color: red Last Review06/10/2022. Bleeding vessels may be ligated or cauterized. Arch Sex Behav. Then in May, Gov. Learn more about a Bloomberg Law subscription. Spack (2013) stated that GD is poorly understood from both mechanistic and clinical standpoints. There was no stenosis in neither group. Level of Evidence = III. OL OL OL LI { The authors concluded that there is very little evidence addressing the options for transgender individuals seeking gender affirming procedures of the hand. Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Both frontal and profile views achieved a loss of masculine features. } Hormone trial must be with a medication prescribed to the member, d. One letter of recommendation from a QMHP to the surgeon is required, (1) Duration of evaluators relationship with the member, (2) Member has well-documented diagnosis of gender dysphoria, (4) Member has capacity to give informed consent for surgery, (6) Member has had a twelve-month or longer real-life experience congruent with their gender identity. All patients showed excellent cosmetic results and were satisfied with their procedures. A diagnosis of gender dysphoria requires a marked difference between the individuals expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months. border: none; A total of 22 publications met inclusion criteria. The overall success of treatment depends partly on the technical success of the surgery, but more crucially on the psychological adjustment of the trans identified personand the support from family, friends, employers and the medical profession. The AMA vignette for CPT code 19318 (reduction mammaplasty) clarifies that this CPT code includes the work that is necessary to reposition and reshape the nipple to create an aesthetically pleasing result, as is necessary in female to male breast reduction. Capacity to make a fully informed decision and to consent for treatment; For members less than 18 years of age, completion of one year of testosterone treatment; If significant medical or mental health concerns are present, they must be reasonably well controlled; Single letter of referral from a qualified mental health professional (, Persistent, well-documented genderdysphoria (s. Completion ofone year of feminizing hormone therapy prior to breast augmentation surgery (unless the member has a medical contraindication or is otherwise medically unable to take hormones); Two referral letters from qualified mental health professionals, one in a purely evaluative role (, Persistent, well-documented gender dysphoria (. Hands exhibit prominent dimorphic sexual features, but despite their visibility, there are limited studies examining gender affirming procedures for the hands. Most facial feminization surgery procedures could be safely completed in 6 months, barring complications. Facial feminization surgery can include forehead re-modeling, rhinoplasty, mentoplasty, thyroid chondroplasty, and voice alteration procedures. To contact the reporter on this story: Sam McQuillan in Washington at smcquillan@bloomberglaw.com, To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloomberglaw.com; Andrew Childers at achilders@bloomberglaw.com. Jolly D, Wu CA, Boskey ER, et al. A mishmash of state policies and a myriad of legal barriers still make getting coverage a challenge. Awareness of the condition appears to be increasing, probably because of greater societal acceptance and available hormonal treatment. They included 8 studies using cricothyroid approximation, 6 studies using anterior glottal web formation, and 6 studies using other surgery types or a combination of surgical techniques, leading to 20 studies in total. list-style-type: decimal; In mastectomy for gender reassignment, the nipple areola complex typically can be preserved. These patients had a high prevalence of mental health and psychiatric problems (over 50 %), with low rates of employment and high levels of disability. This Clinical Policy Bulletin addresses gender affirming surgery. Articles covered a variety of facial feminization procedures. 2010;162(5):831-833. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Two independent reviewers screened the titles and abstracts of all articles; and 2 independent surgeon reviewers examined the full text of all included articles, and relevant data points were extracted. Guan X, Bardawil E, Liu J, Kho R. Transvaginal natural orifice transluminal endoscopic surgery as a rescue for total vaginal hysterectomy. The authors concluded that this was the first study of factors impacting a patient's choice of or a surgeon's recommendation for vulvoplasty over vaginoplasty as gender-affirming genital surgery; it also was the first reported series of patients undergoing vulvoplasty only. Objectively, a substantial rise in post-operative fundamental frequency was identified. Treatments for gender dysphoria. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; A full-thickness skin graft is taken from the right groin to reconstruct the areola. However, none of the studies used a control group and randomization process. Log in to access all of your BLAW products. outline: none; All of your medical information is confidential and protected under Federal law. 2019;21:63-74. Seven states have policies in place barring Medicaid coverage for surgeries, despite a federal law that mandates the coverage. The authors concluded that complications following FFC were rare and infrequently required reoperation. Djordjevic ML, Bizic MR, Duisin D, et al. These researchers compared the results of amnion grafts with amnion seeded with autograft fibroblasts. color:#eee; Leinung MC, Urizar MF, Patel N, Sood SC. The WPATH guidelines state that "Chest surgery in FtM patients could be carried out earlier, preferably after ample time of living in the desired gender role and after one year of testosterone treatment. Breast cancer screening may be medically necessary for transmasculine persons who have not undergone chest masculinization surgery; Prostate cancer screening may be medically necessary for transfeminine persons who have retained their prostate. A spokesperson from Ohios state Medicaid agency confirmed the law is still on the books but defunct in practice. After confirmation of strong and persistent trans gender identification, adolescents with GD should be treated with gender-affirming hormone or puberty-delaying hormone to prevent developing undesired sex characters. Measurement of sexual arousal in postoperative male-to-female transsexuals using vaginal photoplethysmography. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male-to-female transsexuals. Content of the QMHP referral letter must address at minimum. How to Give Yourself a Hormone Injection: Intramuscular (IM), How to Give Yourself a Hormone Injection: Subcutaneous (SQ). padding: 10px; It is recommended that transfeminine persons undergo feminizing hormone therapy (minimum 12 months) prior to breast augmentation surgery. J Sex Med. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Azul and associates (2017) evaluated the currently available discursive and empirical data relating to those aspects of trans-masculine people's vocal situations that are not primarily gender-related, and identified restrictions to voice function that have been observed in this population, and made suggestions for future voice research and clinical practice. Metoidioplasty creation of a penis by releasing hormonally enlarged clitoris. 2009;62(3):294-306; discussion 306-308. The authors concluded that the creation of a neo-vaginal canal and its lining with allograft amnion and seeded autologous fibroblasts is an effective method for imitating a normal vagina. 2016;13(6):1000-1007. This includes the following procedures: Scrotoplasty creation of a scrotum, with testicular implants, Urethroplasty a urethral lengthening procedure done at the time of metoidioplasty, Vaginectomy removal and closure of the vaginal canal. This will include information on the side effects and what to expect, and the permanent and temporary changes due to hormone replace therapy. b. The Iowa law groups gender-affirming surgeries with cosmetic procedures and other plastic surgeries. There is currently no medical literature specifically examining the surgical or non-surgical options for hand gender affirmation. The age threshold should be seen as a minimum criterion and not an indication in and of itself for active intervention." A total of 15 articles were selected and reviewed from the 24 identified, all of which were either retrospective or case series/reports. 2018;45(3):369-380. Then they will go over our informed consent form with you. A total of 33 patients between 19 and 40 years of age were referred for facial feminization surgery between January of 2003 and December of 2013, for a total of 180 procedures. Gender-affirming hormone therapy achieves very good results in FTM persons and is most successful in MTF persons when initiated at younger ages. Gender affirming surgery: A comprehensive, systematic review of all peer-reviewed literature and methods of assessing patient-centered outcomes (Part 1: Breast/chest, face, and voice). cursor: pointer; Outcome of vaginoplasty in male-to-female transgenders: A systematic review of surgical techniques. Arch Sex Behav. Management of transgenderism. Wesp LM, Deutsch MB. In May, Michigan started guaranteeing coverage when it added language to its provider guidelines corresponding with the federal law. Thus,Aetna considersnipple reconstruction, as defined by CPT code 19350, as cosmetic/not medically necessary for mastectomy for transmasculinegender reassignment, and that CPT code 19318 includes the extra work that may be necessary to reshape the nipple and create an aesthetically pleasing male chest. Endocrine. If we dont have a readily accessible provider within the state, we will negotiate a rate at which an out-of-state provider will be paid, Young said. Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between an individuals gender identity and the gender assigned at birth (and the associated gender role and/or primary and secondary sex characteristics). An IM injection places the medicine deep into the muscle. Oles N, Darrach H, Landford W, et al. } list-style-type: decimal; border-radius: 4px; Gender Dysphoria/Reassignment [69 of 171] Endocrinol Metab Clin North Am. } + each additional, Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children, Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children + each additional 1%, Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children, Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children, Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less. The majority of younger people who have been marginalized in our systems are going to be needing Medicaid support, Jamison Green, a former president of the World Professional Association for Transgender Health, said. 2015;12(7):1626-1634. A review of hand feminization and masculinization techniques in gender affirming therapy. Over 8 years, these investigators compared the results of 24 male-to-female transsexual patients retrospectively based on their complications and levels of satisfaction; 16 patients in group A received amnion grafts with fibroblasts, and the patients in group B received only amnion grafts without any additional cellular lining. The diameter of the vaginal opening was 34 to 38 mm in group A and 33 to 38 cm in group B. J Minim Invasive Gynecol. Please enter a valid 5-digit zip code or city or state. Treating providers are solely responsible for medical advice and treatment of members. Meriggiola MC, Jannini EA, Lenzi A, et al. 2018;15(6):902-906. Lee and colleagues (2021) noted that anatomical characteristics that are incongruent with an individual's gender identity can cause significant gender dysphoria. 2015;68(10):1471-1472. J Voice. On the other hand, the sixth (2001) and the seventh (2011) versions of the standards of care for the health of transsexual, transgender, and gender non-conforming people of World Professional Association for Transgender Health (WPATH) recommend that transgender adolescents (Tanner stage 2, [mainly 12 to 13 years of age]) are treated by the endocrinologists to suppress puberty with gonadotropin-releasing hormone (GnRH) agonists until age 16 years old, after which gender-affirming hormones may be given. PPGOH believes that the practices listed are reliable, but it does not guarantee the quality of service provided, nor assume responsibility or liability for that service. Lee YL, Hsu TF, Jiang LY, et al. A Sept. 3 appeal renewed the case, and the court agreed to fast-track its review. Mental health and psychiatric problems were inversely correlated with age at presentation. The purpose is to maximize breast growth in order to obtain better surgical (aesthetic) results. This allows the medication to absorb more slowly than an IM injection. Day P. Trans-gender reassignment surgery. Another skin incision is made around the circumference of the nipple. } Seyed-Forootan and colleagues (2018) stated that plastic surgeons have used several methods for the construction of neo-vaginas, including the utilization of penile skin, free skin grafts, small bowel or recto-sigmoid grafts, an amnion graft, and cultured cells. Prev JAMA Pediatr. This is an elective surgery that if Iowans want to do, thats fine but not with our taxpayer dollars, state Sen. Jake Chapman told the Associated Press as the bill was introduced.