January - March 2025, Volume 21, Issue 1

Hariga CS, Bordeanu-Diaconescu Eliza Maria, Grosu-Bularda A

Management of Gender-Affirming Patients – A Plastic Surgery Perspective

Acta Endo (Buc) 2025, 21 (1): 103-109
doi: 10.4183/aeb.2025.103

Gender diversity is currently recognized as a natural variation of human identity rather than a pathological condition, with the term “gender identity disorder” being replaced in the eleventh revision of the International Classification of Diseases and Related Health Problems (ICD‐11) by “gender incongruence” and reclassified under “conditions related to sexual health” rather than within “mental and behavioral disorders”. Lack of access to genderaffirming care or delays in treatment are associated with poorer physical, psychological, and social outcomes. Current concepts and clinical practices in gender-affirming care focus on the multidisciplinary integration of endocrine and surgical management. This review summarizes diagnostic considerations and surgical perspectives on transgender patient care from a plastic surgery standpoint, while endocrinology specialists manage hormonal therapy. Surgical treatment for transgender women may include procedures such as breast augmentation, body contouring procedures, vaginoplasty, facial feminization, reduction of the thyroid cartilage, and surgeries intended to alter voice characteristics. The surgical options for transgender men include bilateral mastectomy, placement of pectoral implants to create a male-contoured chest, total hysterectomy and salpingooophorectomy, vaginectomy, scrotoplasty, placement of testicular prostheses, metoidioplasty or phalloplasty, and body contouring procedures. This review aims to support clinicians by synthesizing current evidence and best practices to promote safe, effective, and individualized multidisciplinary treatment for transgender and genderdiverse patients.

Keywords: transgender and gender diverse (TGD) patients, gender-affirming surgery, hormone therapy, mastectomy, breast augmentation, vaginoplasty, phalloplasty.

Correspondence: Eliza-Maria Bordeanu-Diaconescu MD, Clinical Emergency Hospital of Bucharest, Clinic of Plastic Surgery and Reconstructive Microsurgery, 8 Calea Floreasca Street, Bucharest, 014461, Romania, E-mail: eliza.diaconescu@umfcd.ro