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Sex Reassignment Surgery for the Treatment of Gender Dysphoria

August 1, 2018

Health Problem: In people with gender identity disorder (GID), formerly called transsexualism, there is severe incongruity between anatomical sex and gender identity. Individuals with GID have persistent discomfort with his or her anatomical sex, usually beginning in childhood. The discomfort or stress caused by this incongruity is gender dysphoria (GD).

Technology Description: Sex reassignment surgery (SRS) is any procedure designed to allow a person to resemble the opposite sex to which they were born. Strictly speaking, SRS involves modification of the genitalia. Experts also consider breast and chest surgery a very important option in gender reassignment strategies.

Controversy: Intense debate regarding the medical necessity of SRS for the treatment of GD has occurred over the last 20 years. The condition does not readily fit traditional concepts of medical necessity since research to date has not established anatomical or physiological anomalies associated with GD. However, many health plans consider SRS medically necessary for patients meeting specific criteria due to the purported psychological benefits associated with aligning the person’s body with their gender identity.

Key Questions: This report addresses the following key questions:

  • Has SRS been shown to be effective in improving patient-important outcomes such as relief of symptoms of GD, quality of life, satisfaction with sex characteristics, psychological well-being, or sexual function?
  • Does SRS confer additional benefits compared with hormone therapy alone?
  • Do outcomes vary according to which components of SRS are performed?
  • Which complications are associated with SRS?