For decades, access to genital surgery related to gender identity has been extremely limited. But more transgender people have been able to get these types of surgery (including vaginoplasty, metoidioplasty, and phalloplasty procedures) in recent years, thanks in part to expansion of care and non-discrimination provisions through the Affordable Care Act.
Now, an open letter, by trans people who have had these surgeries calls for greater oversight, saying that some patients have been given procedures by providers lacking adequate experience, been told inaccurate complication rates based on lack of follow-up or incomplete data collection, and denied appropriate aftercare for these major reconstructive surgeries, among other concerns. According to co-writer Gaines Blasdel, 34 individuals had signed the letter by April 8.
The letter urges the World Professional Association of Transgender Health (WPATH) to offer accreditation for surgical membership, among other interventions, to address the need for quality surgical services for trans people.
"The performance of genital surgery for transgender, transsexual, and gender non-binary people is an exceptionally interdisciplinary endeavor," the letter explains, "and WPATH is uniquely positioned to reduce harm being done to vulnerable patients by the current lack of oversight."
The letter invites members of the "post-operative genital surgery community" to add their endorsement, with the option of just using their initials if they wish to preserve their anonymity.
The letter lists significant concerns about surgeons who are WPATH members, while clarifying that it is not referring to all WPATH-affiliated surgeons or focused on any one particular WPATH member. As stated by the letter, patients have experienced surgeons who are:
- Providing free or low-cost surgeries in which surgeons have not completed adequate training.
- Engaging in pre-operative counseling, academic publishing, and public presentations using misleadingly low complication rates.
- Providing insufficient aftercare.
- Providing patients with inaccurate medical information.
- Offering experimental procedures without full or accurate informed consent.
"Many surgeons have, to our great relief, stepped in after experiences of mistreatment and dismissal in less ethical hands," the letter explains. "We ask [WPATH] to join with us in creating minimum acceptable practices."
The letter asks that WPATH proceed in this endeavor with "substantial input from a Community Advisory Board of patients." The letter also calls for establishment of a third-party "collaborative research database" that can offer up-to-date and reliable information for both providers and patients.
WPATH is currently writing its eight edition of standards of care (SOC) for transgender people, so the letter asks for a response from the leaders of that effort.
"We know that there is no perfect procedure, and no perfect surgeon, and we have no desire to hold the surgical community to unrealistic standards," the letter emphasizes. "We are thankful that surgeons have chosen to specialize in a historically-marginalized population, and understand that they frequently do so at personal and professional risk."
(Disclosure: I contributed editorial suggestions to the draft version of this letter.)