The impact of COVID-19 on gender dysphoria patients

We are going through an unprecedented stressful time around the world. As with many of my plastic surgeon colleagues, most of my surgeries are on hold as they are on the list of the so-called "elective" surgeries. This includes gender-affirming surgeries for gender dysphoria patients.

Gender-affirming surgeries are life-changing procedures that give transgender individuals the physical appearance and functional abilities of the gender they know themselves to be. To have those surgeries delayed can be devastating to patients, but these surgeries will still happen once elective surgeries resume. There is plenty you can do in quarantine by using this time at home to continue your medical care via telehealth while researching and preparing for the surgeries you'll have in the coming months.

During these harsh times, I have been trying to stay positive that we will return to our normal lives soon and similarly trying to help my patients manage their concerns by assuring them that their surgeries will happen as soon as elective surgeries are resumed.

Gender-affirming surgeries deemed "elective"

It is hard not to sympathize with my transgender patients' fears. They fear the loss of their jobs and the loss of insurance coverage. With that comes the additional fear of their procedures being denied since they may have to go through a new pre-authorization process. In some cases, they may experience the fear that we will go back to times when transgender surgeries were not covered by insurance.

Patients with gender dysphoria suffer a significant amount of anxiety and depression, and gender-affirming surgeries performed by plastic surgeons have an effect on bringing those patients back to their right body and improving their mental health and personal lives.

After more than 30 years of Medicare banning gender-affirming surgeries, now it is recognized that gender-affirming surgeries are a medical necessity. The ability to undergo surgeries to reconstruct the face, chest and genitals provides gender dysphoria patients with the ability to improve their psychosocial well-being, decrease stigmatization and improve satisfaction with their bodies and sexual well-being.

Utilizing telehealth during quarantine

While elective procedures may be on hold for now, the times will change after this pandemic and medicine will also change. We are learning to increase the use of telemedicine and improve healthcare digitally.

There are many healthcare professionals using telemedicine – exchange of medical communication by electronic communication – to improve access to care and patients' health. You may consider reaching out to your provider for more information.

Preparing for your surgery while in quarantine

Coordination of care with a multi-disciplinary team including mental health support is paramount to survive this time and make sure that we, plastic surgeons included, will be able to follow the changes coming with the goal to improve gender dysphoria symptoms and minimize prejudice and discrimination.

If you were already in the process of undergoing gender-affirming surgeries, be sure to stay connected to your healthcare team. Utilize telemedicine to continue important conversations with your plastic surgeon and layout a plan to continue with your transition once elective surgeries resume.

For gender dysphoria patients who are still early in their transition with the goal of undergoing gender-affirming surgeries, now is the time to research these procedures and find the right plastic surgeon for you. Work with a mental health provider to get a letter of support for surgery and focus on maintaining your own health so that your body can handle these life-changing procedures.

These surgeries for gender dysphoria patients are unique and require a great deal of planning and preparation. Use this time to improve your chances to become a good candidate for gender-affirming surgeries.

• Do your research; for more information on gender-affirming surgeries look at the ASPS website
• Obtain a letter of support from your mental health provider
• Stop smoking to minimize the chances of complications
• Loose weight for better outcomes
• Assure that your medications are adjusted and if you have any medical conditions that this is controlled
• Stay healthy and remember to cultivate self-awareness
• Look for a board-certified plastic surgeon

What to do when elective procedures resume

The world will get back to normal slowly and elective surgeries will resume. Your preparation during quarantine will help expedite the process with your plastic surgeon. While there is much uncertainty at this time, your gender-affirming surgery will still happen. Be ready to continue your journey as soon as the pandemic passes and elective surgeries begin once again.