Facial Feminization Surgery and The Standards of Care

Readiness Criteria. The readiness criteria include:1. Demonstrable progress in consolidating one’s gender identity;2. Demonstrable progress in dealing with work, family, and interpersonal issues resulting in asignificantly better state of mental health; this implies satisfactory control of problems such associopathy, substance abuse, psychosis, suicidality, for instance).(page 20 – SOC Version 6)Genital surgeries for individuals diagnosed as having GID are to be undertaken only after acomprehensive evaluation by a qualified mental health professional. Genital surgery may be performedonce written documentation that a comprehensive evaluation has occurred and that the person has metthe eligibility and readiness criteria. By following this procedure, the mental health professional, thesurgeon and the patient share responsibility of the decision to make irreversible changes to the body.Genital Surgery for the Male-to-Female Patient. Genital surgical procedures may includeorchiectomy, penectomy, vaginoplasty, clitoroplasty, and labiaplasty. These procedures require skilledsurgery and postoperative care. Techniques include penile skin inversion, pedicled rectosigmoidtransplant, or free skin graft to line the neovagina. Sexual sensation is an important objective invaginoplasty, along with creation of a functional vagina and acceptable cosmesis.Other Surgery for the Male-to-Female Patient. Other surgeries that may be performed to assistfeminization include reduction thyroid chondroplasty, suction-assisted lipoplasty of the waist,rhinoplasty, facial bone reduction, face-lift, and blepharoplasty. These do not require letters ofrecommendation from mental health professionals.There are concerns about the safety and effectiveness of voice modification surgery and more follow-upresearch should be done prior to widespread use of this procedure. In order to protect their vocal cords,patients who elect this procedure should do so after all other surgeries requiring general anesthesiawith intubation are completed.(page 21 – SOC Version 6)2 DSM IV Definition of Gender Identity Disorder302.85 Gender Identity Disorder in Adolescents or AdultsIn adult males, there are two different courses for the development of Gender Identity Disorder. The firstis a continuation of Gender Identity Disorder that had an onset in childhood or early adolescence.These individuals typically present in late adolescence or adulthood. In the other course, the more overtsigns of cross-gender identification appear later and more gradually, with a clinical presentation in earlyto mid-adulthood usually following, but sometimes concurrent with, Transvestic Fetishism. The lateronsetgroup may be more fluctuating in the degree of cross-gender identification, more ambivalentabout sex-reassignment surgery, more likely to be sexually attracted to women, and less likely to besatisfied after sex-reassignment surgery. Males with Gender Identity disorder who are sexuallyattracted to males tend to present in adolescence or early childhood with a lifelong history of genderdysphoria. In contrast, those who are sexually attracted to females, to both males and females, or toneither sex tend to present later and typically have a history of Transvestic Fetishism. If Gender IdentityDisorder is present in adulthood, it tends to have a chronic course, but spontaneous remission hasbeen reported.3The person largely responsible for negotiating the benefits was Shane Snowdon who worked forUCOP at the time. Andre Wilson at University of Minnesota was also involved in an advisory capacityduring the negotiations through contact with Shane Snowdon. The primary administrative contact for theprogram within the university has been Joan Manning at the University of California Office of the President(UCOP).- 21 -