‘The right thing for patients’

surgery for transgender patients

On a Monday morning in late January 2018, surgeons and clinical staff entered the operating room with one primary goal: to forever change the life of the young man who lay before them. More than 14 hours later, the team had made history, performing the first phalloplasty — surgical creation of a penis — for a transgender patient at a major U.S. pediatric hospital.

For the 24-year-old patient, the procedure was the final step in a lifelong path to align his body with his identified gender. But the experience was also transformational for the clinicians in the OR that day. “This was one of the most rewarding experiences in my career,” one of the nurses later wrote to plastic surgeon Amir Taghinia, MD, co-director of the Center for Gender Surgery at Boston Children’s Hospital, and his colleagues. “It was a true team effort and we helped change this boy’s life.”

A full suite of services

Beginning this year, the Center for Gender Surgery offers gender affirmation surgery services to eligible adolescents and young adults. Specialists in plastic surgery, urology, endocrinology, nursing, gender management and social work collaborate to provide patients with a full suite of surgical options, including chest reconstruction, breast augmentation, metoidioplasty, phalloplasty and vaginoplasty.

These procedures are offered as part of clinical care for gender dysphoria, the significant distress that can occur when there is a conflict between the gender a person was assigned at birth and the gender with which they identity. To qualify for such procedures, patients must meet certain criteria, including specific age minimums and clinical documentation of gender dysphoria. Gender surgery, and surgery on the genitals in particular, is typically one of the final steps in the gender affirmation process and usually occurs after a patient has explored other social and medical options, such as taking supplemental hormones.

Caring for a condition of childhood

The decision to launch the Center for Gender Surgery was a natural next step for a hospital that has always been at the forefront of pediatric care, says the center’s co-director, plastic surgeon Oren Ganor, MD. The growing number of transgender patients in both the local community and in the hospital’s Gender Management Service sparked his interest in forming the center. “This is a population that is medically underserved,” he says. “We want to provide all the care possible to patients who need our help, including transgender patients.”

Throughout the process, the co-directors discussed the potential ethical concerns associated with creating such a center, says co-director David Diamond, MD, who is also Boston Children’s urologist-in-chief. At top of mind was the question of whether such services should be offered at a children’s hospital. Patients must meet certain age requirements to qualify for specific procedures: The age minimum for phalloplasty is 18, for example.

But just as important was the obligation to provide young patients with necessary care. “Boston Children’s treats conditions of childhood, and gender dysphoria often begins in childhood,” explains Ganor. “We believe this center and the services we provide are fully in line with the hospital’s mission.”

‘Something special’

With their first phalloplasty procedure a success, the clinical team is screening and preparing future candidates and continuing to offer other gender surgeries. With its location in a major academic hospital, the center has a unique opportunity to spearhead research and innovation in this area, which will ideally inform clinical knowledge of gender surgery and related issues.

“Boston Children’s has a long tradition of bold surgical breakthroughs, of being willing to take risks and of doing the right thing for patients,” explains Diamond. “To be the first pediatric hospital to offer these services is something special.”

Learn about the Center for Gender Surgery and listen to the WBUR radio story about its genesis.