A single center case series of perioperative outcomes and anesthesia management for transgender and gender-diverse people undergoing metiodioplasty
OA Version
Citation
Abstract
Metoidioplasty is an elective masculinizing gender-affirming genital surgery, also informally known as bottom surgery, that involves the creation of a neophallus using the patient’s anatomical clitoris that is enlarged with testosterone prior to surgery. Metoidioplasty is often the most requested bottom surgery for transgender men interested in genital reconstruction as another step towards improving their gender congruence. Yet, there is a knowledge gap in anesthesia management and perioperative outcomes for genital and gender-affirming surgeries at academic medical centers with gender health programs. This single center case series offers an examination of descriptive and analytical data into the perioperative outcomes and anesthesia management of transgender and gender-diverse (TGD) patients at an academic hospital with a gender surgical program. In this observational study, the use of epidurals combined with general anesthesia influenced perioperative outcomes by reducing opioid consumption and determining the return to functional status in the postoperative period (including ambulation and bowel movement capabilities). These findings, key evidence-informed strategies, and balanced decision-making (via clinical expertise) support the creation of a patient-centered enhanced recovery after surgery (ERAS) protocol for TGD patients. Future recommendations include increasing the cohort sample size, prospective studies, and collaboration with multiple centers to better understand the specific anesthesia management techniques that are generalizable to TGD people.
Description
2025