Keywords:

Transgender; Gender non-conforming; Gender dysphoria; Gender-affirming hormone therapy (GAHT); Gender-affirming genital surgery; Vaginoplasty; Vulvoplasty/Shallow/Zero-depth vaginoplasty; Phalloplasty with urethral lengthening; Phalloplasty without urethral lengthening; Metoidioplasty; Management of patient expectations; Erogenous sensation; Complications

Keypoints:

• General urologists can expect to see and care for transgender and gender non-binary patients
• Culturally sensitive, gender-affirming terminology is important for care-quality
• Historically, transgender and gender non-binary people have been subject to healthcare disparities. The trauma informed care and interdisciplinary care models are valuable tools and models for care delivery
• The World Professional Association for Transgender Health (WPATH) distributes care guidelines for care of transgender patients; these are endorsed by the majority of U.S. professional medical associations and health insurance companies
• Patients today have numerous genital gender-affirming surgery options. The challenge for providers is to help patients identify which specific surgery best balances risks and benefits for themselves, using an informed care model
• The general urologist can be especially helpful to transgender and gender non-binary patients, and significantly improve their care quality

1. Introduction

Transgender and gender diverse (TGD) people have historically been marginalized by society and the healthcare system. With growing awareness of TGD identities, and expanding coverage of gender-affirming care by private insurers and some State Medicaid plans, urologists will encounter an increasing number of TGD patients for both gender-affirming and general urologic care. The most common complications after genital gender-affirming surgery (gGAS) relate to the lower urinary tract and sexual function. Thus, urologists are likely to see more TGD patients for management of urinary and sexual dysfunction.

This Core Curriculum section introduces the urologist to the transgender patient population to facilitate sensitive care, provide information on the process of gender transition, and provide insight on how gender transition affects the genitourinary system. We recommend that readers also refer to Lesson 5 of the 2017 AUA Updates Series: Genital Gender Affirming Surgery for Transgender Patients and the 2022 AUA Update Series: A Urologist’s Guide to Caring for Transgender Women for additional and more detailed information about gender-affirming surgery.¹