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Transgender Medicine and Surgery

Frequently Asked Questions

Frequently Asked Questions

Download: The Center for Transgender Medicine and Surgery at Boston Medical Center FAQs (PDF)

Q. What services will the new Center for Transgender Medicine and Surgery include?

A. To meet the community’s longstanding demand for access to comprehensive transgender medicine, the new center will add male-to-female genital surgery for adult transgender patients, which primarily consists of an orchiectomy (removal of the testicles) and neovaginoplasty. The new surgery will supplement the comprehensive transgender medical services already in place. At BMC, we have been providing compassionate, thoughtful and comprehensive care to members of the transgender community for many years. This includes everything from primary and specialty care, to services tailored to this population, including hormone therapy, mammoplasty and facial feminization. The launch of this new program will allow us to take our treatment one step further, allowing us to truly care for the whole patient.

Q. Why has BMC decided to offer this procedure, and why now?

A. BMC has a long history of providing a range of services to the transgender community and offering this surgery is a natural evolution of our commitment to provide the most comprehensive care to all of our patients. BMC is proud to have been recognized by Healthcare Equality Index as a Leader in LGBT Healthcare Equality Status in both 2015 and 2016.

Q. What are the medical indications that lead to genital surgery for transgender patients?

A. Neovaginoplasty is medically indicated for transgender patients as part of their program to match physical characteristics to gender identity. Typically, the patient must have undergone at least 12 months of hormone therapy under the care of a licensed clinician and must have lived for at least 12 months in their preferred gender role.

Q. Who is eligible for this procedure?

A. The patient’s medical and mental health history along with appropriate diagnostic results will be reviewed by our transgender surgery panel to determine whether the patient is an appropriate surgical candidate. The panel membership currently includes physician representatives from the following areas: endocrinology, surgery and primary care, along with a licensed psychologist. The criteria for eligibility include the following:

The patient is at least 18 years of age.
The patient is transgender and has the desire to live and be accepted as a member of a sex other than natal sex, accompanied by the desire to make the physical body more congruent with the gender identity through surgery and hormone treatment.
The gender identity has been expressed for at least 12 months and is not a symptom of a mental disorder.
For those patients without a medical or mental health contraindication, they must have lived at least 12 months in their new gender role.

Q. Is board review of a patient’s case common?

A. Yes, in many cases, a patient’s medical information will be reviewed by a panel before determining the best treatment plan. For example, many hospitals have tumor boards that review cases of patients diagnosed with cancer to determine the best approach, including if the patient is an appropriate candidate for surgery. These boards are developed to ensure that the patients’ range of needs are met and to ensure that the most appropriate course of treatment is followed.

Q. Why would a patient be considered ineligible for the procedure?

A. As with many other surgical procedures, patients may not be eligible for surgery if they have medical, mental health, or substance abuse conditions that would pose significant risk.

Q. How long does the procedure take, and is it all done in one surgery or multiple surgeries?

A. Orchiectomy and neovaginoplasty are completed in one procedure, which takes approximately five to six hours. However, some patients may need additional procedures.

Q. What should patients expect after the surgery?

A. Following the neovaginoplasty, patients will be required to stay in the hospital for approximately five days. Other than the routine follow-up for surgical patients, patients will continue being followed by their primary care provider and/or endocrinologist. While each case is different, patients can generally get back to a full, active life after approximately six weeks.

Q. Does insurance cover gender affirmation surgery for transgender patients?

A. Yes, this treatment has been recognized by national clinical bodies and insurers are required by law in Massachusetts to cover this surgery for all cases that are medically indicated. In 2014, the state mandated that insurance carriers cover transgender medical care including surgery, when it is medically indicated. This decision followed a federal mandate earlier in the year by the U.S. Department of Health and Human Services (HHS) which ended a 1981 ban on coverage for transgender medical care under Medicare.

Q. How many neovaginoplasty surgeries do you expect to perform at BMC in the first year?

A. Given the unmet need in the market, BMC anticipates performing an average of one to two neovaginoplasty surgeries per month to start, and then to increase to at least one per week.