Gender Transition: A Consideration for Anesthesia

Clinicians have long lacked guidance on how to appropriately manage transgender patients perioperatively. This chapter aims to provide guidance on the safe management of transgender patients in the preoperative, intraoperative, and postoperative phases of surgical procedures. Understanding how gender transition influences anatomy and physiology is essential for the optimization of surgical outcomes and patient safety. Many parameters differ for cisgender and transgender patients, while others stay similar. As the practice of medicine evolves, implementing guidelines from new data on traditionally understudied patient populations, such as LGBT+ individuals, will translate to improved healthcare outcomes and decreased healthcare disparities in these populations. This chapter will focus specifically on the perioperative considerations for patients undergoing a gender transition, also known as transgender patients or (formerly) known as transsexual patients. This information will also be effective in better caring for patients who were born intersex, as they often have had similar surgical procedures and medical treatments as transgender individuals. Overall, we aim to present a brief analysis of critical physiologic, anatomical, procedural, and pharmacological considerations for transgender patients when they require surgical care.