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Gender-Affirming Surgery: Female to Male
Kyle K. Jensen, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Gender-affirming surgery (GAS)
            • Transgender and gender diverse (TGD)
            • Transmasculine (TM)
          • Synonyms

            • "Top" (chest/face) and "bottom" (genital) surgeries, colloquially
            • "Transgender" used as adjective, never as noun
            • Transgender men: Trans men, transmasculine, female to male
            • Offensive terms no longer used: Sex change, sex reassignment surgery, gender reassignment surgery, gender-confirming surgery
          • Definitions

            • TGD persons: Gender identity is discordant with biologic sex
              • e.g., persons with female sex at birth with male gender identity = transgender men
              • Gender dysphoria: Distress caused by this incongruence
            • Cisgender persons: Gender identity concordant with birth sex
            • Goal of GAS: Aligning anatomy with gender identity to relieve gender dysphoria
              • TM GAS: Chest/face masculinization, hysterectomy ± oophorectomy, phallus construction (metoidioplasty or phalloplasty), scrotal construction
              • Individualized plan to relieve dysphoria: From hysterectomy only to complex staged procedure
                • Treatment standard of care created by World Professional Association for Transgender Health

          IMAGING

          • Mammographic Findings

            • Fluoroscopic Findings

              • CT Findings

                • CT Angiography Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      CLINICAL ISSUES

                      • Demographics

                        • Treatment

                          • Masculinizing Procedures

                            • Complications

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                • Reporting Tips

                                  Selected References

                                  1. Hassan O et al: Imaging in gender affirmation surgery. Curr Urol Rep. 22(2):14, 2021
                                  2. Annen AW et al: Masculinizing genital surgery: an imaging primer for the radiologist. AJR Am J Roentgenol. 214(1):W27-36, 2020
                                  3. Dabela-Biketi A et al: Urethrographic evaluation of anatomic findings and complications after perineal masculinization and phalloplasty in transgender patients. Radiographics. 40(2):393-402, 2020
                                  4. Parikh U et al: Breast imaging in transgender patients: what the radiologist should know. Radiographics. 40(1):13-27, 2020
                                  5. Stowell JT et al: Gender-affirming surgical techniques, complications, and imaging considerations for the abdominal radiologist. Abdom Radiol (NY). 45(7):2036-48, 2020
                                  6. Shergill AK et al: Imaging of transgender patients: expected findings and complications of gender reassignment therapy. Abdom Radiol (NY). 44(8):2886-98, 2019
                                  7. Stowell JT et al: Imaging findings in transgender patients after gender-affirming surgery. Radiographics. 39(5):1368-92, 2019
                                  8. Stowell JT et al: Serving the needs of transgender and gender-diverse persons in radiology. J Am Coll Radiol. 16(4 Pt A):533-5, 2019
                                  9. De Beule T et al: Anatomical variations and pre-operative imaging technique concerning the anterolateral thigh flap: guiding the surgeon. Br J Radiol. 89(1063):20150920, 2016
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Clinical Issues

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Gender-affirming surgery (GAS)
                                            • Transgender and gender diverse (TGD)
                                            • Transmasculine (TM)
                                          • Synonyms

                                            • "Top" (chest/face) and "bottom" (genital) surgeries, colloquially
                                            • "Transgender" used as adjective, never as noun
                                            • Transgender men: Trans men, transmasculine, female to male
                                            • Offensive terms no longer used: Sex change, sex reassignment surgery, gender reassignment surgery, gender-confirming surgery
                                          • Definitions

                                            • TGD persons: Gender identity is discordant with biologic sex
                                              • e.g., persons with female sex at birth with male gender identity = transgender men
                                              • Gender dysphoria: Distress caused by this incongruence
                                            • Cisgender persons: Gender identity concordant with birth sex
                                            • Goal of GAS: Aligning anatomy with gender identity to relieve gender dysphoria
                                              • TM GAS: Chest/face masculinization, hysterectomy ± oophorectomy, phallus construction (metoidioplasty or phalloplasty), scrotal construction
                                              • Individualized plan to relieve dysphoria: From hysterectomy only to complex staged procedure
                                                • Treatment standard of care created by World Professional Association for Transgender Health

                                          IMAGING

                                          • Mammographic Findings

                                            • Fluoroscopic Findings

                                              • CT Findings

                                                • CT Angiography Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      CLINICAL ISSUES

                                                      • Demographics

                                                        • Treatment

                                                          • Masculinizing Procedures

                                                            • Complications

                                                              DIAGNOSTIC CHECKLIST

                                                              • Image Interpretation Pearls

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Hassan O et al: Imaging in gender affirmation surgery. Curr Urol Rep. 22(2):14, 2021
                                                                  2. Annen AW et al: Masculinizing genital surgery: an imaging primer for the radiologist. AJR Am J Roentgenol. 214(1):W27-36, 2020
                                                                  3. Dabela-Biketi A et al: Urethrographic evaluation of anatomic findings and complications after perineal masculinization and phalloplasty in transgender patients. Radiographics. 40(2):393-402, 2020
                                                                  4. Parikh U et al: Breast imaging in transgender patients: what the radiologist should know. Radiographics. 40(1):13-27, 2020
                                                                  5. Stowell JT et al: Gender-affirming surgical techniques, complications, and imaging considerations for the abdominal radiologist. Abdom Radiol (NY). 45(7):2036-48, 2020
                                                                  6. Shergill AK et al: Imaging of transgender patients: expected findings and complications of gender reassignment therapy. Abdom Radiol (NY). 44(8):2886-98, 2019
                                                                  7. Stowell JT et al: Imaging findings in transgender patients after gender-affirming surgery. Radiographics. 39(5):1368-92, 2019
                                                                  8. Stowell JT et al: Serving the needs of transgender and gender-diverse persons in radiology. J Am Coll Radiol. 16(4 Pt A):533-5, 2019
                                                                  9. De Beule T et al: Anatomical variations and pre-operative imaging technique concerning the anterolateral thigh flap: guiding the surgeon. Br J Radiol. 89(1063):20150920, 2016