hormones and/or surgically removing or modifying genitals and reproductive organs

Transgender individuals do not need to undergo medical intervention to have valid identities.

Reasons for Undergoing Surgery

Many transgender people experience a marked incongruence between their gender and their assigned sex at birth. The American Psychiatric Association (APA) has identified this as gender dysphoria.

Gender dysphoria is the distress some trans people feel when their appearance does not reflect their gender. Dysphoria can be the cause of poor mental health or trigger mental illness in transgender people.

For these individuals, social transitioning, hormone therapy, and gender confirmation surgery permit their outside appearance to match their true gender.

Steps Required Before Surgery

In addition to a comprehensive understanding of the procedures, hormones, and other risks involved in gender-affirming surgery, there are other steps that must be accomplished before surgery is performed. These steps are one way the medical community and insurance companies limit access to gender affirmative procedures.

Steps may include:

Mental health evaluation : A mental health evaluation is required to look for any mental health concerns that could influence an individual’s mental state, and to assess a person’s readiness to undergo the physical and emotional stresses of the transition.
Clear and consistent documentation of gender dysphoria
A "real life" test : The individual must take on the role of their gender in everyday activities, both socially and professionally (known as “real-life experience” or “real-life test”).

Firstly, not all transgender experience physical body dysphoria. The “real life” test is also very dangerous to execute, as trans people have to make themselves vulnerable in public to be considered for affirmative procedures. When a trans person does not pass (easily identified as their gender), they can be clocked (found out to be transgender), putting them at risk for violence and discrimination.

Requiring trans people to conduct a “real-life” test despite the ongoing violence out transgender people face is extremely dangerous, especially because some transgender people only want surgery to lower their risk of experiencing transphobic violence.

Hormone Therapy & Transitioning

Hormone therapy involves taking progesterone, estrogen, or testosterone. An individual has to have undergone hormone therapy for a year before having gender affirmation surgery.

The purpose of hormone therapy is to change the physical appearance to reflect gender identity.

Effects of Testosterone

When a trans person begins taking testosterone , changes include both a reduction in assigned female sexual characteristics and an increase in assigned male sexual characteristics.

Bodily changes can include:

Beard and mustache growth
Deepening of the voice
Enlargement of the clitoris
Increased growth of body hair
Increased muscle mass and strength
Increase in the number of red blood cells
Redistribution of fat from the breasts, hips, and thighs to the abdominal area
Development of acne, similar to male puberty
Baldness or localized hair loss, especially at the temples and crown of the head
Atrophy of the uterus and ovaries, resulting in an inability to have children

Behavioral changes include:

Aggression
Increased sex drive

Effects of Estrogen

When a trans person begins taking estrogen , changes include both a reduction in assigned male sexual characteristics and an increase in assigned female characteristics.

Changes to the body can include:

Breast development
Loss of erection
Shrinkage of testicles
Decreased acne
Decreased facial and body hair
Decreased muscle mass and strength
Softer and smoother skin
Slowing of balding
Redistribution of fat from abdomen to the hips, thighs, and buttocks
Decreased sex drive
Mood swings

When Are the Hormonal Therapy Effects Noticed?

The feminizing effects of estrogen and the masculinizing effects of testosterone may appear after the first couple of doses, although it may be several years before a person is satisfied with their transition. This is especially true for breast development.

Timeline of Surgical Process

Surgery is delayed until at least one year after the start of hormone therapy and at least two years after a mental health evaluation. Once the surgical procedures begin, the amount of time until completion is variable depending on the number of procedures desired, recovery time, and more.

Transfeminine Surgeries

Transfeminine is an umbrella term inclusive of trans women and non-binary trans people who were assigned male at birth.

Most often, surgeries involved in gender affirmation surgery are broken down into those that occur above the belt (top surgery) and those below the belt (bottom surgery). Not everyone undergoes all of these surgeries, but procedures that may be considered for transfeminine individuals are listed below.

Top surgery includes:

Breast augmentation
Facial feminization
Nose surgery: Rhinoplasty may be done to narrow the nose and refine the tip.
Eyebrows: A brow lift may be done to feminize the curvature and position of the eyebrows.
Jaw surgery: The jaw bone may be shaved down.
Chin reduction: Chin reduction may be performed to soften the chin's angles.
Cheekbones: Cheekbones may be enhanced, often via collagen injections as well as other plastic surgery techniques.
Lips: A lip lift may be done.
Alteration to hairline
Male pattern hair removal
Reduction of Adam’s apple
Voice change surgery

Bottom surgery includes:

Removal of the penis (penectomy) and scrotum (orchiectomy)
Creation of a vagina and labia

Transmasculine Surgeries

Transmasculine is an umbrella term inclusive of trans men and non-binary trans people who were assigned female at birth.

Surgery for this group involves top surgery and bottom surgery as well.

Top surgery includes :

Subcutaneous mastectomy/breast reduction surgery.
Removal of the uterus and ovaries
Creation of a penis and scrotum either through metoidioplasty and/or phalloplasty

Complications and Side Effects

Surgery is not without potential risks and complications. Estrogen therapy has been associated with an elevated risk of blood clots ( deep vein thrombosis and pulmonary emboli ) for transfeminine people. There is also the potential of increased risk of breast cancer (even without hormones, breast cancer may develop).

Testosterone use in transmasculine people has been associated with an increase in blood pressure, insulin resistance, and lipid abnormalities, though it's not certain exactly what role these changes play in the development of heart disease.

With surgery, there are surgical risks such as bleeding and infection, as well as side effects of anesthesia . Those who are considering these treatments should have a careful discussion with their doctor about potential risks related to hormone therapy as well as the surgeries.

Cost of Gender Confirmation Surgery

Surgery can be prohibitively expensive for many transgender individuals. Costs including counseling, hormones, electrolysis, and operations can amount to well over $100,000. Transfeminine procedures tend to be more expensive than transmasculine ones. Health insurance sometimes covers a portion of the expenses.

Quality of Life After Surgery

Quality of life appears to improve after gender-affirming surgery for all trans people who medically transition. One 2017 study found that surgical satisfaction ranged from 94% to 100%.

Since there are many steps and sometimes uncomfortable surgeries involved, this number supports the benefits of surgery for those who feel it is their best choice.

A Word From Verywell

Gender affirmation surgery is a lengthy process that begins with counseling and a mental health evaluation to determine if a person can be diagnosed with gender dysphoria.

After this is complete, hormonal treatment is begun with testosterone for transmasculine individuals and estrogen for transfeminine people. Some of the physical and behavioral changes associated with hormonal treatment are listed above.

After hormone therapy has been continued for at least one year, a number of surgical procedures may be considered. These are broken down into "top" procedures and "bottom" procedures.

Surgery is costly, but precise estimates are difficult due to many variables. Finding a surgeon who focuses solely on gender confirmation surgery and has performed many of these procedures is a plus. Speaking to a surgeon's past patients can be a helpful way to gain insight on the physician's practices as well.

For those who follow through with these preparation steps, hormone treatment, and surgeries, studies show quality of life appears to improve. Many people who undergo these procedures express satisfaction with their results.

Bizic MR, Jeftovic M, Pusica S, et al. Gender dysphoria: Bioethical aspects of medical treatment . Biomed Res Int . 2018;2018:9652305. doi:10.1155/2018/9652305

American Psychiatric Association. What is gender dysphoria? . 2016.

The World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender, and gender-nonconforming people . 2012.

Tomlins L. Prescribing for transgender patients . Aust Prescr . 2019;42(1): 10–13. doi:10.18773/austprescr.2019.003

T'sjoen G, Arcelus J, Gooren L, Klink DT, Tangpricha V. Endocrinology of transgender medicine . Endocr Rev . 2019;40(1):97-117. doi:10.1210/er.2018-00011

Unger CA. Hormone therapy for transgender patients . Transl Androl Urol . 2016;5(6):877-884. doi:10.21037/tau.2016.09.04

Seal LJ. A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria . Ann Clin Biochem . 2016;53(Pt 1):10-20. doi:10.1177/0004563215587763

Schechter LS. Gender confirmation surgery: An update for the primary care provider . Transgend Health . 2016;1(1):32-40. doi:10.1089/trgh.2015.0006

Altman K. Facial feminization surgery: current state of the art . Int J Oral Maxillofac Surg . 2012;41(8):885-94. doi:10.1016/j.ijom.2012.04.024

Therattil PJ, Hazim NY, Cohen WA, Keith JD. Esthetic reduction of the thyroid cartilage: A systematic review of chondrolaryngoplasty . JPRAS Open. 2019;22:27-32. doi:10.1016/j.jpra.2019.07.002

Top H, Balta S. Transsexual mastectomy: Selection of appropriate technique according to breast characteristics . Balkan Med J . 2017;34(2):147-155. doi:10.4274/balkanmedj.2016.0093

Chan W, Drummond A, Kelly M. Deep vein thrombosis in a transgender woman . CMAJ . 2017;189(13):E502-E504. doi:10.1503/cmaj.160408

Streed CG, Harfouch O, Marvel F, Blumenthal RS, Martin SS, Mukherjee M. Cardiovascular disease among transgender adults receiving hormone therapy: A narrative review . Ann Intern Med . 2017;167(4):256-267. doi:10.7326/M17-0577

Hashemi L, Weinreb J, Weimer AK, Weiss RL. Transgender care in the primary care setting: A review of guidelines and literature . Fed Pract . 2018;35(7):30-37.

Van de grift TC, Elaut E, Cerwenka SC, Cohen-kettenis PT, Kreukels BPC. Surgical satisfaction, quality of life, and their association after gender-affirming aurgery: A follow-up atudy . J Sex Marital Ther . 2018;44(2):138-148. doi:10.1080/0092623X.2017.1326190

American Society of Plastic Surgeons. Gender confirmation surgeries .

American Psychological Association. Transgender people, gender identity, and gender expression .

Colebunders B, Brondeel S, D'Arpa S, Hoebeke P, Monstrey S. An update on the surgical treatment for transgender patients . Sex Med Rev . 2017 Jan;5(1):103-109. doi:10.1016/j.sxmr.2016.08.001

Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .

Vaccines
Masking Guidelines
Visitor Guidelines

Preparing for Gender Affirmation Surgery: Ask the Experts

Preparing for your gender affirmation surgery can be daunting. To help provide some guidance for those considering gender affirmation procedures, our team from the  Johns Hopkins Center for Transgender and Gender Expansive Health (JHCTGEH) answered some questions about what to expect before and after your surgery.

What kind of care should I expect as a transgender individual?

What kind of care should I expect as a transgender individual? Before beginning the process, we recommend reading the World Professional Association for Transgender Health Standards Of Care (SOC). The standards were created by international agreement among health care clinicians and in collaboration with the transgender community. These SOC integrate the latest scientific research on transgender health, as well as the lived experience of the transgender community members. This collaboration is crucial so that doctors can best meet the unique health care needs of transgender and gender-diverse people. It is usually a favorable sign if the hospital you choose for your gender affirmation surgery follows or references these standards in their transgender care practices.

Can I still have children after gender affirmation surgery?

Many transgender individuals choose to undergo fertility preservation before their gender affirmation surgery if having biological children is part of their long-term goals. Discuss all your options, such as sperm banking and egg freezing, with your doctor so that you can create the best plan for future family building. JHCTGEH has fertility specialists on staff to meet with you and develop a plan that meets your goals.

Are there other ways I need to prepare?

It is very important to prepare mentally for your surgery. If you haven’t already done so, talk to people who have undergone gender affirmation surgeries or read first-hand accounts. These conversations and articles may be helpful; however, keep in mind that not everything you read will apply to your situation. If you have questions about whether something applies to your individual care, it is always best to talk to your doctor.

You will also want to think about your recovery plan post-surgery. Do you have friends or family who can help care for you in the days after your surgery? Having a support system is vital to your continued health both right after surgery and long term. Most centers have specific discharge instructions that you will receive after surgery. Ask if you can receive a copy of these instructions in advance so you can familiarize yourself with the information.

An initial intake interview via phone with a clinical specialist.

This is your first point of contact with the clinical team, where you will review your medical history, discuss which procedures you’d like to learn more about, clarify what is required by your insurance company for surgery, and develop a plan for next steps. It will make your phone call more productive if you have these documents ready to discuss with the clinician:

Medications. Information about which prescriptions and over-the-counter medications you are currently taking.
Insurance. Call your insurance company and find out if your surgery is a “covered benefit" and what their requirements are for you to have surgery.
Medical Documents. Have at hand the name, address, and contact information for any clinician you see on a regular basis. This includes your primary care clinician, therapists or psychiatrists, and other health specialist you interact with such as a cardiologist or neurologist.

After the intake interview you will need to submit the following documents:

Pharmacy records and medical records documenting your hormone therapy, if applicable
Medical records from your primary physician.
Surgical readiness referral letters from mental health providers documenting their assessment and evaluation

An appointment with your surgeon. 

After your intake, and once you have all of your required documentation submitted you will be scheduled for a surgical consultation. These are in-person visits where you will get to meet the surgeon. typically include: The specialty nurse and social worker will meet with you first to conduct an assessment of your medical health status and readiness for major surgical procedures. Discussion of your long-term gender affirmation goals and assessment of which procedures may be most appropriate to help you in your journey. Specific details about the procedures you and your surgeon identify, including the risks, benefits and what to expect after surgery.

A preoperative anesthesia and medical evaluation. 

Two to four weeks before your surgery, you may be asked to complete these evaluations at the hospital, which ensure that you are healthy enough for surgery.

What can I expect after gender affirming surgery?

When you’ve finished the surgical aspects of your gender affirmation, we encourage you to follow up with your primary care physician to make sure that they have the latest information about your health. Your doctor can create a custom plan for long-term care that best fits your needs. Depending on your specific surgery and which organs you continue to have, you may need to follow up with a urologist or gynecologist for routine cancer screening. JHCTGEH has primary care clinicians as well as an OB/GYN and urologists on staff.

Among other changes, you may consider updating your name and identification. This list of  resources for transgender and gender diverse individuals can help you in this process.

The Center for Transgender and Gender Expansive Health Team at Johns Hopkins

Embracing diversity and inclusion, the Center for Transgender and Gender Expansive Health provides affirming, objective, person-centered care to improve health and enhance wellness; educates interdisciplinary health care professionals to provide culturally competent, evidence-based care; informs the public on transgender health issues; and advances medical knowledge by conducting biomedical research.

Find a Doctor

Specializing In:

Gender Affirmation Surgery
Transgender Health

Find a Treatment Center

Center for Transgender and Gender Expansive Health

Find Additional Treatment Centers at:

Howard County Medical Center
Sibley Memorial Hospital
Suburban Hospital

Trans couple smiles at each other and holds hands.

Request an Appointment

Metoidioplasty for Gender Affirming Care

Phalloplasty for Gender Affirmation

Doctor speaks with smiling transgender woman

Vaginoplasty for Gender Affirmation

Save citation to file

Email citation, add to collections.

Create a new collection
Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

Search in PubMed
Search in NLM Catalog
Add to Search

Mental Health Evaluation for Gender Confirmation Surgery

Affiliation.

1 New Health Foundation Worldwide, 1214 Lake Street, Evanston, IL 60201, USA. Electronic address: [email protected].
PMID: 29908617
DOI: 10.1016/j.cps.2018.03.002

The requests for medically necessary surgical interventions for transgender individuals have steadily increased over the past several years. So too has the recognition of the diverse nature of this population. The surgeon relies heavily on the mental health provider to assess the readiness and eligibility of the patient to undergo surgery, which the mental health provider documents in a referral letter to the surgeon. The mental health provider explores the individual's preparedness for surgery, expectations, and surgical goals and communicates with the surgeon and other providers to promote positive outcomes and inform multidisciplinary care.

Keywords: Gender; Gender dysphoria; Gender-affirming; Mental health; Surgery.

PubMed Disclaimer

Publication types

Search in MeSH

Related information

Linkout - more resources, full text sources.

Elsevier Science
W.B. Saunders

Other Literature Sources

scite Smart Citations
MedlinePlus Health Information

Miscellaneous

NCI CPTAC Assay Portal
Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

gender reassignment surgery psychological evaluation

Gender Affirmative Surgery Psychological Evaluations

If you or a loved one are in the process of transitioning or are looking to have a gender affirmative surgery, we want to help .

Deep Eddy Psychotherapy offers psychological evaluations for gender affirmative surgery candidacy for our clients (ages 18 and up). Our clinicians are dedicated to helping the transgender, non-binary, genderqueer, and gender-expansive community by providing this evaluation service along with individual, group, and couples therapy .

We also recognize that transphobia and transmisogyny are interwoven into our society and that the mental health profession has had an unfortunate history of perpetuating these ideas. Our therapists are committed to being part of the change for good and live more fully within our values – you deserve nothing less.

Ready to sign up to get an evaluation? Don’t wait – contact us today. Please read on to learn more about gender affirmative surgery evaluations and answers to common questions.

What is a gender affirmative surgery evaluation?

Under the current guidelines, transgender, non-binary, and gender non-conforming clients seeking gender affirmative surgeries must have letters from mental health providers attesting to whether they meet the guidelines for surgical intervention established by the World Professional Association for Transgender Health (WPATH).

Anyone who is seeking an attestation letter must meet with a mental health provider for an evaluation (typically just an interview, but occasionally more than one session) to determine whether they are good candidates for surgery. Based on the results of the evaluation, the provider will write a letter summarizing your candidacy and their recommendations.

Do you need an evaluation for hormone replacement treatment (HRT)?

No. In Texas (and in most other states), we now use an informed consent model in place for HRT. So, you no longer need letters from mental health providers in order to receive HRT.

What does a gender affirmative surgery evaluation assess for?

At Deep Eddy Psychotherapy, our clinicians recognize the inherent gatekeeping role that mental health providers have in this compulsory letter-writing process, and we seek to reduce any undue gatekeeping while also having to work within the structure of the WPATH Standards of Care.

Our clinicians who provide this service have a welcoming and affirmative stance toward gender-diverse clients and want to help clients receive the gender-affirming medical care they seek. We have training and experience in this area, and we actively consult with each other about the process.

We say all of this so that you can rest easier knowing that our process is designed with your rights in mind. Our goal is not to keep you from getting the surgery you need, but rather to ensure that you are the right fit and have the support you need to succeed.

Some of the things your evaluator might ask about might include:

Your gender story
Past and current emotional wellbeing
Social supports you can lean on
What sorts of surgical interventions you are seeking
Your understanding of the risks and benefits of surgery

Our providers understand that there is no one gender story narrative. Your story is unique and does not have to be tied together with a sense of certainty. Likewise, our providers understand that your past and current emotional wellbeing could be impacted by both gender dysphoria and the effects of living in a cisnormative society, and we want to give you the support you deserve.

In addition to us asking you questions, we also welcome questions from the interviewee. We recognize how hard it is to get to this point, and we want to be here for you however we can.

Who can write an attestation letter?

In Texas, some insurance companies require all letters to be written by doctoral level (PhD or PsyD) clinicians. Some insurance companies and surgery centers allow master’s level clinicians (LMFT, LCSW, LPC) to provide letters, but not all will. To make matters a bit more complicated, some insurances and some procedures may require multiple letters from different providers.

Before scheduling a session, it can be helpful to talk with your insurance company and/or surgery center about what they each require in the letter and who can write the letters.

If you do not have insurance, as advocates for equity and social justice, we do not want the ability to pay to keep you from receiving a letter from a mental health professional. Please feel free to reach out to us if you have financial need, and we can let you know which clinicians have sliding scale spots open for this service at the time.

Psychological and Neuropsychological Assessment with Transgender and Gender Nonbinary Adults

Currently, there is not ample literature (or peer-reviewed consensus) about how to score psychological tests with transgender, gender nonbinary, or gender diverse clients. This is especially true when an assessment scale utilizes normative data to place clients on a scale based on the performance of cisgender individuals.

Here are some key points to consider when administering or conducting an assessment with transgender, gender nonbinary, or gender diverse adults ( Keo-Meier & Fitzgerald, 2017 ):

What is the functional purpose of the assessment being done? (i.e., what assessment question(s) is/are being addressed?)
What is the current identity and transition status of the client?
Is there any aspect of the client’s identity and transition status that may affect scoring? If so, what are the key factors with which scorers should be aware?
Has the client obtained medical transition interventions? Is the client taking gender affirming hormone therapy? Has the client pursued gender-affirming surgical interventions ?

The client’s transition status may have implications for any tests that use norms based on sex/gender. For example, there is evidence that exogenous hormone treatment may impact cognitive abilities in these clients, although it is far from conclusive. Some authors have suggested waiting to complete any testing until the client has undergone three months of hormone treatment in order to allow hormone levels to reach the level commonly observed in those of their identified gender levels commonly observed in cisgender males/females ( Meyer et al., 1986 ).

Many gender diverse people may neither have interest in medical transition nor seek medical interventions pertaining to gender identity. It is important to address each client’s gender identity status as unique and consider the facets of medical and non-medical transition or identity actualization.

Psychologists are encouraged to AVOID using any norms with transgender, gender nonbinary or gender diverse clients that are developed along binary gender categories only. Assessments with cisgender-normed tools could unintentionally harm the client.

Many cisgender-normed assessments fail to accurately represent transgender, gender nonbinary, and gender diverse people. For example, one prospective study, that examined Minnesota Multiphasic Personality Inventory ( MMPI) scoring results in a sample of transgender men, revealed that the male and female scoring templates produced different results for the same client (Keo-Meier et al., 2015).

In addition to providing potentially inaccurate data, use of gender-based norms may over-pathologize the transgender and gender diverse client. For example, the MMPI-2nd edition is commonly used in evaluations which have a significant impact on personnel selection and custody hearings, areas where transgender, gender nonbinary and gender diverse people experience bias and discrimination.

Scale elevations are interpreted as clinically significant and used to support mental health diagnoses and inform treatment. Compared with cisgender controls, transgender clients show elevations on several scales, especially earlier in their identity development and, as applicable, transition process ( Borgogna et al., 2019 ). This is due, in large part, to experiences of gender dysphoria as well as stigma, and other social and familial stressors and should not be conflated with higher rates of mental health diagnoses in this population overall. These elevations, however, may also decrease if the client progresses in a medical transition and presents with gender transition stability ( Tomita et al., 2019 ).

Transgender, gender nonbinary and gender diverse clients may present for psychological assessment for the same reasons as cisgender clients. These assessments may be necessary in order to obtain appropriate supports or treatment. However, in the case of clients who do not identify as cisgender, use of gender in the scoring procedure may harm the patient or provide inaccurate results. For those tests that do rely on gender-based norms, the approach taken to scoring should depend on the reason for the assessment and factors such as how long the person has lived in their identified gender and any current gender-affirming medical interventions (e.g., hormone therapy). It is prudent to consider the client’s experience of gender dysphoria at the time of the assessment and any influence this could have on results (particularly when evaluating reported psychological distress).

Given the lack of appropriate norms specific to this patient population, qualitative clinical interviews and symptom inventories for transgender, gender nonbinary and gender diverse clients may be preferable to using cisgender-normed assessments for transgender and non-binary clients. If possible, use a non-gender normed tool.

Few, if any tests have been normed or validated with transgender, nonbinary or gender diverse people. Many tests or scales are not gender-based and can therefore be utilized in the same fashion with all clients regardless of gender identity.

Psychologists do not have a standard for determining what scoring template to use. Providers should remember clients possess intersectional identities and that identity and self-definition are both shaped by multi-faceted social contexts for each client ( American Psychological Association, 2017 ).

If the psychologist has no other options than using a cisgender-normed assessment with transgender, gender nonbinary or gender diverse clients, it is recommended providers score the test using both norms (once as if the client was male and a second time as if the client was female) and compare results. Then, consider the treatment implications in the context of the client's affirmed gender. If producing a report for another stakeholder, it is prudent to include a note that any results based on these tests should be interpreted with caution for many of the reasons shared here.

When utilizing tests that require use of gender-based norms, consider whether the test norms pertain to gender identity or evidence-based biological sex differences

For example, in the case of interest testing, a client’s gender identity is most salient when interpreting results. However, some neuropsychological tests (e.g., motor or continuous performance tasks) have demonstrated biological sex-based performance differences that need to be considered when interpreting the results for a client who is transgender or nonbinary ( Strauss et al., 2006 ).

When gender-based norms are unavoidable, it has been recommended that the performance of transgender clients be scored using both gender norms and the clinician should determine which are most appropriate in the context of the referral question and the needs of the client ( Trittschuh et al., 2018 ). Once the client’s performance has been scored based on norms of both genders, it is helpful to determine if there is a significant difference between the two scores. In some cases, there may be no meaningful difference when scored with either gender (e.g. if scores from either gender norm set fall within the same confidence interval) and this can therefore be stated in the results.

If scoring a measure using both gender norms is not advisable, due to the nature of the instrument or assessment question, it is recommended the client choose (or choose in consultation with the psychologist) which gender would be the most appropriate for comparison purposes. In cases where the client’s affirmed gender exists within a gender binary, if the person has lived in their affirmed gender for at least one year, in many cases it is clinically appropriate to use the cisgender-normed scale for the identified gender (Keo-Meier et al., 2015).

In summary, psychologists must exercise awareness of the current limitations in test development and assessment with clients who are transgender, gender nonbinary or gender diverse. Psychologists should above all avoid harm in performing assessments with transgender, gender nonbinary and gender diverse clients with consideration of the specific functional reason(s) for the assessment (i.e., is the assessment addressing matters of identity, biological influences of sex-based structures or hormones, both or neither) and what is in the best interests of the client.

This tip sheet is not meant to be a comprehensive set of guidelines for assessment of clients who are transgender, gender nonbinary, or gender diverse. It should serve only as a starting point for clinicians, who should seek appropriate consultation and supervision to obtain competence in performing any type of assessment with this client population.

This resource was developed by the APA Committee on Sexual Orientation and Gender Diversity with contributions from Elizabeth Baumann, PhD; Sarah E. Burgamy, PsyD; Seth Pardo, PhD; Brett Parmenter, PhD; Stephen Sireci, PhD; and Stephanie Towns, PsyD, ABPP.

American Psychological Association. 2017. Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. Retrieved from: http://www.apa.org/about/policy/multicultural-guidelines.pdf

Borgogna, N. C., McDermott, R. C., Aita, S. L., & Kridel, M. M. (2019). Anxiety and depression across gender and sexual minorities: Implications for transgender, gender nonconforming, pansexual, demisexual, asexual, queer, and questioning individuals. Psychology of Sexual Orientation and Gender Diversity, 6 (1), 54–63. https://doi.org/10.1037/sgd0000306

Keo-Meier, C. L., & Fitzgerald, K.M., (2017). Affirmative Psychological Testing and Neurocognitive Assessment with Transgender Adults, Psychiatric Clinics of North America , 40 (1), 51-64, https://doi.org/10.1016/j.psc.2016.10.011

Meyer, W. J. 3rd, Webb, A., Stuart, C. A ., Finkelstein, J. W., Lawrence, B., & Walker, P. A. (1986). Physical and hormonal evaluation of transsexual patients: a longitudinal study. Arch Sex Behav . 15 (2):121-38. doi: 10.1007/BF01542220. PMID: 3013122

Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary (3 rd Ed.). New York, NY: Oxford University Press

Tomita, K. K., Testa, R. J., & Balsam, K. F. (2019). Gender-affirming medical interventions and mental health in transgender adults. Psychology of Sexual Orientation and Gender Diversity, 6 (2), 182–193. https://doi.org/10.1037/sgd0000316

Trittschuh, E. H., Parmenter, B. A., Clausell, E. R., Mariano, M. J., & Reger, M. A. (2018). Conducting neuropsychological assessment with transgender individuals. The Clinical Neuropsychologist, 32(8), 1393-1410. https://doi.org/10.1080/13854046.2018.1440632

LGBT Resources

Psychological Practice With LGBT People
Transgender Issues in Psychology
Safe and Supportive Schools Project

Contact the Office

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

View all journals
Explore content
About the journal
Publish with us
Sign up for alerts
Review Article
Published: 12 April 2011

Gender reassignment surgery: an overview

Gennaro Selvaggi 1 &
James Bellringer 1

Nature Reviews Urology volume 8 , pages 274–282 ( 2011 ) Cite this article

3991 Accesses

153 Citations

42 Altmetric

Metrics details

Pathogenesis
Reconstruction
Urogenital diseases

This article has been updated

Gender reassignment (which includes psychotherapy, hormonal therapy and surgery) has been demonstrated as the most effective treatment for patients affected by gender dysphoria (or gender identity disorder), in which patients do not recognize their gender (sexual identity) as matching their genetic and sexual characteristics. Gender reassignment surgery is a series of complex surgical procedures (genital and nongenital) performed for the treatment of gender dysphoria. Genital procedures performed for gender dysphoria, such as vaginoplasty, clitorolabioplasty, penectomy and orchidectomy in male-to-female transsexuals, and penile and scrotal reconstruction in female-to-male transsexuals, are the core procedures in gender reassignment surgery. Nongenital procedures, such as breast enlargement, mastectomy, facial feminization surgery, voice surgery, and other masculinization and feminization procedures complete the surgical treatment available. The World Professional Association for Transgender Health currently publishes and reviews guidelines and standards of care for patients affected by gender dysphoria, such as eligibility criteria for surgery. This article presents an overview of the genital and nongenital procedures available for both male-to-female and female-to-male gender reassignment.

The management of gender dysphoria consists of a combination of psychotherapy, hormonal therapy, and surgery

Psychiatric evaluation is essential before gender reassignment surgical procedures are undertaken

Gender reassignment surgery refers to the whole genital, facial and body procedures required to create a feminine or a masculine appearance

Sex reassignment surgery refers to genital procedures, namely vaginoplasty, clitoroplasty, labioplasty, and penile–scrotal reconstruction

In male-to-female gender dysphoria, skin tubes formed from penile or scrotal skin are the standard technique for vaginal construction

In female-to-male gender dysphoria, no technique is recognized as the standard for penile reconstruction; different techniques fulfill patients' requests at different levels, with a variable number of surgical technique-related drawbacks

This is a preview of subscription content, access via your institution

Access options

Subscribe to this journal

Receive 12 print issues and online access

195,33 € per year

only 16,28 € per issue

Buy this article

Purchase on Springer Link
Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

Principles and outcomes of gender-affirming vaginoplasty

Sexual function of transgender assigned female at birth seeking gender affirming care: a narrative review

The effect of early puberty suppression on treatment options and outcomes in transgender patients

Change history, 26 april 2011.

In the version of this article initially published online, the statement regarding the frequency of male-to-female transsexuals was incorrect. The error has been corrected for the print, HTML and PDF versions of the article.

Meyer, W. 3rd. et al . The Harry Benjamin International Gender Dysphoria Association's standards of care for gender identity disorders, sixth version. World Professional Association for Transgender Health [online] , (2001).

Google Scholar

Bakker, A., Van Kesteren, P., Gooren, L. & Bezemer, P. The prevalence of transsexualism in The Netherlands. Acta Psychiatr. Scand. 87 , 237–238 (1993).

Article CAS Google Scholar

Selvaggi, G. et al . Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals. Plast. Reconstr. Surg. 116 , 135e–145e (2005).

Article Google Scholar

Benjamin, H. (ed.) The Transsexual Phenomenon (Julian Press Inc., New York, 1966).

World Professional Association for Transgender Health [online] , (2010).

Zhou, J. N., Hofman, M. A., Gooren, L. J. & Swaab, D. F. A sex difference in the human brain and its relation to transsexuality. Nature 378 , 68–70 (1995).

Kruijver, F. P. et al . Male-to-female transsexuals have female neuron numbers in a limbic nucleus. J. Clin. Endocrinol. Metab. 85 , 2034–2041 (2000).

Swaab, D. F., Chun, W. C., Kruijver, F. P., Hofman, M. A. & Ishuina, T. A. Sexual differentiation of the human hypothalamus. Adv. Exp. Med. Biol. 511 , 75–105 (2002).

Garcia-Falgueras, A. & Swaab, D. F. A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. Brain 131 , 3115–3117 (2008).

Cohen-Kettenis, P. & Kuiper, B. Transseksualiteit en psychotherapie [Dutch]. Tijdschr. Psychoth. 3 , 153–166 (1984).

Kuiper, B. & Cohen-Kettenis, P. Sex reassignment surgery: a study of 141 Dutch transsexuals. Arch. Sex. Behav. 17 , 439–457 (1988).

Kanhai, R. C., Hage, J. J., Karim, R. B. & Mulder, J. W. Exceptional presenting conditions and outcome of augmentation mammoplasty in male-to female transsexuals. Ann. Plast. Surg. 43 , 476–483 (1999).

Kanagalingm, J. et al . Cricothyroid approximation and subluxation in 21 male-to-female transsexuals. Laryngoscope 115 , 611–618 (2005).

Bouman, M. Laparoscopic assisted colovaginoplasty. Presented at the 2009 biennial World Professional Association for Transgender Health meeting, Oslo.

Rubin, S. O. Sex-reassignment surgery male-to-female. Review, own results and report of a new technique using the glans penis as a pseudoclitoris. Scand. J. Urol. Nephrol. Suppl. 154 , 1–28 (1993).

CAS PubMed Google Scholar

Fang, R. H., Chen, C. F. & Ma, S. A new method for clitoroplasty in male-to-female sex reassignment surgery. Plast. Reconstr. Surg. 89 , 679–682 (1992).

Selvaggi, G. et al . Genital sensitivity in sex reassignment surgery. Ann. Plast. Surg. 58 , 427–433 (2007).

Watanayusakul, S. SRS procedures. The Suporn Clinic [online] , (2010).

Melzer, T. Managing complications of male to female surgery. Presented at the 2007 World Professional Association for Transgender Health biennial meeting, Chicago.

Gilleard, O., Qureshi, M., Thomas, P. & Bellringer, J. Urethral bleeding following male to female gender reassignmetn surgery. Presented at the 2009 World Professional Association for Transgender Health biennial meeting, Oslo.

Beckley, I., Thomas, P. & Bellringer, J. Aetiology and management of recto-vaginal fistulas following male to female gender reassignment. Presented at 2008 EAU section of genitourinary surgeons and the EAU section of andrological urology meeting, Madrid.

Monstrey, S. et al . Chest wall contouring surgery in female-to-male (FTM) transsexuals: a new algorithm. Plast. Reconstr. Surg. 121 , 849–859 (2008).

Mueller, A. & Gooren, L. Hormone-related tumors in transsexuals receiving treatment with cross-sex hormones. Eur. J. Endocrinol. 159 , 197–202 (2008).

Selvaggi, G., Elander, A. & Branemark, R. Penile epithesis: preliminary study. Plast. Reconstr. Surg. 126 , 265e–266e (2010).

Selvaggi, G. & Elander, A. Penile reconstruction/formation. Curr. Opin. Urol. 18 , 589–597 (2008).

Gilbert, D. A., Jordan, G. H., Devine, C. J. Jr & Winslow, B. H. Microsurgical forearm “cricket bat-transformer” phalloplasty. Plast. Reconstr. Surg. 90 , 711–716 (1992).

Bettocchi, C., Ralph, D. J. & Pryor, J. P. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 95 , 120–124 (2005).

Monstrey, S. et al . Penile reconstruction: is the radial forearm flap really the standard technique? Plast. Reconstr. Surg. 124 , 510–518 (2009).

Selvaggi, G. et al . Donor-site morbidity of the radial forearm free flap after 125 phalloplasties in gender identity disorder. Plast. Reconstr. Surg. 118 , 1171–1177 (2006).

Hoebeke, P. et al . Impact of sex reassignment surgery on lower urinary tract function. Eur. Urol. 47 , 398–402 (2005).

Agrawal, V. & Ralph, D. An audit of implanted penile prosteses in the UK. BJU Int. 98 , 393–395 (2006).

Hoebeke, P. B. et al . Erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur. Urol. 57 , 334–340 (2010).

Vesely, J. et al . New technique of total phalloplasty with reinnervated latissimus dorsi myocutaneous free flap in female-to-male transsexuals. Ann. Plast. Surg. 58 , 544–550 (2007).

Selvaggi, G. et al . Scrotal reconstruction in female-to-male transsexuals: a novel scrotoplasty. Plast. Reconstr. Surg. 123 , 1710–1718 (2009).

Download references

Author information

Authors and affiliations.

Gender Surgery Unit, Charing Cross Hospital, Imperial College NHS Trust, 179–183 Fulham Palace Road, London, W6 8QZ, UK

Gennaro Selvaggi & James Bellringer

You can also search for this author in PubMed Google Scholar

Contributions

G. Selvaggi and J. Bellringer contributed equally to the research, discussions, writing, reviewing, and editing of this article.

Corresponding author

Correspondence to James Bellringer .

Ethics declarations

Competing interests.

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Selvaggi, G., Bellringer, J. Gender reassignment surgery: an overview. Nat Rev Urol 8 , 274–282 (2011). https://doi.org/10.1038/nrurol.2011.46

Download citation

Published : 12 April 2011

Issue Date : May 2011

DOI : https://doi.org/10.1038/nrurol.2011.46

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

This article is cited by

A bibliometric and visualisation analysis on the research of female genital plastic surgery based on the web of science core collection database.

Xianling Zhang

Aesthetic Plastic Surgery (2024)

Chest Feminization in Transwomen with Subfascial Breast Augmentation—Our Technique and Results

James Roy Kanjoor
Temoor Mohammad Khan

Aesthetic Plastic Surgery (2023)

Vaginoplasty in Male to Female transgenders: single center experience and a narrative review

Luca Ongaro
Giulio Garaffa
Giovanni Liguori

International Journal of Impotence Research (2021)

Urethral complications after gender reassignment surgery: a systematic review

L. R. Doumanian

Overview on metoidioplasty: variants of the technique

Marta Bizic
Borko Stojanovic
Miroslav Djordjevic

Quick links

Explore articles by subject
Guide to authors
Editorial policies

Olympic Boxer Imane Khelif Is Not a Trans Athlete

One controversy coming out of the 2024 paris olympics concerned a fight between algerian boxer imane khelif and italian boxer angela carini., alex kasprak, published aug. 2, 2024.

On Aug. 1, 2024, Algerian boxer Imane Khelif faced Italian boxer Angela Carini in an opening bout of the women's welterweight boxing tournament at the 2024 Paris Olympics. Forty-six seconds into the fight, after receiving a few punches, Carini ended the fight early, delivering an unusual win to Khelif.

Carini later said she ended the fight due to severe nose pain following one of Khelif's blows. Video showed her sobbing after her loss and not shaking Khelif's hand when offered to her. "I have never felt a punch like this," she said after the fight.

Anti-trans activists and social media pundits immediately painted this fight as an example of the alleged unfairness and danger of allowing trans women to fight against those assigned female at birth.

The author J.K. Rowling, for example, described the match on X as "a young female boxer" having "everything she's worked and trained for snatched away because [the International Olympic Committee] allowed a male to get in the ring with her."

The virulently anti-trans X account Libs of TikTok also weighed in , describing Khelif as "a man … being allowed to compete in women's Olympic boxing in Paris."

Former U.S. President Donald Trump chimed in as well, describing Khelif as "a person that transitioned":

The problem with these arguments was Khelif is not trans. Khelif was born, and has lived her entire life, as a female. The sanctioned International Boxing Association (IBA) alleged in a confidential report she did not meet the World Boxing Championship requirements for female competition in 2023, despite having competed as a woman in that same competition for many years prior, winning silver in 2022.

Khelif's eligibility was challenged only after she beat a Russian opponent to advance to the World Championship quarterfinal round in 2023. The IBA was once recognized by the IOC as the official governing body for boxing — but that title was rescinded in April 2023 following, among other things, allegations of corruption and ties to Russian money . As a result, the IOC, not the IBA, sets the rules for Olympic women's boxing.

Who is Imane Khelif?

Khelif is an Algerian boxer who has competed, as a woman, at the international level for years. She has always identified as a woman, and as a UNICEF ambassador has discussed the role that being a young girl in a tiny rural village has had on her development as a boxer:

When Imane Khelif, 24, one of Algeria's top female boxers is asked what achievements she is most proud of, she says, "It's being able to overcome the obstacles in my life." Imane recalls how at 16 she managed to excel in football in her rural village in Tiaret in western Algeria despite football not being seen as a game fit for girls. Moreover, the boys in her village felt threatened and picked fights with her. Ironically it was her ability to dodge the boys' punches that got her into boxing.

She came in 17th at the 2018 IBA World Boxing Championships and 33rd in the 2019 IBA World Boxing Championships. She represented Algeria in the 2020 Tokyo Olympics. In those games, she lost to the tournament's bronze medalist, Ireland's Kellie Harrington. Her presence did not generate any controversy. She went on to win silver in the 2022 World Boxing Championships.

What Happened in 2023?

Khelif also competed in the 2023 IBA World Championships in New Delhi — that is, until she beat a Russian boxer. On March 22, 2023, Khelif " dominated " Russian boxer Amineva Azalia with a 4-1 victory, securing her a position in the quarterfinals scheduled to begin a few days later.

On March 24, however, the IBA disqualified Khelif, suggesting a "failure to meet the eligibility criteria for participating in the women's competition." In 2023, the head of the IBA told the Russian news agency TASS that DNA tests had "proved they had XY chromosomes and were thus excluded from the sports events." XY chromosomes are typically associated with males.

Responding to controversy a year later, however, the IBA more generally claimed that Khelif was "subject to [a] … recognized test" but that "the specifics remain confidential." The IOC had suggested the 2023 disqualification was due to her testosterone level, but the IBA pushed back on that claim.

Can Women Have XY Chromosomes or Elevated Testosterone?

Gender testing for women's sports remains controversial . The rationale is that the process of going through puberty as a male imparts significant physical advantages over females that could make competition between the sexes dangerous. The controversy, historically at least, has largely been over how these tests should work and how to handle cases complicated by the natural genetic diversity of human life.

There are genetic conditions, termed differences of sexual development, in which biological females are born with XY chromosomes but possess female anatomy, or that affect how a biological female regulates and reacts to testosterone, causing levels typically associated with males. Though there is no independent confirmation that Khelif has these conditions, people born this way would legally be considered female or intersex.

Debates over these issues in the context of women's sports have nothing to do with a purported "woke" or "trans agenda," because such instances involve women who were born as women, identify as women and have not undergone any sex reassignment surgery or procedure to change this fact. That is what IOC spokesperson Mark Adams meant when he clarified to the press "this is not a transgender issue."

Gender-reassignment procedures require significant financial and medical resources. The notion that a woman from a rural western Algerian village who sold scrap metal to support her boxing career would have had the ability to undergo such a procedure in a deeply conservative Muslim country that prohibits the practice is extremely unlikely , at best.

IOC Responds

On Aug. 1, 2024, the day Khelif defeated Carini, the IOC released a statement defending both Khelif and another boxer facing similar accusations, Taiwan's Lin Yu-ting:

We have seen in reports misleading information about two female athletes competing at the Olympic Games Paris 2024. The two athletes have been competing in international boxing competitions for many years in the women's category, including the Olympic Games Tokyo 2020, International Boxing Association (IBA) World Championships and IBA-sanctioned tournaments. … The current aggression against these two athletes is based entirely on this arbitrary decision, which was taken without any proper procedure – especially considering that these athletes had been competing in top-level competition for many years. Such an approach is contrary to good governance. Eligibility rules should not be changed during ongoing competition, and any rule change must follow appropriate processes and should be based on scientific evidence.

The IOC stated that both boxers have met the IOC eligibility requirements for competition as a woman in boxing.

Angela Carini Was Not Making a Political Statement

Social media accounts falsely attempting to make this story about transgender athletes attempted to paint a sorrowful picture of Carini's loss, describing her dreams as having been crushed by a man pretending to be a woman and suggesting that photos of the fight and of Carini's tearful reaction evoked images of domestic violence . Carini's tears and her not shaking Khelif's hand were used to support this narrative.

But according to The Associated Press, Carini was not making a political statement at all, and did not intend to refuse to shake Khelif's hand:

"All this controversy makes me sad," Carini said. "I'm sorry for my opponent, too. … If the IOC said she can fight, I respect that decision." Carini was apologetic for not shaking Khelif's hand after the bout. "It wasn't something I intended to do," Carini said. "Actually, I want to apologize to her and everyone else. I was angry because my Olympics had gone up in smoke. I don't have anything against Khelif. Actually, if I were to meet her again I would embrace her."

It is not uncommon for athletes of any gender to shed tears after losing a shot at a medal in the Olympic Games, nor is it uncommon for a punch to the head from an Olympic boxer to cause pain. Boxing is a sport in which two people try to punch each other hard enough to cause a knockout.

Bottom Line

The only purported evidence for the claim that Khelif is trans comes from an undisclosed test performed by an allegedly corrupt sports governing body that may have shown she has a DSD condition. The IOC has said Khelif meets its requirements for participation, with Adams, the IOC spokesman, specifically clarifying , "This is not a transgender issue."

Because Khelif is not transgender, claims attempting to make her victory against Carini an issue about transgender rights or "woke" politics are without basis.

Snopes reporter Jordan Liles contributed to this report.

"Algeria Boxer Imane Khelif Wins First Olympic Fight When Opponent Angela Carini Quits." AP News, 1 Aug. 2024, https://apnews.com/article/olympics-2024-boxing-gender-4b6eb881cce9c34484d30c68ad979127.

Boxing/Women's World Championships (Day 6): Algerian Imane Khelif Secures Her Ticket to the Quarter-Finals. https://al24news.com/fr/boxe-championnats-du-monde-feminin-6e-journee-lalgerienne-imane-khelif-valide-son-billet-pour-les-quarts-de-finale/. Accessed 2 Aug. 2024.

"Childhood of Boxer Imane Khelif as She Faces Accusations of Being 'Biological Male.'" The Independent, 2 Aug. 2024, https://www.independent.co.uk/news/uk/home-news/imane-khelif-olympics-boxer-trans-debate-gender-carini-b2590229.html.

Ewing, Lori. "Explainer: Olympics-DSD Rules in Focus in Women's Boxing." Reuters, 31 July 2024. www.reuters.com, https://www.reuters.com/sports/olympics/olympics-dsd-rules-focus-womens-boxing-2024-07-31/.

"Joint Paris 2024 Boxing Unit/IOC Statement." Olympics.Com, 1 Aug. 2024, https://olympics.com/ioc/news/joint-paris-2024-boxing-unit-ioc-statement.

"Lin Yu-Ting and Imane Khelif: Boxers Cleared for Paris Olympics." BBC Sport, 30 July 2024, https://www.bbc.com/sport/olympics/articles/c4ngr93d9pgo.

Newsweek. Olympics Officials Make It "Absolutely Clear" On Women Boxers Controversy. 2024. YouTube, https://www.youtube.com/watch?v=0do8voeKFNY.

"Olympic Association Calls for Successor to Run Boxing's Global Duties after Excluding IBA." BBC Sport, 9 Apr. 2024. www.bbc.com, https://www.bbc.com/sport/boxing/68773451.

"Statement Made by the International Boxing Association Regarding Athletes Disqualifications in World Boxing Championships 2023." IBA, 31 July 2024, https://www.iba.sport/news/statement-made-by-the-international-boxing-association-regarding-athletes-disqualifications-in-world-boxing-championships-2023.

Tokyo 2020: Harrington Guarantees Medal with Khelif Win. Aug. 2021. www.rte.ie, https://www.rte.ie/sport/olympics/2021/0803/1238700-tokyo-2020-harrington-guarantees-medal-with-khelif-win/.

"Who Is Italian Boxer Angela Carini and Why Did She Quit Her Fight against Imane Khelif?" AP News, 2 Aug. 2024, https://apnews.com/article/angela-carini-imane-khelif-boxing-63e9dbaa30f1e29196d4162c72c2babf.

By Alex Kasprak

Alex Kasprak is an investigative journalist and science writer reporting on scientific misinformation, online fraud, and financial crime.

Article Tags

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

Advanced Search
Journal List
Anaesthesiol Intensive Ther
v.53(4); 2021 Oct
PMC10165989

Gender reassignment surgery – a narrative overview of anaesthetic considerations and implications

Priyanka mishra.

1 Department of Anaesthesia, All India Institute of Medical Sciences, Rishikesh, India

Amborish Nath

2 Department of Burns and Plastic Surgery, AIIMS Rishikesh, India

Ashutosh Kaushal

3 Department of Anaesthesia, AIIMS Bhopal, India

Rakesh Kain

4 Department of Burns and Plastic Surgery, VMMC Safdarjung Hospital, India

The twenty-first century, with its transforming ideology and rising acceptance, is witnessing an increased number of transgender people applying for gender reassignment surgery (GRS). The procedure of GRS is a lengthy and complex one involving the active collaboration of multiple disciplines including psychology, psychiatry, family medicine, plastic surgery, endocrinology, otolaryngology, urology, gynaecology, maxillofacial surgery, and anaesthesiology. The considerable paucity of literature regarding the management of patients presenting for GRS places health care providers at a disadvantage. It is imperative to cautiously regard the specific medical, emotional, social, and economic concerns regarding these patients. Health care providers need to be trained well to deal empathetically with such patients. The present literature about GRS deals mainly with the surgeon’s perspective, while the anaesthetist’s approach remains hazy. This is because GRS imposes the need for anaesthesiologists to search for better and more efficient modes of anaesthesia so as to improve prognosis and minimize the associated morbidity. Anaesthetists should understand the associated psychological aspects and effects of hormone therapy while performing an extensive and informative pre-operative evaluation to formulate an effective strategy. Providing the optimal modes for anaesthesia and keeping a cautious watch for complications along with timely intervention in the advent of the same comprise the approach for high-quality anaesthetic care. This review aims to provide a detailed overview of significant considerations and competent peri-operative outcomes in patients presenting for GRS.

The right to gender identity is one that amounts to contouring an individual’s personality. The present hour calls for an understanding of the meaning that the term transgender holds. It needs to be recognized that sex and gender although often used interchangeably are quite distinct. Sex refers to the physical characteristics (e.g. reproductive organs, chromosomes, hormones) employed to assign people to be female, male, or intersex. However, gender is more of a social construct, sprouting from cultural expectations that shape an individual’s external appearance and conduct [ 1 ]. Gender identity disorders have been frowned upon throughout their existence, making their treatment quite controversial. Gender dysphoria, earlier known as gender identity disorder, describes a heterogeneous group of individuals having the desire to possess secondary sexual characteristics of the opposite sex and possessing varying degrees of dissatisfaction regarding their anatomical gender [ 2 ]. Gender reassignment surgery (GRS) has proven to be a revolutionary intervention for patients with gender dysphoria, hence playing a pivotal role in alleviating their psychological discomfort. GRS is a multidisciplinary endeavour requiring a collaborative effort of psychology, psychiatry, family medicine, plastic surgery, endocrinology, otolaryngology, urology, gynaecology, maxillofacial surgery, and, last but not least, anaesthesiology.

Though GRS is becoming popular and more acceptable, there is still a relative lack of awareness of the process and its associated challenges amongst healthcare professionals. GRS has been performed with various approaches, single and multiple settings, hence imposing the need for anaesthetists to search for better and more efficient modes of anaesthesia to improve prognosis and minimize the associated morbidity. Just as surgeons develop areas of specialization to better care for their patients, anaesthesiologists have specialized in out- and inpatient surgery, both cosmetic and reconstructive.

The vanishing stigma, increasing demographic and acceptance of transgender and gender non-binary (TGNB) individuals calls for the field of medicine to catch up too. Hence, it is only discerning to expect that in coming times, they will present more frequently in general surgical settings and as they do, we would be well prepared to provide them high-quality peri-operative care. The ardent need to review this topic is rooted in the acknowledgement that although there are articles discussing the surgical and peri-operative outlooks of this procedure, there is scarce literature about the role, considerations, and strategies for anaesthesia in these procedures. This substantial shortfall in the published literature regarding the holistic concerns of GRS demands further strategies to be explored. We have discussed the anaesthetist strategy governed by consideration of the psychological aspects, effects of hormone therapy, optimal modes for anaesthesia and cautious watch for complications along with timely intervention for handling the same for providing high-quality anaesthetic care. In this article, we aim to analyse, understand, and formulate an approach for the entire procedure from an anaesthesiologist’s perspective.

RESEARCH METHODS

For this review, we retrieved data by a systematic literature search carried out in the research databases including PubMed, EMBASE, and Google Scholar. We included review articles, original studies, and case reports in our search.

History and current scenario

Dr Alan L. Hart, a TB specialist in the US, became one of the first female-to-male transgender persons who underwent gonadectomy and hysterectomy for his gender dysphoria in 1917 [ 3 ]. According to the 2018 census, nearly 0.6% of adults in the United States, or 1.5 million individuals, make up the transgender community. The estimated transgender population worldwide in the 2018 census ranged between 1% and 2% of the total population, which is nearly 900 million people. The American Society for Plastic Surgeons (ASPS) has reported an expeditious rise in GRS of up to 155% within the span of 2016 to 2017 [ 4 ]. With the legalization of transgender in most of the countries throughout the globe, the curve of GRS surgery is probably going to run further upslope.

OVERVIEW OF THE PROCEDURE

As already described, GRS requires a multidisciplinary approach. To begin with, the guidelines for the Recommendation of GRS indicate that the patient should be physically and psychologically prepared for surgery and should have a clear perception of the interventions to be performed along with the risks and possible complications [ 5 ]. Preparation for GRS is a multistage process that includes an elaborate psychological and wellbeing assessment of the patient. This may take nearly 12 months for complete psychosocial preparation of the patient to deal with the transition. Psychological evaluation is then followed by feminizing or masculinizing hormone replacement therapy (HRT) prescribed by a consulting endocrinologist. There should be documented “real-life experience in the desired role” for at least a whole year [ 5 ]. GRS ensues at the end of this process. The algorithm for the entire procedure is summarized in Figure 1 .

An external file that holds a picture, illustration, etc.
Object name is AIT-53-45284-g001.jpg

Algorithm for the procedure of gender reassignment surgery

INITIAL EVALUATION

What is required is having an elaborate understanding and assessment of the patient’s psychological, medical, legal, and social concerns. In developing countries, a substantial proportion of this relates to social and psychological aspects. The mental wellbeing assessment aims at evaluating and treating the mental health issues, offering suggestions with peer support with or without family therapy, assessing the gender expression level and the readiness of the patient for fully or partially reversible and irreversible interventions [ 6 ]. A reassuring and sensitive attitude towards the patient affirming that they would receive the best available care without any judgment aids in alleviating their anxiety and concerns. A holistic approach to assessment involves the multidisciplinary effort of various medical teams.

ANAESTHETIC PLAN OF CARE

Pre-operative assessment.

Apart from the routine preoperative assessment as for any other surgery, here we need to address specific history, examination, and investigations. The aim should be at the optimization of the patient care through risk reduction and informed consent [ 7 ]. It also caters to efficiently preparing the patient for surgery and anaesthesia while encouraging their compliance and participation.

The biological sex and current gender identity of the patient should be noted.
In the absence of specific gender assignment, measurements and calculations with gender specificity become tricky, e.g. ideal body weight, target-controlled propofol infusion using Schneider mode [ 8 ].
Medical concerns.
Patient’s preferred form of address (i.e., title, name, pronouns).
History of use of anti-depressants, anti-anxiety, and other psychotropic drugs should be derived.
Higher risk of tobacco, substance abuse, and sexually transmitted diseases (STDs) should be taken into consideration [ 9 ]. The prevalence of HIV was found to be 8.2% in the Indian transgender community as compared to 0.31% national HIV prevalence in India [ 10 ].
History of multiple silicone injections can cue towards the existence of granulomatous disease, pneumonitis, organ failure, and infection [ 11 , 12 ].
Masculinizing or feminizing therapy with a detailed description of drugs.
Duration of therapy.
Should be done with due respect to the privacy and dignity of the patient while maintaining professionalism.
A chaperone of the gender of the patient’s choice should be present during physical examination.
Should include assessment of any restrictive lung disease (common in female-to-male [FTM] chronic chest binders) [ 8 ].
Most of the parameters should be evaluated as per the patient’s biological sex.
However, for patients who have received HRT for more than six months, it has been suggested to compare the laboratory values to their cis-counterparts rather than their biological sex [ 13 ].
There is still limited evidence regarding interpretations in different stages of gender transition.

Investigations to evaluate effects of HRT:

complete lipid profile to screen for dyslipidaemias;
liver function assessment to screen for any liver dysfunction;
complete coagulation profile;
screening for thromboembolism, breast and endometrial malignancy [ 15 , 16 ].
Recognition and management of depression, anxiety, and regret.
Advice on quitting smoking and explanation of its implications.
Discontinuation of HRT for nearly 2-4 weeks before surgery in consultation with the endocrinologist and surgeon, keeping in consideration that prolonged withdrawal of hormones may culminate in the reversal of desirable effects [ 17 ].
Considering the use of low-dose aspirin along HRT to reduce the risk of thromboembolism.
Patients should be well informed regarding the overall cost, duration of hospitalization, surgical and anaesthetic options, complications, and post-operative care, and consent should be obtained.

Anaesthetic implications and concerns of HRT

It is not only relevant but imperative for an anaes-thesiologist to be aware of the various effects of HRT as it can guide the formulation of an efficient plan for anaesthesia. The various medications given in feminizing hormonal therapy include gonadotropin-releasing hormone agonists such as leuprolide and goserelin, spironolactone (androgen blockers), oral, parenteral or transdermal oestrogens and 5-α-reductase inhibitors such as finasteride. These medications can pose a higher risk of endocrine (e.g., diabetes) and cardiovascular (e.g., hypertension, venous thromboembolism [VTE]) implications. Testosterone therapy has been associated with derangements in liver function, which in turn complicate the drug metabolism. These risks are higher in the patients receiving oral formulations, hence necessitating the discontinuation of HRT for a few weeks prior to the surgery [ 16 ]. However, the withdrawal of hormone therapy can potentially make these patients more emotional, with rapid mood swings. This in turn can pose certain challenges for the anaesthetist in patient handling in the perioperative window ( Table 1 ). Incidence of postoperative delirium and post-operative nausea and vomiting (PONV) has also been found to be higher in patients on HRT. Some cases have revealed the occurrence of migraines in patients on anti-androgens. It is important to remember that in many cases these patients require lifelong administration of HRT unless curtailed by severe adverse effects.

Anaesthetic implications and concerns of hormone replacement therapy

Concern	Cause
Dyslipidaemias	Attributable to oestrogen therapy
Venous thromboembolism Pulmonary embolism	Derangement of coagulation physiology:
Cardiovascular:	Increased insulin resistance DyslipidaemiasIncreased erythropoietin and high haematocrit due to testosterone therapy
Altered drug metabolism due to liver dysfunction	Attributable to testosterone therapy
Post-operative nausea and vomiting Migraine	Attributable to anti-androgens
Emotional lability/mood swings Post-operative delirium	Withdrawal of hormone therapy prior to surgery Attributable to testosterone therapy

Intra-operative considerations

The intra-operative care of these patients is distinctive as it needs the discernment of special anatomical, psychological, physiological, and pharmacological issues as numerated in Figure 2 . An anaesthesiologist needs to pay close attention to the following considerations:

An external file that holds a picture, illustration, etc.
Object name is AIT-53-45284-g002.jpg

Intra-operative considerations of gender reassignment surgery

There should be clear instructions to the peri-operative team to maintain minimum traffic within the operating room (OR), particularly when the surgery involves exposure of the chest and/or genital regions.
The patient’s preferred pronouns should be known and used at all times by the peri-operative staff when addressing the patient and any unnecessary questions should be discouraged.

Modes of anaesthesia

Type of surgery	Modes of anaesthesia	Advantages over GA
Breast surgery:	Thoracic epidural Thoracic paravertebral block Pectoral nerve blocks (type 1, 2) Serratus plane block CSE, GA	Decreased need for opioids Fewer post-operative pulmonary complications Less PONV Shorter PACU stay Avoiding interaction of GA agents with HRT Prevention and avoidance of consequences of poor metabolism of systemic drugs.
Reproductive organ removal	GA, CSE
Genitalia reconstruction and minor urological procedures	GA, CSE LA with sedation
Facial aesthetic procedures:	PNB LA with sedation GA
Pitch-altering procedures	LA with sedation Tubeless anaesthesia GA
Other specific procedures:	Monitored anaesthetic care (MAC) with conscious sedation PNB CSE GA

CSE – combined spinal-epidural, GA – general anaesthesia, LA – local anaesthesia, PNB – peripheral nerve block, PONV – post-operative nausea and vomiting, PACU – post-anaesthesia care unit, HRT – hormone replacement therapy.

Transfer and positioning of the transgender patients who have undergone external body contouring procedures can be challenging and needs to be done with utmost caution.
FTM transgenders may be using chest wraps and breast binders that need to be removed beforehand. Though there is still insufficient literature on the topic, chronic use of these tight chest binders can pose the risk of a restrictive respiratory pattern [ 14 ].
Interestingly, even the most routine procedure of urinary catheterization can get tricky and challenging in the patients who have already had GRS concerning the urethra done, e.g. metoidioplasty with urethral lengthening, phalloplasty, or vaginoplasty.
Patients who have recently had various facial aesthetic procedures such as rhinoplasty or jaw reconstruction may pose a challenge during bag and mask ventilation and should be handled with care and caution.
Patients who have had previous voice pitch altering surgery such as chondroplasty or laryngoplasty may present as a difficult airway scenario as they pose the risk of tracheal stenosis or perforation, vocal cord damage, and dysphagia. Hence, a difficult airway cart should be kept ready [ 22 ].
It needs to be taken into consideration that transgender women suffer from higher rates of HIV infection and might be on anti-retroviral therapy (ART). The various sedatives, anxiolytics, hypnotics, and antibiotics may present significant interactions with antiretroviral agents and result in altered drug metabolism [ 23 ].
As these patients have been off steroid therapy for few weeks, they might experience steroid withdrawal syndrome. This can be prevented by administering a steroid bolus of 100-200 mg hydrocortisone intra-operatively.
An anaesthetist needs to be vigilant for elevated intraoperative risks due to the possible existing respiratory, renal, cardiovascular, and hepatic compromise of the patient.
VTE is a major perioperative concern due to the use of HRT medications and needs to be looked out for and relevant preventive interventions should be adopted. Cautious haemodynamic monitoring needs to be done for the early identification and management of this dreaded complication. Intraoperative prophylaxis should be provided with subcutaneous heparin and graded compression devices.
Higher incidence of stroke has been linked to greater erythropoietin production and haematocrit and hence increased blood viscosity, attributed to parenteral testosterone therapy. Therefore, adequate hydration should be maintained for the patient [ 24 ].
Considering the extensive nature of surgery, efficient pain control is imperative.

COMPLICATIONS

GRS presents with its arena of complications to be looked out for and dealt with. Amongst them, certain complications demand the anaesthesiologist’s ardent attention ( Table 3 ). These patients may be suffering from anaemia owing to the multiple and prolonged operations they undergo over some time. This needs to be taken care of by adopting appropriate pre-operative optimizing and perioperative blood loss reducing strategies. Two of the dreaded complications that the patients on oestrogen therapy should be monitored for are pulmonary embolism (PE) and deep vein thrombosis (DVT) [ 25 ]. These haematological events are attributed to peri-operative immobility, but due to the thrombotic effects of transgender HRT, there is a considerably higher risk of the same in these patients. The range of occurrence of VTE in transgender women on oestrogen therapy is from 0% to 6% [ 26 ]. The hypercoagulable state resulting due to HRT medications (both male-to-female and FTM) can precipitate cerebrovascular accidents and myocardial infarction and also aggravate any pre-existing coronary disease. This in turn warrants maintenance of adequate hydration at all times along with utmost care during all the phases of anaesthesia, supplemented by cautious intra-operative monitoring.

Complications in gender reassignment surgery, associated risk factors and preventive measures

Complication	Risk factors	Preventive measures
Peri-operative blood loss and anaemia	Prolonged and multiple surgery	Auto-transfusion
Infection	Extensive wound area	Adequate peri-operative antibiotic therapy
Altered wound healing	Steroid and hormone treatment Smoking	Presurgical discontinuation of HRT Smoking cessation
Deep vein thrombosis Pulmonary embolism	Steroid and hormone treatment Smoking	Thromboprophylaxis Mechanical: graduated compression stockings Pharmacological:
Stroke	Testosterone therapy	Adequate hydration
Rectal injury and rectovaginal fistula Stenosis – vaginal/urethral	–	Careful tissue interposition Adequate peri-operative antibiotic therapy
Flap necrosis	Smoking Infection	Smoking cessation Adequate peri-operative antibiotic therapy Meticulous surgery with caution for adequate vascularity, draining hematoma below flap, avoiding tight suturing and dressings
Asymmetry Unspecific events (e.g., compartment syndrome)	–	–

The extensive wound surface, adverse effects of steroid therapy, and repeated surgery make these patients more susceptible to various infections, necrotizing fasciitis, and septicaemia [ 27 ]. The various other surgical complications include gastrointestinal events (e.g., rectal injury and rectovaginal fistula) and urinary tract complications (e.g., urethral stricture, fistula, and incontinence). Some unspecific events such as inguinal hernia, compartment syndrome, and asymmetry can also be witnessed after the surgery.

POSTOPERATIVE CONSIDERATIONS

The challenges continue after the completion of surgery, as the post-operative period in these patients has its concerns of postoperative pain, anxiety, depression, withdrawal, and at times regret [ 28 ]. Amongst the other parts of a detailed handover to the post-operative care team, one of the most important is validation of the patient’s preferred pronoun and name to avoid any unnecessary and repeated questioning [ 8 ]. It should be ensured that there is a multi-pronged approach with optimal analgesic strategies to manage post-operative pain. This can include epidural anaesthesia, intravenous analgesics, peripheral nerve blocks, parenteral therapy, and patient-controlled analgesia (PCA). There should be a collaborative approach to tend to the patient’s mental health, as well as social and spiritual needs. Canner et al . [ 29 ] reported that transgender patients require a higher level of care, highlighting the significance of formal training of health care providers for best practices to encourage and achieve a respectful and holistic approach towards anaesthesia delivery. Early implementation of social work and community support in the postoperative period plays a major part to smoothen the process of discharge while assisting the transition to patient recovery.

IMPORTANCE OF TEAMWORK AND COLLABORATION

As already mentioned, the complex procedure of gender reassignment involves a multidisciplinary effort of psychology, psychiatry, family medicine, plastic surgery, endocrinology, otolaryngology, urology, gynaecology, maxillofacial surgery, and anaesthesia. Evaluation by mental health professionals for eligibility criteria is a precondition for GRS as it can be a physically, emotionally, financially, and socially overwhelming procedure. The plastic surgeons, otolaryngologists, urologists and all other contributing surgeons need to have clear and competent participation in this long-term therapy. The surgeon and endocrinologist should also collaborate in optimizing HRT withdrawal and restart in the peri-operative period. The current state of affairs is still lacking such a closed loop inter-disciplinary approach. Hence, an efficient and especially dedicated team can help in achieving the ultimate goal of quality management to harness favourable outcomes for the patient.

CONCLUSIONS

Various parts of the world still suffer through an under-representation of the transgender community which stays confined to the margins of society. However, there is no denying the fact that with the changing tide and rising acceptability of transgender persons, the field of medicine is going to be presented with an increased proportion of these patients. The specific emotional, physiological, and pharmacological concerns coupled with the collaborative interplay of multiple disciplines make this class of patients a challenging lot. It is the attitude, preparedness and prudence of the medical team that can bring about a favourable outcome. Proper training of various health care professionals appears imperative here to empathetically handle and efficiently treat these patients. We would not be wrong in believing that the quality care provided before, during and after surgery has a substantial impact on patient outcomes after GRS. This simultaneously deserves acknowledgement of the fact that extensive studies and evidence are needed to understand and define better strategies for perioperative care in patients presenting for GRS.

ACKNOWLEDGEMENTS

Financial support and sponsorship, conflict of interest.

Fact check on Algerian fighter Imane Khelif, DSDs, biology and Olympic boxing

Despite outcries from anti-trans celebrities and politicians, the International Olympic Committee confirmed Imane Khelif is eligible to compete in women's boxing at the Paris Games.

Khelif went viral on social media after winning her opening bout Thursday against Italy's Angela Carini , who stopped fighting after 46 seconds. Khelif, along with Taiwanese boxer Lin Yu-ting , were both disqualified from their championships in 2023 after the International Boxing Association said they failed gender eligibility testing, a move that the IOC has called a “ sudden and arbitrary decision ."

The two boxers also competed in the 2021 Tokyo Games, but did not medal.

"The IOC is committed to protecting the human rights of all athletes participating in the Olympic Games," the organization said in a statement . "The IOC is saddened by the abuse that the two athletes are currently receiving."

More: As gender eligibility issue unfolds, Olympic boxer Lin Yu-Ting dominates fight

Fact check: Imane Khelif is a woman

Khelif is a woman, who is not transgender, nor identifies as intersex, according to GLAAD and InterACT.

Khelif reportedly has differences of sexual development, known as DSDs, the organizations said in a Fact Sheet released Friday. Having DSD is not the same as being transgender.

What is DSDs?

Differences in sex development is a set of rare conditions involving genes, hormones and reproductive organs that can cause the sexual development of a person to be different than others, according to the NHS.

Sometimes, this can lead to a person having XY chromosomes but develop otherwise female.

Paris Games has full gender parity, IBA stripped of its governing rights

The IBA, long mired with scandal and controversy, oversaw Olympic boxing before being stripped of its right before the Tokyo Games and is no longer recognized of the international federation of boxing.

In the face of backlash over Khelif's 2024 win, the IBA stood by its decision to disqualify the boxers over two "trustworthy" and "independent" tests, though they did not disclose what the tests were. The Washington Post reported IBA president claimed they were disqualified over finding XY chromosomes.

The IOC said the gender and age for the athletes is based on their passports.

The Paris Games is the first in history to reach gender parity. Transgender inclusion has had no negative effect on gender parity at the Olympics, according to GLAAD and InterACT. Also, IOC guidelines state athletes should not be excluded from competing due to alleged unfair advantage based on sex variations, according to GLAAD.

Conservatives seize on boxing to spread anti-trans rhetoric

As part of a large wave of anti-LGBTQ laws in the U.S., transgender women in sports has become a key rallying call for conservatives. In the last five years, 25 states have passed laws banning transgender students from participating in sports that match their gender identity, according to data compiled by MAP , despite research from the Human Rights Campaign showing transgender youth are a small part of the population and not all of them are interested in playing sports.

Former President Donald Trump jumped on Khelif's win at the Olympics to further his campaign promise, posting a video of the fight on social media "I WILL KEEP MEN OUT OF WOMEN'S SPORTS!"

Trump's running mate JD Vance shared a video of the match on X, falsely calling Khelif a man and suggesting Kamala Harris' stance on gender leads to a "disgusting," outcome.

“From my point of view, this was not an equal competition,” conservative Italian Prime Minister Giorgia Meloni said, according to POLITICO.

Khelif told UNICEF earlier this year that she was picked-on for participating in sports as a girl growing up, and had to raise money for her boxing lessons as her father did not approve of her getting into the sport, because she is a girl.

“I started with nothing and now I have everything,” she said.

Contributing: Josh Peter

The olympic gender eligibility questions surrounding boxers from algeria and taiwan, explained, share this article.

Welcome to FTW Explains, a guide to catching up on and better understanding stuff going on in the world. This is FTW Explains: The Olympics.

You may have heard about some talk about a couple of boxers at the 2024 Paris Olympics who had questions about their gender eligibility, and what that all means, and how it all works.

That’s what we’ll dive into when it comes to Algeria’s Imane Khelif and Taiwan’s Lin Yu-ting, especially with the former fighting her first bout on Thursday that made some headlines.

Let’s dive in with what we know about them and the questions heading into the Olympics.

Who are the two boxers at the center of gender eligibility questions?

That would be Khelif and Yu-Ting. The pair of them were disqualified from the women’s boxing world championships in 2023 when reports said they failed gender eligibility tests.

How were they cleared for the 2024 Paris Olympics?

More from USA TODAY Sports’ Josh Peter:

The International Olympic Committee confirmed the two boxers have been cleared to compete here at the Paris Games , as they both did at the Tokyo Games in 2021. The issues of so-called gender verification or sex testing have fueled discussion at the Olympics as the fighters prepare to enter the ring at North Paris Arena. … Last year the IOC banished the International Boxing Association (IBA), long plagued with scandal and controversy that jeopardized the future of Olympic boxing. In fact, the IOC denied IBA the right to run Olympic boxing during the Tokyo Games in 2021 and instead turned over control to an ad-hoc unit. With that ad-hoc unit in charge, Kehlif and Lin both competed at the Tokyo Olympics. Neither won a medal. But the IBA has maintained control of the world championships and gender eligibility rules. And after Lin won gold and Kehlif won bronze at the event in March 2023, officials announced the boxers had failed medical eligibility tests and stripped them of the medals. IBA president Umar Kremlev said DNA tests “proved they had XY chromosomes and were thus excluded.”

We should say out loud, and explicitly, though: they are women. They have not identified themselves in any other way. And per Time, this was said by IOC spokesperson Mark Adams:

“Everyone competing in the women’s category is participating, following, complying with the competition eligibility rules,” IOC spokesperson Mark Adams said during a press conference on Tuesday. “These athletes have competed many times before for many years—they haven’t just suddenly arrived.”

What happened with Khelif in her fight?

She was boxing with Italy’s Angela Carini, who quit 46 seconds in. But she claimed it wasn’t because of the gender eligibility questions but because she was in pain from Khelif’s punches. From ESPN:

A tearful Carini said she quit because of intense pain in her nose after the opening punches. Carini, who had a spot of blood on her trunks, said she wasn’t making a political statement and was not refusing to fight Khelif. “I felt a severe pain in my nose, and with the maturity of a boxer, I said ‘enough,’ because I didn’t want to, I didn’t want to, I couldn’t finish the match,” Carini said. Carini said she is not qualified to judge whether Khelif should be allowed to compete but had no problem fighting her. “I am not here to judge or pass judgment,” Carini said. “If an athlete is this way, and in that sense it’s not right or it is right, it’s not up to me to decide. I just did my job as a boxer. I got into the ring and fought. I did it with my head held high and with a broken heart for not having finished the last kilometer.”

What did the IOC say about this?

There was a lengthy statement that included this:

“We have seen in reports misleading information about two female athletes competing at the Olympic Games Paris 2024. The two athletes have been competing in international boxing competitions for many years in the women’s category …

These two athletes were the victims of a sudden and arbitrary decision by the IBA. Towards the end of the IBA World Championships in 2023, they were suddenly disqualified without any due process.

Joint Paris 2024 Boxing Unit/IOC Statement https://t.co/22yVzxFuLd pic.twitter.com/fZvgsW8OOi — IOC MEDIA (@iocmedia) August 1, 2024

More Olympics

Kevin durant shared the classiest message after making olympic scoring history for team usa, jordan chiles explained how the mantra 'i'm that girl' powered her to another olympic medal, college conferences keep stealing each other's olympic valor thanks to realignment.

Watch the 2024 Paris Olympics FREE on Fubo .

We occasionally recommend interesting products and services. If you make a purchase by clicking one of the links, we may earn an affiliate fee. FTW operates independently, though, and this doesn’t influence our coverage.

Rudy Gobert claimed he had surgery at the Olympics, but Team France coach immediately denied it

9 photos that show just how dominant Sydney McLaughlin-Levrone was in the Olympic 400m hurdle semi-final

1 incredible stat shows just how dominant Sydney McLaughlin-Levrone is in the 400m hurdles

Most popular, nfl power rankings, preseason: only these 3 teams can prevent a historic chiefs’ super bowl three-peat, 9 intense beach volleyball photos from the 2024 paris olympics, 12 photos of noah lyles’ bonkers comeback photo finish to win olympic men’s 100m gold, ranking the 10 best cornerbacks in nfl history, team brazil roster: meet the underdogs that will play team usa in the quarterfinals at the olympics, anglers catching this peculiar fish are urged to ‘kill it on sight’, this trippy 8-frame composite photo of noah lyles' 100m finish should be hung in the louvre.

Please enter an email address.

Thanks for signing up.

Please check your email for a confirmation.

Something went wrong.

What happened with Imane Khelif, boxer who had gender test issue, at Olympics?

Khelif was disqualified from the 2023 world championships after failing an unspecified gender eligibility test, and her presence at the paris olympics has become a divisive issue, by nbc chicago staff and greg beacham | the associated press • published august 1, 2024 • updated on august 2, 2024 at 12:33 pm.

UPDATE: The latest updates on this story, including if Khelif will box again, can be found here . Our original story continues below.

Imane Khelif of Algeria won her opening Olympic boxing bout Thursday when opponent Angela Carini of Italy quit after just 46 seconds in an unexpected and highly unusual moment, but what exactly caused it?

📺 24/7 Chicago news stream: Watch NBC 5 free wherever you are

Carini set the record straight following the headline-making moment.

Here's what to know:

What happened in the Imane Khelif-Angela Carini match?

Carini and Khelif exchanged only a few punches before Carini walked away and abandoned the bout — an extremely unusual occurrence in Olympic boxing.

Carini’s headgear apparently became dislodged at least once before she quit.

Paris 2024 Summer Olympics

Watch all the action from the Paris Olympics live on NBC

Why are there more bronze medals awarded than gold and silver at the 2024 Olympics?

Michael Phelps calls for lifetime ban for anyone who's caught doping

Carini didn't shake Khelif's hand after the decision was announced but cried in the ring on her knees.

Who is Imane Khelif?

329 medal events. 32 sports. Endless drama. Catch all the action at the Paris Olympics. Sign up for our free Olympics Headlines newsletter.

Khelif was disqualified from the 2023 world championships after failing an unspecified gender eligibility test, and her presence at the Paris Olympics has become a divisive issue.

Khelif is an accomplished amateur who won a silver medal at the International Boxing Association's 2022 world championships. The same governing body disqualified her from last year's championships shortly before her gold-medal match because of what it claimed were elevated levels of testosterone.

The 25-year-old entered the ring at the North Paris Arena to a chorus of cheers, but the crowd was confused by the bout's sudden end. Khelif, who fights again Saturday, didn't speak to reporters.

What did Carini say?

After the match, a still-tearful Carini said she quit because of intense pain in her nose after the opening punches. Carini, who had a spot of blood on her trunks, said she wasn't making a political statement and was not refusing to fight Khelif.

“I felt a severe pain in my nose, and with the maturity of a boxer, I said ‘enough,’ because I didn’t want to, I didn’t want to, I couldn’t finish the match," Carini said.

Carini further said she is not qualified to decide whether Khelif should be allowed to compete, but she had no problem fighting her.

“I am not here to judge or pass judgment,” Carini said. "If an athlete is this way, and in that sense it’s not right or it is right, it’s not up to me to decide. I just did my job as a boxer. I got into the ring and fought. I did it with my head held high and with a broken heart for not having finished the last kilometer.”

Carini said she was "heartbroken" by her decision.

“I am heartbroken because I am a fighter," Carini said. “My father taught me to be a warrior. I have always stepped into the ring with honor and I have always (served) my country with loyalty. And this time I couldn’t do it because I couldn’t fight anymore, and so I ended the match.”

What else to know about the controversy

Khelif and Lin Yu‑ting of Taiwan suddenly have received massive scrutiny for their presence in Paris after years of amateur competition. Lin won IBA world championships in 2018 and 2022, but the governing body stripped her of a bronze medal last year because it claimed she failed to meet unspecified eligibility requirements in a biochemical test.

Lin begins her Paris run Friday, fighting Uzbekistan’s Sitora Turdibekova in her opening bout after receiving a first-round bye.

The Algerian Olympic Committee issued a statement Wednesday condemning what it termed “lies” and “unethical targeting and maligning of our esteemed athlete, Imane Khelif, with baseless propaganda from certain foreign media outlets.”

Italian Premier Giorgia Meloni, who was visiting Italy athletes in the Olympic Village on Thursday, voiced criticism that Carini had to box Khelif, saying she had since 2021 opposed allowing athletes with “genetically male” characteristics to compete against women.

“We have to pay attention, in an attempt to not discriminate, that we’re actually discriminating,” against women’s rights, Meloni said.

She said it was necessary to guarantee the rights of athletes so they are competing on an even playing field.

“In these things what counts is your dedication, your head and character, but it also counts having a parity of arms,” Meloni said.

Khelif and Lin are two-time Olympians who fought in the Tokyo Games with no controversy. Lin has been an elite-level amateur boxer for a decade and Khelif for six years. They were allowed to compete in Paris by the IOC task force, which has run the past two Olympic boxing tournaments.

The IOC on Tuesday defended their right to compete. Olympic boxing reached gender parity for the first time this year, with 124 men and 124 women competing in Paris.

“Everyone competing in the women’s category is complying with the competition eligibility rules,” IOC spokesperson Mark Adams said. ”They are women in their passports and it’s stated that this is the case, that they are female.”

Lin is the top seed in the 57-kilogram category, although Olympic seeding is frequently unindicative of the top medal contenders in a division.

Several sports have updated their gender rules over the past three years, including World Aquatics , World Athletics and the International Cycling Union . The track body also last year tightened rules on athletes with differences in sex development.

The IOC said it made its eligibility decisions on boxers based on the gender-related rules that applied at the 2016 Rio de Janeiro Olympics.

The IOC is in charge of boxing in Paris because the IBA has been banned from the past two Olympics because of years of governance problems, a lack of financial transparency and many perceived instances of corruption in judging and refereeing.

The IOC has revoked the Olympic status of the IBA, which is controlled by president Umar Kremlev, who is Russian. He brought in Russian state-owned Gazprom as its primary sponsor and moved much of the IBA’s operations to Russia.

The IBA has since lost more than three dozen members who have formed a new group called World Boxing, which hopes to be recognized by the IOC as the sport’s governing body ahead of the 2028 Los Angeles Games.

The IBA has aggressively seized on the boxers’ presence in Paris to criticize the IOC. After the Court of Arbitration for Sport upheld the IOC’s ban earlier this year, the IBA appealed to the Swiss Federal Tribunal.

The banned body issued a statement Wednesday in which it claimed both boxers did not have a “testosterone examination” last year but were “subject to a separate and recognized test” for their disqualification. The IBA said the test’s “specifics remain confidential,” refusing to explain it.

Women’s boxers have been asked about Khelif and Lin repeatedly this week. Many have expressed concern, while others have urged more consideration of an obviously complicated issue.

“I don’t agree with that being allowed, especially in combat sports as it can be incredibly dangerous,” Australia middleweight Caitlin Parker said. “But right now, my focus is on getting through each fight. It’s not like I haven’t sparred with guys before, but it can be dangerous for combat sports, and it should be seriously looked into. It is good that these things are coming out, and it’s being put under the spotlight to be looked into further.

“Biologically and genetically, they are going to have more advantages. Combat sports can be dangerous. Fairness is what it’s all about. We all want fairness in sport.”

This article tagged under:

BREAKING: Rep. Cori Bush, an outspoken critic of Israel, loses her Democratic primary in Missouri after massive spending against her by pro-Israel groups

Boxer previously barred from women’s events wins fight after opponent quits in 46 seconds

A female boxer whose gender identity has recently been questioned won her first fight at the Paris Olympics on Thursday.

Imane Khelif of Algeria defeated Angela Carini of Italy after Carini quit 46 seconds into the match. Carini stopped the fight after only a few punches were exchanged, avoided shaking Khelif’s hand and then fell to the floor in tears.

Khelif’s participation in Olympic women’s boxing has been scrutinized in recent days after reports resurfaced that she and another boxer, Lin Yu‑ting of Taiwan, failed to meet gender eligibility tests at the Women’s World Boxing Championships in New Delhi last year. At the time, sporting officials alleged that the boxers failed an unspecified test because they had male chromosomes.

Khelif, 25, has always competed as a woman — including during the Tokyo Olympics — and there’s no indication that she identifies as transgender or intersex, the latter referring to people born with sex characteristics that do not fit strictly into the male-female gender binary.

Carini said she ended Thursday’s fight because she felt a “severe pain” in her nose. She added that she is not qualified to decide whether Khelif should have been allowed to compete.

“I am not here to judge or pass judgment,” Carini told reporters after the match. “If an athlete is this way, and in that sense it’s not right or it is right, it’s not up to me to decide.”

Others were less reserved.

“We have to pay attention, in an attempt to not discriminate, that we’re actually discriminating” against women, Italian Prime Minister Giorgia Meloni told reporters during a visit to the Olympic Village. “In these things what counts is your dedication, your head and character, but it also counts having a parity of arms.”

Several American politicians, including former President Donald Trump, Sen. Marco Rubio, R-Fla., and South Dakota Gov. Kristi Noem , also shared their views on the match.

“I WILL KEEP MEN OUT OF WOMEN’S SPORTS!” Trump wrote on his social media site, Truth Social .

Khelif’s win also provoked responses from several prominent figures who are frequently criticized for their remarks about transgender people.

“Harry Potter” author J.K. Rowling repeatedly referred to Khelif as “male” and called the match a “ brutal injustice ” in a series of posts on X.

Billionaire entrepreneur Elon Musk, who recently drew criticism for his comments about his estranged trans daughter , also weighed in on X, which he owns. Replying to a post that included a video of the fight and read “Kamala supports this…vote accordingly,” Musk, who endorsed Trump last month, wrote: “True or let her deny it.”

While most of the responses online appear to be critical, Khelif was not without support.

Ismaël Bennacer, who plays soccer for the Algerian national team, was among those who defended Khelif.

“Full support for our champion Imane Khelif, who is suffering a wave of unjustified hatred,” he wrote on X. “Her presence at the Olympic Games is simply the result of her talent and hard work.”

Khelif celebrated her win on social media, sharing a photo of herself from Thursday’s fight on Instagram and writing, “first Victory.” She did not address the criticisms in the post; she has said her disqualification from the world championships last year was a “conspiracy.”

In a s tatement Thursday, the International Olympic Committee criticized the backlash directed at Khelif and Taiwan's Lin during the Olympics, as well as the decision by the International Boxing Association, or IBA, to disqualify them from last year's Women’s World Boxing Championships.

"The current aggression against these two athletes is based entirely on this arbitrary decision, which was taken without any proper procedure — especially considering that these athletes had been competing in top-level competition for many years," the statement said, in part. "Such an approach is contrary to good governance."

The IOC noted in its statement that it withdrew recognition of the IBA last year. The relationship was severed following years of governance and financial transparency issues, as well as perceived instances of corruption.

Instead of the IBA, the IOC refers to the Paris 2024 Boxing Unit — an ad-hoc unit it developed — for its eligibility standards. In Thursday's statement, the IOC said, "As with previous Olympic boxing competitions, the gender and age of the athletes are based on their passport."

The Algerian Olympic and Sports Committee did not respond to a request for comment about the criticisms surrounding Khelif’s win.

Abderrahmane Hammad, Algeria’s minister of youth and sports, addressed concerns over Khelif’s gender identity Wednesday.

“I strongly condemn the baseless attacks on our athlete, Imane Khelif, by certain foreign outlets,” he wrote on X . “These cowardly attempts to tarnish her reputation are utterly unacceptable.”

The Shameful Controversy Over Olympic Boxer Imane Khelif

Image may contain Clothing Glove Helmet Adult Person Boxing and Sport

This story was originally published in WIRED Italia and has been translated from Italian.

Algerian boxer Imane Khelif won her first match of the 2024 Paris Olympics when her opponent, Angela Carini of Italy, quit after taking several blows to the face in the opening seconds of the bout. The victory only fueled the misguided controversy around Khelif, who has been targeted by critics who have misgendered her throughout the Games.

Born in 1999 in Tiaret, Algeria, Khelif has been boxing since she was a child and has always competed in women's categories. In her career, she competed in the Women's World Boxing Championships in New Delhi in 2018 (finishing in 17th place), then competed in Russia the following year. She competed in the 2020 Tokyo Olympic Games, reaching all the way to the quarterfinals, and she finished second in the 2022 Women's World Championships in Istanbul.

Everything seemed to be running smoothly until the 2023 World Cup, organized by the International Boxing Association. The Russia-led IBA, which is not recognized by the International Olympic Committee, disqualified Khelif after a gender eligibility test allegedly found she has XY chromosomes. IBA president Umar Kremlev has said that both Khelif and Taiwanese boxer Lin Yu-ting, who allegedly had a similar test result, “were trying to deceive their colleagues and pretend to be women.” Khelif has contested the allegations.

The Olympics Controversy

Both Khelif and Lin were admitted to Olympic boxing competitions. Admission rules in this case are handled by the so-called Boxing Unit, which has ensured that all athletes participating in the Games' boxing tournament comply with the rules of eligibility and registration for the competition as well as all medical regulations, which also includes the appropriate demonstration of medical certificates stamped and verified to at least three months before the start of the competitions.

“These boxers are completely eligible. They are women on their passports, they are women who have competed in the Tokyo Olympics and have been competing for many years, I think we all have a responsibility to tone it down and not turn it into a witch hunt,” said IOC spokesperson Mark Adams, at a news conference on Tuesday.

Still, prominent figures on social media decried Khelif's participation in the Games. X owner Elon Musk amplified a tweet from swimmer Riley Gaines that “men don't belong in women's sports,” while author J.K. Rowling falsely referred to Khelif as “a male who’s knows he’s protected by a misogynist sporting establishment enjoying the distress of a woman he’s just punched in the head.”

The fact is that Khelif is participating in the Games because she is allowed to by the rules, and has passed the IOC's standards. “The current aggression against these two athletes is based entirely on this arbitrary decision,” said the Boxing Unit and IOC in a statement Thursday, referring to the IBA ban. “[It] was taken without any proper procedure—especially considering that these athletes had been competing in top-level competition for many years. Such an approach is contrary to good governance.”

The controversies of the past few days took serious issues such as hyperandrogynism—the excessive production of testosterone by female bodies—and intersexuality, in which someone is born with sex characteristics that don't fit neatly into traditional definitions of male and female, and debased them. They then further poisoned an already very sensitive debate around transgender women's participation in the Olympics and sports competitions in general.

Beyond everything, however, the fact remains that Imane Khelif has always defined herself as a woman and the IOC is allowing her participate in the Olympics as such. Even in the face of assaultive public opinion, there is nothing to add.

Give Your Back a Break With Our Favorite Office Chairs

You Might Also Like …

In your inbox: Our biggest stories , handpicked for you each day

How one bad CrowdStrike update crashed the world’s computers

The Big Story: How soon might the Atlantic Ocean break ?

Welcome to the internet's hyper-consumption era

Olympics: Follow all our coverage from Paris this summer here

Everything You See Is a Computational Process, If You Know How to Look

IMAGES

How Gender Reassignment Surgery Works (Infographic)
Psychiatric evaluation for gender reassignment surgery india Indore Mumbai Bhopal Lucknow Raipur
Using Therapeutic Assessment in Psychological Assessments Required for
The Comprehensive Guide to Gender Reassignment Surgery: Risks and
(PDF) Gender reassignment surgery
Guide On Gender Reassignment Surgery

VIDEO

Gender reassignment surgery
Gender reassignment surgery😄😅 "Do i contradict myself? Whatever, i contain multitudes" W. Whitman😄
Things I didn't expect after gender reassignment surgery |Transgender MTF
Sexual Reassignment Surgery #transgendercenterbrazil #transgender #transwoman
Gender Reassignment Surgery M-T-F
Gender Reassignment Surgery catch-up 🩷🩷 #shorts #trans #transition

COMMENTS

PDF Guidelines for Psychosocial Assessments for Sexual Reassignment Surgery
A comprehensive assessment for gender dysphoria covers a lot of territory. It includes a gender assessment and a solid basic assessment as well as identifying strengths and resources. Most agencies and clinicians have their own clinical assessment tools. A current Mental Status Exam (MSE) is important for informed consent.
Readiness assessments for gender-affirming surgical treatments: A
The only other manuscripts that include a mention of psychological testing describe processes in Iran and China, both of which require extensive psychological testing prior to approval for ... Ethical issues in psychosocial assessment for sex reassignment surgery in Canada. Canad Psychol. (2017) 58:178-86. 10.1037/cap0000087 ...
PDF Assessment and Treatment of Gender Dysphoria and Gender Variant
Gender Incongruence (capitalized): A diagnostic category (analogous to Gender Dysphoria in DSM-5) proposed for ICD-11. Gender variance: any variation of experienced or expressed gender from socially ascribed norms within the gender binary. Genderqueer: an identity label used by some individuals whose experienced and/or ex-pressed gender does ...
Should Mental Health Screening and Psychotherapy Be Required Prior to
In short, psychological assessment and counseling can be instruments of success in gender transition rather than impediments to the exercise of choice. Still, a skeptic might respond that assessment and counseling are not equally valuable or necessary to all people. If so, these processes should be optional, not obligatory.
Gender Affirmation Surgeries: Common Questions and Answers
Mental health evaluation: A mental health evaluation is required to look for any mental health concerns that could influence an individual's mental state, and to assess a person's readiness to undergo the physical and emotional stresses of the transition.; Clear and consistent documentation of gender dysphoria; A "real life" test: The individual must take on the role of their gender in ...
Preparing for Gender Affirmation Surgery: Ask the Experts
Request an Appointment. 844-546-5645 United States. 855-695-4872 Outside of Maryland. +1-410-502-7683 International. To help provide guidance for those considering gender affirmation surgery, two experts from the Johns Hopkins Center for Transgender Health answer questions about what to expect before and after your surgery.
Mental Health Evaluation for Gender Confirmation Surgery
Mental Health Evaluation for Gender Confirmation Surgery Clin Plast Surg. 2018 Jul;45(3):307-311. doi: 10.1016/j.cps.2018.03.002. Epub 2018 Apr 19. Author Randi Ettner 1 Affiliation 1 New Health Foundation Worldwide, 1214 Lake Street, Evanston, IL 60201, USA. Electronic address: [email protected]. ... Sex Reassignment Surgery / psychology*
Evaluation of Mental Health and Satisfaction Following Transfeminine
Keywords: gender reassignment procedures, major depressive disorder, PHQ-9, sex reassignment surgery, trans women. Introduction. Depression is one of the most common, yet under-recognized medical conditions around the world. ... Comparative assessment of psychological factors and treatment outcomes. As shown in Table 2, all aspects of ...
Overview of gender-affirming treatments and procedures
Transgender people may seek any one of a number of gender-affirming interventions, including hormone therapy, surgery, facial hair removal, interventions for the modification of speech and communication, and behavioral adaptations such as genital tucking or packing, or chest binding. All of these procedures have been defined as medically ...
Gender Affirmative Surgery Psychological Evaluations
Deep Eddy Psychotherapy offers psychological evaluations for gender affirmative surgery candidacy for our clients (ages 18 and up). Our clinicians are dedicated to helping the transgender, non-binary, genderqueer, and gender-expansive community by providing this evaluation service along with individual, group, and couples therapy.
PDF Providing Mental Health Assessments for Gender Affirming Surgery
At FHC: Complete the intake evaluation and readiness assessment, present the case and add person to the waitlist. Depending on person's timeline needed for having surgery, you can offer to complete the assessment for the letter. The person can remain on the waitlist during that time. Outside of FHC: Complete intake evaluation per agency or ...
Psychiatric Assessment of Transgender Adults for Sex Reassignment Surgery
Article: 0154 Topic: W08 - Workshop 09: Lesbian, gay, bisexual, and transgender affirmative psychiatry: The next generation Psychiatric Assessment of Transgender Adults for Sex Reassignment Surgery C. McIntosh1 1Gender Identity Clinic, Centre for Addiction and Mental Health, Toronto, Canada While pre-surgical assessments by an internist are relatively common, those by psychiatrists are much ...
Psychological and Neuropsychological Assessment with Transgender and
Transgender, gender nonbinary and gender diverse clients may present for psychological assessment for the same reasons as cisgender clients. These assessments may be necessary in order to obtain appropriate supports or treatment. However, in the case of clients who do not identify as cisgender, use of gender in the scoring procedure may harm ...
PDF Clinical Review Criteria Related to Gender Reassignment Surgery
There is no hormonal therapy requirement for mastectomy only. 5. Member has lived as their reassigned gender full time for 12 months or more. 6. Member's medical and mental health providers document that there are no contraindications for the planned surgery and agree with the plan. 7.
Using therapeutic assessment in psychological assessments required for
Citation. Finn, S. E. (2016). Using therapeutic assessment in psychological assessments required for sex reassignment surgery. In V. M. Brabender & J. L. Mihura (Eds.), Handbook of gender and sexuality in psychological assessment (pp. 511-533).
PDF Gender reassignment surgery: an overview
Gender reassignment surgery is a series of complex surgical procedures (genital ... psychological perspectives, without supportive evidence ... Psychiatric evaluation is essential before gender ...
Psychosocial Adjustment to Sex Reassignment Surgery: A Qualitative
For people undergoing gender transition, psychological monitoring is organized through all phases of medical treatment. ... were asked a series of open-ended questions related to the decision-making process regarding transition and sex reassignment surgery, their experience of discrimination due to gender dysphoria, social support during the ...
Gender reassignment surgery: an overview
The management of gender dysphoria consists of a combination of psychotherapy, hormonal therapy, and surgery. Psychiatric evaluation is essential before gender reassignment surgical procedures are ...
Ethical issues in psychosocial assessment for sex reassignment surgery
Transgender individuals often pursue sex reassignment surgery to reduce the distress that results from a mismatched physical appearance and gender identity. Depending on the specific procedure, 29%-93% of transgender individuals desire some form of surgery. Sex reassignment surgery as a therapeutic intervention is controversial, as it entails the alteration or removal of healthy tissue. Due ...
Full article: Surgical Satisfaction, Quality of Life, and Their
We assessed the outcomes of gender-affirming surgery (GAS, or sex-reassignment surgery) 4 to 6 years after first clinical contact, and the associations between postoperative (dis)satisfaction and quality of life (QoL). ... On the measures of this outcome research, Kuiper and Cohen-Kettenis (Citation 1988) stated, "In our opinion an evaluation ...
Olympic Boxer Imane Khelif Is Not a Trans Athlete
Gender testing for women's sports remains controversial. The rationale is that the process of going through puberty as a male imparts significant physical advantages over females that could make ...
Olympics gender testing discussed as two female boxers cleared
The issues of so-called gender verification or sex testing have fueled discussion at the Olympics as the fighters prepare to enter the ring at North Paris Arena. Khelif, a silver medalist at the ...
Gender reassignment surgery
Preparation for GRS is a multistage process that includes an elaborate psychological and wellbeing assessment of the patient. This may take nearly 12 months for complete psychosocial preparation of the patient to deal with the transition. ... Complications in gender reassignment surgery, associated risk factors and preventive measures ...
Fact check: Imane Khelif is a biological woman, not trans or intersex
In the last five years, 25 states have passed laws banning transgender students from participating in sports that match their gender identity, according to data compiled by MAP, despite research ...
Olympic boxing gender eligibility questions, explained
The pair of them were disqualified from the women's boxing world championships in 2023 when reports said they failed gender eligibility tests. How were they cleared for the 2024 Paris Olympics?
What happened with Imane Khelif, boxer who had gender test issue, at
The IOC on Tuesday defended their right to compete. Olympic boxing reached gender parity for the first time this year, with 124 men and 124 women competing in Paris.
Boxer Imane Khelif, previously barred from women's events, wins first
A female boxer whose gender identity has recently been questioned won her first fight at the Paris Olympics on Thursday. Imane Khelif of Algeria defeated Angela Carini of Italy after Carini quit ...
Ethical issues in psychosocial assessment for sex reassignment surgery
Transgender individuals often pursue sex reassignment surgery to reduce the distress that results from a mismatched physical appearance and gender identity. Depending on the specific procedure, 29%-93% of transgender individuals desire some form of surgery. Sex reassignment surgery as a therapeutic intervention is controversial, as it entails the alteration or removal of healthy tissue. Due ...
The Shameful Controversy Over Olympic Boxer Imane Khelif
The Russia-led IBA, which is not recognized by the International Olympic Committee, disqualified Khelif after a gender eligibility test allegedly found she has XY chromosomes. IBA president Umar ...
Boxer Imane Khelif, who faced gender-eligibility claim, wins Olympic
After Algeria's Imane Khelif beats Italy's Angela Carini in opener, social media erupts with critics citing disqualifications from 2023 world championships.

Preparation and Procedures Involved in Gender Affirmation Surgeries

Transitioning

Reasons for Undergoing Surgery

Steps Required Before Surgery

Hormone Therapy & Transitioning

Effects of Testosterone

Effects of Estrogen

When Are the Hormonal Therapy Effects Noticed?

Timeline of Surgical Process

Transfeminine Surgeries

Transmasculine Surgeries

Complications and Side Effects

Cost of Gender Confirmation Surgery

Quality of Life After Surgery

A Word From Verywell

Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Preparing for Gender Affirmation Surgery: Ask the Experts

What kind of care should I expect as a transgender individual?

Can I still have children after gender affirmation surgery?

Are there other ways I need to prepare?

An initial intake interview via phone with a clinical specialist.

An appointment with your surgeon.

A preoperative anesthesia and medical evaluation.

What can I expect after gender affirming surgery?

The Center for Transgender and Gender Expansive Health Team at Johns Hopkins

Find a Doctor

Find a Treatment Center

Request an Appointment

Related Topics

Save citation to file

Add to My Bibliography

Mental Health Evaluation for Gender Confirmation Surgery

Similar articles

Publication types

Related information

Other Literature Sources

Miscellaneous

Gender Affirmative Surgery Psychological Evaluations

What is a gender affirmative surgery evaluation?

Do you need an evaluation for hormone replacement treatment (HRT)?

What does a gender affirmative surgery evaluation assess for?

Who can write an attestation letter?

Psychological and Neuropsychological Assessment with Transgender and Gender Nonbinary Adults

LGBT Resources

Contact the Office

Gender reassignment surgery: an overview

Access options

Similar content being viewed by others

Principles and outcomes of gender-affirming vaginoplasty

Sexual function of transgender assigned female at birth seeking gender affirming care: a narrative review

The effect of early puberty suppression on treatment options and outcomes in transgender patients

Author information

Contributions

Corresponding author

Ethics declarations

Rights and permissions

About this article

Share this article

This article is cited by

Chest Feminization in Transwomen with Subfascial Breast Augmentation—Our Technique and Results

Vaginoplasty in Male to Female transgenders: single center experience and a narrative review

Urethral complications after gender reassignment surgery: a systematic review

Overview on metoidioplasty: variants of the technique

Quick links

Olympic Boxer Imane Khelif Is Not a Trans Athlete

Who is Imane Khelif?

What Happened in 2023?

Can Women Have XY Chromosomes or Elevated Testosterone?

IOC Responds

Angela Carini Was Not Making a Political Statement

Bottom Line

By Alex Kasprak

Article Tags

Gender reassignment surgery – a narrative overview of anaesthetic considerations and implications

Amborish Nath

Ashutosh Kaushal

Rakesh Kain

RESEARCH METHODS

History and current scenario

OVERVIEW OF THE PROCEDURE

An appointment with your surgeon. 

A preoperative anesthesia and medical evaluation. 