Skip to main content

Advertisement

SpringerLink
Log in

Perioperative Considerations for Gender-Affirming Surgery

  • Global Health Anesthesia (M Prin, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

As perioperative patient advocates, anesthesiology providers should be well prepared to deliver compassionate gender-affirming care to their transgender patients. The purpose of this paper is to identify areas where there is a lack of knowledge and to review this standard of care and to highlight high-yield topics that are directly applicable to the perioperative care of transgender patients.

Recent Findings

A wide range of anatomical, physiological, psychological, and anatomical changes exist within the transgender and gender-diverse community who seek gender-affirming care. Resources such as the World Professional Association for Transgender Health (WPATH) standard of care version 8 and UCSF Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People are valuable resources to guide your management.

Summary

The lack of knowledge about gender-affirming care results in discrimination against the transgender and gender-diverse community. There should be a focus on educating anesthesiology providers on gender-affirming care and highlighting possible challenges that these patients might pose in perioperative period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. James SE, Herman JL, Rankin S, et al. The report of the 2015 U.S. transgender survey. Washington, DC: National Center for Transgender Equality. (2016)

  2. Ayhan CHB, Bilgin H, Uluman OT, et al. A systematic review of the discrimination against sexual and gender minority in health care settings. Int J Health Serv. 2020;50(1):44–61.

    Article  PubMed  Google Scholar 

  3. MacCormick H, George RB. Sexual and gender minorities educational content within obstetric anesthesia fellowship programs: a survey. Can J Anesth. 2020;67:532–40.

    Article  PubMed  Google Scholar 

  4. Roque RA, O’Reilly-Shah V, Lorello GR, et al. Transgender patient care: a prospective survey of pediatric anesthesiologist attitudes and knowledge. Can J Anesth. 2021;68(11):1723–6.

    Article  PubMed  Google Scholar 

  5. Tollinche LE, Rosa WE, van Rooyen CD. Perioperative considerations for person-centered gender-affirming surgery. Adv Anesth. 2021;39:77–96. https://doi.org/10.1016/j.aan.2021.07.005.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Grant JM, Motter LA, Tanis J, et al. Injustice at every turn: a report of the national transgender discrimination survey. Washington, DC; 2011

  7. Valentine SE, Shipherd JC. A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev 2018. Q18

  8. Kcomt L. Profound health-care discrimination experienced by transgender people: rapid sys tematic review. Soc Work Health Care 2019; https://doi.org/10.1080/00981389.2018.1532941

  9. Seelman KL, Kattari SK, Harvey P, et al. Trans men’s access to knowledgeable providers and their experiences in health care settings: differences by demographics, mental health, and degree of being ‘“out”’ to providers. Health Soc Work. 2020. https://doi.org/10.1093/hsw/hlaa030.

    Article  Google Scholar 

  10. Ruben MA, Livingston NA, Berke DS, et al. Lesbian, gay, bisexual, and transgender veterans’ experiences of discrimination in health care and their relation to health outcomes: a pilot study examining the moderating role of provider

  11. Flower L, Edwardson S. Peri-operative management of transgender patients: time for some guidance? Anaesthesia. 2022;77:1313–4. https://doi.org/10.1111/anae.15819. UK researchers investigated the confidence or anesthesiologist in the perioperative management of transgender patients. The importance of this survey does not just lie in identifying the lack of knowledge of confidence of providers but rather the impact of what a 2-h webinar covering peri-operative anesthetic, surgical, and endocrine considerations for transgender patients can have on the providers.

    Article  CAS  PubMed  Google Scholar 

  12. Boskey ER, Taghinia AH, Ganor O. Association of surgical risk with exogenous hormone use in transgender patients: a systematic review. JAMA Surg. 2019;154:109–15.

    Article  Google Scholar 

  13. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society*clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869–903.

    Article  PubMed  Google Scholar 

  14. Standards of care for the health of transsexual, transgender, and gender nonconforming people. Available at: https://www.wpath.org/publications/soc.

  15. Middeldorp S, Meijers JCM, Van Den Ende AE, et al. Effects on coagulation of levonorgestrel and desogestrel-containing low dose oral contraceptives: a crossover study. ThrombHaemost. 2000;84(1):4–8.

    CAS  Google Scholar 

  16. Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman M-B, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D’Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St C, Amand TD, Steensma JF, Strang GB, Taylor K, Tilleman GG, T’Sjoen LN, Van Vala NM, Mello JF, Veale JA, Vencill B, Vincent LM, Wesp MA, West, Arcelus J. Standards of care for the health of transgender and gender diverse people, Version 8. Int J Transgen Health. 2022;23(sup1):S1–259. https://doi.org/10.1080/26895269.2022.2100644. One of the main functions of the World Professional Association for Transgender Health (WPATH) is to promote top-quality healthcare through publishing regularly updated standard of care (SOC) documentation. The SOC is based on the best available science and expert professional consensus. The most recent version, version 8, was released this year as a guideline for providers world-wide.

    Article  CAS  Google Scholar 

  17. Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism 2012; https://doi.org/10.1080/15532739.2011.700873.

  18. Leinung MC, Feustel PJ, Joseph J. Hormonal treatment of transgender women with oral estradiol. Transgender Heal. 2018;3(1):74–81.

    Article  Google Scholar 

  19. Sica DA. Pharmacokinetics and pharmacodynamics of mineralocorticoid blocking agents and their effects on potassium homeostasis. Heart Fail Rev. 2005;10(1):23–9.

    Article  CAS  PubMed  Google Scholar 

  20. Nota NM, Wiepjes CM, de Blok CJM, et al. The occurrence of benign brain tumours in transgender individuals during cross-sex hormone treatment. Brain. 2018;141(7):2047–54.

    Article  PubMed  Google Scholar 

  21. Streed CG, Harfouch O, Marvel F, et al. Cardiovascular disease among transgender adults receiving hormone therapy: a narrative review. Ann Intern Med. 2017;167(4):256–67.

    Article  PubMed  Google Scholar 

  22. Becasen JS, Denard CL, Mullins MM, et al. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systematic review and meta-analysis, 2006–2017. Am J Public Health. 2019;109(1):E1-8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee K, Trujillo L, Olansky E, Robbins T, Brune CA, Morris E, Finlayson T, Kanny D, Wejnert C, National HIV Behavioral Surveillance among Transgender Women Study Group; National HIV Behavioral Surveillance among Transgender Women Study Group. Factors associated with use of HIV prevention and health care among transgender women - seven urban areas, 2019–2020. MMWR Morb Mortal Wkly Rep.(2022) 71(20):673–679. https://doi.org/10.15585/mmwr.mm7120a1

  24. McGowan JP. Perioperative management of patients with HIV. Clinical guidelines program.

  25. Oluwabukola A, Oluwabukola O. Anaesthetic considerations for the HIV positive partu rient. Ann Ibadan Postgrad Med. 2011;7(1):31.

    Article  Google Scholar 

  26. Wierckx K, Elaut E, Declercq E, et al. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study. Eur J Endocrinol. 2013;169(4):471–8.

    Article  CAS  PubMed  Google Scholar 

  27. Elbers JMH, Giltay EJ, Teerlink T, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol (Oxf). 2003;58(5):562–71.

    Article  CAS  PubMed  Google Scholar 

  28. Schulman JK, Erickson-Schroth L. Mental health in sexual minority and transgender women. Med Clin North Am. 2019;103(4):723–33.

    Article  PubMed  Google Scholar 

  29. Nuttbrock L, BocktingW, Rosenblum A, et al. Gender abuse, depressive symptoms, and sub stance use among transgender women: a 3-year prospective study. Am J Public Health 2014;104(11) https://doi.org/10.2105/AJPH.2014.302106.

  30. Lennie Y, Leareng K, Evered L. Perioperative considerations for transgender women undergoing routine surgery: a narrative review. Br J Anaesth. 2020;124(6):702–11. https://doi.org/10.1016/j.bja.2020.01.024.

    Article  PubMed  Google Scholar 

  31. Vowles BJ, Ahmad I, Christodoulides G. Unexpected difficult airway management in a transgender female patient. Anaesth Rep. 2020;8(1):36–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Therattil PJ, Hazim NY, Cohen WA, et al. Esthetic reduction of the thyroid cartilage: a systematic review of chondrolaryngoplasty. JPRAS Open. 2019;22:27–32.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kim HT. Vocal feminization for transgender women: current strategies and patient perspectives. Int J Gen Med. 2020;13:43–52.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Peitzmeier S, Gardner I, Weinand J, et al. Health impact of chest binding among trans-gender adults: a community-engaged, cross-sectional study. Cult Heal Sex. 2017;19(1):64–75.

    Article  Google Scholar 

  35. Cumming R, Sylvester K, Fuld J. P257 Understanding the effects on lung function of chest binder use in the transgender population. Thorax. 2016;71(Suppl 3):A227.

    Article  Google Scholar 

  36. Kim E, Mukerji S, Debryn D, Price R, Streed C, Nozari A. Oxygen desaturation in a transgender man: initial concerns and recommendations regarding the practice of chestbinding: a case report. J Med Case Reports. 2022;16:333.

    Article  Google Scholar 

  37. Discepolo K, Aquino N. Considerations for transgender patients requiring dental rehabilitation. J Dent Child (Chic). 2022;89:46–51.

    PubMed  Google Scholar 

  38. Committee on Quality Management and Departmental Administration, October 13, 2021. Pregnancy testing prior to anesthesia and surgery. https://www.asahq.org/standards-and guidelines/pregnancy-testing-prior-to-anesthesia-and-surgery

  39. Thornton KGS, Mattatall F. Pregnancy in transgender men. CMAJ. 2021;193(33):E1303.

    Article  PubMed  PubMed Central  Google Scholar 

  40. BRIDGE Study Investigators. Bridging anticoagulation. Circulation 2012;125(12); https://doi.org/10.1161/CIRCULATIONAHA.111.084517.

  41. Goldstein Z, Corneil TA, Greene DN. When gender identity doesn’t equal sex recorded at birth: the role of the laboratory in providing effective healthcare to the transgender community. Clin Chem. 2017;63(8):1342–52.

    Article  CAS  PubMed  Google Scholar 

  42. Rosendale N, Goldman S, Ortiz GM, Haber LA. Acute clinical care for transgender patients. JAMA Intern Med. 2018;178(11):1535–43.

    Article  PubMed  Google Scholar 

  43. Gupta PK, Gupta H, Sundaram A, et al. Development and validation of a risk calculator forprediction of cardiac risk after surgery. Circulation. 2011;124(4):381–7.

    Article  PubMed  Google Scholar 

  44. Chung F, Abdullah HR, Liao P. STOP-bang questionnaire a practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3):631–8.

    Article  PubMed  Google Scholar 

  45. Pan S, Honig SC. Gender-affirming surgery: current concepts. Curr Urol Rep 2018;19(8); https://doi.org/10.1007/s11934-018-0809-9.

  46. Klaver M, Dekker M, Schreiner T, et al. Cross-sex hormone therapy affects body fat distribution in transgender persons. Endocr Abstr 2016;41; https://doi.org/10.1530/endoabs.41.ep397

  47. Moreault O, Lacasse Y, Bussie’res JS. Calculating ideal body weight: keep it simple. Anesthesiology. 2017;127(1):203–4.

    Article  PubMed  Google Scholar 

  48. Robertson GS. Serum protein and cholinesterase changes in association with contraceptive pills. Lancet. 1967;289(7484):232–5.

    Article  Google Scholar 

  49. Chandrasekhar K, Togioka BM, Jeffers JL. Sugammadex 2020. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470263/. Accessed December 18, 2020

  50. Adams DR, Tollinche LE, Yeoh CB, et al. Short-term safety and effectiveness of sugammadex for surgical patients with end-stage renal disease: a two-centre retrospective study. Anaesthesia. 2020. https://doi.org/10.1111/anae.14914.

    Article  PubMed  Google Scholar 

  51. Tsen LC, Arthur GR, Datta S, et al. Estrogen-induced changes in protein binding of bupivacaine during in vitro fertilization. Anesthesiology. 1997;87(4):879–83.

    Article  CAS  PubMed  Google Scholar 

  52. Lao WP, Crawley BK. Airway considerations in transgender patients: complicated intubation. Ear, Nose & Throat Journal. 2021;100(5_suppl):755S-756S. https://doi.org/10.1177/0145561320910680.

    Article  Google Scholar 

  53. Pisklakov S, Carullo V. Care of the transgender patient. Top Pain Manag. 2016;31(11):1–8.

    Article  Google Scholar 

  54. Rokhtabnak F, Sayad S, Izadi M, DjalaliMotlagh S, Rahimzadeh P. Pain control after mastectomy in transgender patients: ultrasound-guided pectoral nerve block II versus conventional intercostal nerve block: a randomized clinical trial. Anesth Pain Med. 2021;11(5):119440. https://doi.org/10.5812/aapm.119440.

    Article  Google Scholar 

  55. Salgado CJ, Gonzalez DI, Wolfe EM, et al. Combined general and epidural anesthesia is associated with decreased opioid consumption and enhanced pain control after penile inversion vaginoplasty in transwomen. Ann Plast Surg. 2019;83(6):681–6.

    Article  CAS  PubMed  Google Scholar 

  56. Kukreja P, Deichmann P, Selph JP, et al. Sacral erector spinae plane block for gender reas-ignment surgery. Cureus 2020;12(4); https://doi.org/10.7759/cureus.7665.

  57. Gan, Tong J, Belani, Kumar G, Bergese, Sergio , Chung, Frances Diemunsch, Pierre, Habib, Ashraf S, Jin, Zhaosheng MBBS, Kovac, Anthony L, Meyer, Tricia A, Urman, Richard D, Apfel, Christian C., Ayad, Sabry, Beagley, Linda, Candiotti, Keith, Englesakis, Marina BA (Hons), Hedrick, Traci L, Kranke, Peter, Lee, Samuel, Lipman, Daniel DNP, Minkowitz, Harold S, Morton, John, Philip, Beverly K. (2020) Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia: 131 (2) 411-448https://doi.org/10.1213/ANE.0000000000004833

  58. Sener EB, Kocamanoglu S, Cetinkaya MB, et al. Effects of menstrual cycle on postoperative analgesic requirements, agitation, incidence of nausea and vomiting after gynaecological laparoscopy. Gynecol Obstet Invest. 2005;59(1):49–53.

    Article  PubMed  Google Scholar 

  59. Apfel CC, La ̈a ̈ra ̈ E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999;91(3):693–700

  60. Mahfouda S, Moore JK, Siafarikas A, Hewitt T, Ganti U, Lin A, Zepf FD. Gender affirming hormones and surgery in transgender children and adolescents. Lancet Diabetes Endocrinol. 2019;7:484–98.

    Article  CAS  PubMed  Google Scholar 

  61. de Vries ALC, McGuire JK, Steensma TD, Wagenaar ECF, Doreleijers TAH, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134:696–704.

    Article  PubMed  Google Scholar 

  62. Grannis C, Leibowitz SF, Gahn S, Nahata L, Morningstar M, Mattson WI, Chen D, Strang JF, Nelson EE. Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys. Psychoneuroendocrinology. 2021;132:105358.

    Article  PubMed  Google Scholar 

  63. van der Miesen AIR, Steensma TD, de Vries ALC, Bos H, Popma A. Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers. J Adolesc Health. 2020;66:699–704.

    Article  PubMed  Google Scholar 

  64. Tordoff DM, Wanta JW, Collin A, Stepney C, Inwards-Breland DJ, Ahrens K. Mental health outcomes in transgender and nonbinary youths receiving gender- affirming care. JAMA Netw Open. 2022;5:e220978.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Taylor J, Zalewska A, Gates JJ, Millon G. An exploration of the lived experiences of non-binary individuals who have presented at a gender identity clinic in the United Kingdom. Int J Transgenderism. 2019;20:195–204.

    Article  Google Scholar 

  66. Sheppard M, Mayo JB. The social construction of gender and sexuality: learning from two spirit traditions. Soc Stud. 2013;104:259–70.

    Article  Google Scholar 

  67. C. Garthe, Allyson M. Blackburn, Amandeep Kaur, Jesus N. Sarol Jr., Jacob Goffnett, Agnes Rieger, Crystal Reinhart, and Doug C. Smith Transgender Health, ] Suicidal ideation among transgender and gender expansive youth: mechanisms of risk Rachel 2022 7:5 416–422

  68. Streed CG, Beach LB, Caceres BA, et al. Assessing and addressing cardiovascular health in people who are transgender and gender diverse: a scientific statement from the American Heart Association. Circulation. 2021. https://doi.org/10.1161/CIR.0000000000001003.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Conron, K. J, O’Neill, K., & Vasquez, L. A. (2021). Prohibiting gender-affirming medical care for youth. UCLA: The Williams Institute. Retrieved from https://escholarship.org/uc/item/040032xd

  70. McIntosh CA. Interdisciplinary care for transgender patients. In: Eckstrand K, Ehrenfeld JM, editors. Lesbian, Gay, Bisexual, and Transgender Healthcare. Cham: Springer International Publishing; 2016. p. 339–49.

    Chapter  Google Scholar 

  71. Aquino NJ, Boskey ER, Staffa SJ, Ganor O, Crest AW, Gemmill KV, Cravero JP, Vlassakova B. A single center case series of gender-affirming surgeries and the evolution of a specialty anesthesia team. JCM. 2022;11:1943.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Oles N, Ganor O, Aquino NJ, Boskey ER. Surgical affirmation for gender-diverse youth. Journal of Pediatric Surgical Nursing. 2021;10:32–9.

    Article  Google Scholar 

  73. Block J (2022) US transgender health guidelines leave age of treatment initiation open to clinical judgment. BMJ o2303

  74. World Professional Association for Transgender Health (2011) Standards of care for the health of transsexual, transgender, and gender nonconforming people, 7th Version. WPATH

  75. Littman L. Correction: parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS ONE. 2019;14:e0214157.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Bauer GR, Lawson ML, Metzger DL. Do clinical data from transgender adolescents support the phenomenon of “rapid onset gender dysphoria”? J Pediatr. 2022;243:224-227.e2.

    Article  PubMed  Google Scholar 

  77. Madeline B. Deutsch. Guidelines for the Primary and gender-affirming care of transgender and gender nonbinarypeople. 2016. Available at: https://transcare.ucsf.edu/guidelines. UCSF Transgender Care published Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. These guidelines aim to address inequalities by providing primary care providers with the tools and knowledge to meet the healthcare needs of their TGD patients. It is useful to both providers and patients to have access to resources like this and refer to them when facing clinical challenges

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, UW Medical Center, University of Washington, Pacific Street, Seattle, WA, 1959 NE98195, USA

    Christian van Rooyen

  2. Department of Anesthesiology, Critical Care and Pain Medicine, Gender Affirming Surgical Perioperative Program (GASPP) Team Leadership, Boston Children’s Hospital, 300 Longwood Avenue Boston, Boston, MA, 02115, USA

    Nelson J. Aquino

  3. Department of Anesthesiology, MetroHealth Medical Center of Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Luis E. Tollinche

  4. Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, 453 Quarry Road, MC 5663, Stanford, CA, 94305, USA

    Travis L. Reece-Nguyen

Authors
  1. Christian van Rooyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nelson J. Aquino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luis E. Tollinche
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Travis L. Reece-Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis E. Tollinche.

Ethics declarations

Conflict of Interest

LET is a grant recipient through Merck Investigator Studies Program (MISP) to fund clinical trial at MSKCC (NCT03808077). LET serves a consultancy and advisory role for Merck & Co. Pharmaceutical Company. LET serves a consultancy and advisory role for GE Healthcare. LET receives stipend for his role as examiner with The American Board of Anesthesiology. LET is an expert testimony witness and receives compensation for this role. CV, NA, TR have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Rooyen, C., Aquino, N.J., Tollinche, L.E. et al. Perioperative Considerations for Gender-Affirming Surgery. Curr Anesthesiol Rep 13, 90–98 (2023). https://doi.org/10.1007/s40140-023-00553-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40140-023-00553-5

Keywords

Search

Navigation