Genital gender-affirming surgery trends in Germany: Total population data with 19,600 cases from 2006 to 2022.
gender‐affirming surgery
health services research
population‐based study
transgender
treatment trends
Journal
Andrology
ISSN: 2047-2927
Titre abrégé: Andrology
Pays: England
ID NLM: 101585129
Informations de publication
Date de publication:
17 Sep 2024
17 Sep 2024
Historique:
revised:
30
08
2024
received:
10
08
2024
accepted:
04
09
2024
medline:
17
9
2024
pubmed:
17
9
2024
entrez:
17
9
2024
Statut:
aheadofprint
Résumé
To delineate the current trends regarding gender-affirming surgeries (GAS) in Germany. Analysis of German hospital quality reports from 2006 to 2022 was conducted using the reimbursement.info tool. The German procedure classification (OPS) codes 5-646.0 for masculinizing- and 5-646.1 for feminizing surgery were assessed to identify GAS. Linear regression models were utilized for the analysis and depiction of current trends. A total of 19,632 gender-affirming procedures were performed during the study period with an exponential increase over the years. Masculinizing surgeries increased from 246 in 2006 to 1291 cases in 2022 (increase by 424%; p < 0.001). The highest annual increase of 37.2% in numbers was from 2018 to 2019 (from 1235 to 1694 cases). Feminizing surgeries increased from 180 cases in 2006 to 799 procedures in 2022 (increase by 343%; p < 0.001). The cases increased most between 2015 and 2016 from 277 to 502 cases (81.2%). The number of hospitals offering these surgeries expanded from 24 in 2006 to 29 in 2022 (21% increase; p < 0.001). This study demonstrates an exponential growth in numbers feminizing and masculinizing of GAS performed each year in Germany. Furthermore, a discernible trend emerges with a propensity for concentration of procedures within selected high-caseload centers across Germany.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Andrology published by John Wiley & Sons Ltd on behalf of American Society of Andrology and European Academy of Andrology.
Références
Canner JK, Harfouch O, Kodadek LM, et al. Temporal trends in gender‐affirming surgery among transgender patients in the United States. Jama Surg. 2018;153:609.
Zurada A, Salandy S, Roberts W, Gielecki J, Schober J, Loukas M. The evolution of transgender surgery. Clin Anat. 2018;31:878‐886.
Selvaggi G, Bellringer J. Gender reassignment surgery: an overview. Nat Rev Urol. 2011;8:274‐282.
Selvaggi G, et al. Gender identity disorder: general overview and surgical treatment for vaginoplasty in male‐to‐female transsexuals. Plast Reconstr Surg. 2005;116:135e‐145e.
Frey JD, Poudrier G, Chiodo MV, Hazen AA. An update on genital reconstruction options for the female‐to‐male transgender patient: a review of the literature. Plast Reconstr Surg. 2017;139:728‐737.
Bränström R, Pachankis JE. Reduction in mental health treatment utilization among transgender individuals after gender‐affirming surgeries: a total population study. Eur J Public Health. 2019;29. 727‐734. doi:10.1176/appi.ajp.2019.19010080
Passos TS, Teixeira MS, Almeida‐Santos MA. Quality of life after gender affirmation surgery: a systematic review and network meta‐analysis. Sex Res Soc Policy. 2020;17:252‐262.
El‐Hadi H, Stone J, Temple‐Oberle C, Harrop AR. Gender‐affirming surgery for transgender individuals: perceived satisfaction and barriers to care. Plast Surg‐chir Plas. 2018;26:263‐268.
Coleman E, Radix AE, Bouman WP, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgender Heal. 2022;23:S1‐S259.
Zucker KJ. Epidemiology of gender dysphoria and transgender identity. Sex Heal. 2017;14:404‐411.
Intersexualität DG, für und Zahlenspiele T, oder: Wo sind sie denn hin? “transsexuelleMenschenin transsexuelle Menschen in Deutschland”. 2021. Accessed July 9, 2024. https://dgti.org/2021/08/12/zahlenspiele/#:~:text=1%3A2600
Das RK, Perdikis G, Al Kassis S, Drolet BC. Gender‐affirming chest reconstruction among transgender and gender‐diverse adolescents in the US from 2016 to 2019. JAMA Pediatr. 2023;177:89‐90.
Chaya BF, Berman ZP, Boczar D, et al. Gender affirmation surgery on the rise: analysis of trends and outcomes. LGBT Heal. 2022;9:582‐588.
Flegar L, Thoduka SG, Librizzi D, et al. Adoption of Lutetium‐177 PSMA radioligand therapy for metastatic castration resistant prostate cancer: a total population analysis in Germany from 2016 to 2020. Eur J Nucl Med Mol Imaging. 2023;50:2188‐2195.
Ammari T, Sluiter EC, Gast K, Kuzon WM. Female‐to‐male gender‐affirming chest reconstruction surgery. Aesthet Surg J. 2018;39:150‐163.
Merrick E, Weissman JP, Ascha M, Jordan SW, Ellis M. National trends in gender‐affirming surgical procedures: a Google trends analysis. Cureus. 2022;14:e25906.
Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BPC, Mullender MG. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male to female transsexuals. J Sex Med. 2015;12:1626‐1634.
Eftekhar Ardebili M, Janani L, Khazaei Z, Moradi Y, Baradaran HR. Quality of life in people with transsexuality after surgery: a systematic review and meta‐analysis. Heal Qual Life Outcomes. 2020;18:264.
Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet. 2016;388:390‐400.
Brower T. Sexual orientation and transgender issues in organizations. Global Perspectives on LGBT Workforce Diversity. Springer; 2016:149‐166. Accessed July 9, 2024. doi:10.1007/978‐3‐319‐29623‐4_9
Kailas M, Lu HMS, Rothman EF, Safer JD. Prevalence and types of gender‐affirming surgery among a sample of transgender endocrinology patients prior to state expansion of insurance coverage. Endocr Pr. 2017;23:780‐786.
Ha A, Garoosi K, Hale E, et al. Trends in gender‐affirming surgeries in the United States from 2010 to 2021. Indian J Plast Surg. 2024;57:47‐53.
Proctor K, Haffer SC, Ewald E, Hodge C, James CV. Identifying the transgender population in the medicare program. Transgender Heal. 2016;1:250‐265.
Shen JK, Seebacher NA, Morrison SD. Global interest in gender affirmation surgery: a Google trends analysis. Plast Reconstr Surg. 2018;143:254e‐256e.
Ross. Gender‐confirmation‐surgeries‐rise‐20‐percent‐in‐first‐ever‐report. Press Release. 2017. https://www.plasticsurgery.org/news/press‐releases/gender‐confirmation‐surgeries‐rise‐20‐percent‐in‐first‐ever‐report
Flegar L, Groeben C, Koch R, et al. Trends in renal tumor surgery in the United States and Germany between 2006 and 2014: organ preservation rate is improving. Ann Surg Oncol. 2020;27:1920‐1928.
Wright JD, Chen L, Suzuki Y, Matsuo K, Hershman DL. National estimates of gender‐affirming surgery in the US. JAMA Netw Open. 2023;6:e2330348.
Fisher AD, Ristori J, Fanni E, Castellini G, Forti G, Maggi M. Gender identity, gender assignment and reassignment in individuals with disorders of sex development: a major of dilemma. J Endocrinol Investig. 2016;39:1207‐1224.
Oleru OO, Rohde CH. The most‐cited publications in gender‐affirming surgery: a cross‐sectional bibliometric analysis. Plast Surg. 2024;32:54‐63.
Bouman M‐B, Van Zeijl MCT, Buncamper ME, Meijerink WJHJ, Van Bodegraven AdA, Mullender MG. Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function. J Sex Med. 2014;11:1835‐1847.
Papadopulos NA, Zavlin D, Lellé J‐D, et al. Combined vaginoplasty technique for male‐to‐female sex reassignment surgery: operative approach and outcomes. J Plast Reconstr Aesthetic Surg. 2017;70:1483‐1492.
Ascha M, Massie JP, Morrison SD, Crane CN, Chen ML. Outcomes of single stage phalloplasty by pedicled anterolateral thigh flap versus radial forearm free flap in gender confirming surgery. J Urol. 2018;199:206‐214.
Sukumar S, Pijush DB, Brandes SB. Gender affirming surgery experience and exposure among reconstructive urologists. Urol Pr. 2020;7:234‐240.
Berner M, Briken P, Ettmeier W, et al. S3 Guideline for Diagnostic, Consulting and Treatment of gender dysphoria. 2018. Accessed July 9, 2024. https://register.awmf.org/assets/guidelines/138‐001l_S3_Geschlechtsdysphorie‐Diagnostik‐Beratung‐Behandlung_2019‐02.pdf
Mehta A, Awuah WA, Ng JC, et al. Elective surgeries during and after the COVID‐19 pandemic: case burden and physician shortage concerns. Ann Med Surg. 2022;81:104395.
Hunger R, König V, Stillger R, Mantke R. Impact of the COVID‐19 pandemic on delays in surgical procedures in Germany: a multi‐center analysis of an administrative registry of 176,783 patients. Patient Saf Surg. 2022;16:22.
Aksoy C, Reimold P, Karschuck P, et al. Trends in the use of testicular prostheses in Germany: a total population analysis from 2006–2021. Andrology. 2024;12:1209‐1214. doi:10.1111/andr.13598
Bundesvereinigung K. AOP‐Vertrag nach §115 b. 2023. https://www.kbv.de/media/sp/AOP‐Vertrag_Anlage_1.pdf