Transgender problematika a chirurgie female to male

Title in English Transgender issues and surgery female to male


Year of publication 2022
Type Conference abstract
MU Faculty or unit

Faculty of Medicine

Description Introduction: Transgender (trans) is a designation for people who have not identified with the biological sex and have a desire to have physical characteristics and manifestations of the opposite sex. In the Czech Republic, rules and conditions for official gender reassignment are set. This is permissible on the basis of assessment of the diagnosis and prognosis by the Expert Commission of the Ministry of Health of the Czech Republic. The number of pending applications is steadily increasing (137 in 2019, with a predominance of female-to-male (F-M) conversion requests (95). The current optimal solution is a combination of hormonal treatment and surgical correction to change anatomical gender. Transgender identity orientation. Methodology and results: Operational gender reassignment is preceded by a period of so-called RLE (real life experience) and RLT (real life test), when a trans person makes a new experience and tests the correctness of his decision. The transformation of a woman into a man takes place in several stages. At least a year of hormonal treatment with testosterone will cause menstruation to stop, muscle structure to strengthen, hair and beard to grow, and the voice to change. Surgical transition in anatomical women begins with breast ablation performed by a plastic surgeon. Trans F-M already plays a male role at the time of the gynecologist's visit. This is followed by a hysterectomy with adnexectomy, possibly a collectectomy performed by a gynecologist. Techniques for removing the uterus with adnexa have evolved from abdominal (until 2000), vaginal (until 2004), laparoscopically assisted vaginal (until 2011) to total laparoscopic hysterectomy (TLH). TLH is a mini-invasive technique of uterine removal with vaginal extraction of the uterus using a special uterine manipulator and supplementing the procedure on the adnexa. It is advantageous in trans women with a narrow vagina, it is associated with lower blood loss, shorter hospital stay and convalescence. Deviation from performing collectectomies is due to the complexity of the surgical technique. A limitation is the risk of injury to the surrounding organs of the vagina, paravaginal vascular plexuses, ureters, bladder, urethra and rectum. Any phalloplasty and scrotal prostheses are considered an extension of transgender surgery and are performed by a plastic surgeon. Discussion: Only a few workplaces in the Czech Republic deal with gender reassignment. In Brno, for the first time, the related change of name and documents was successfully enforced in 1975. The condition for official gender reassignment is the removal of the uterus. Our workplace has been dealing with this issue since the 1980s. Gender reassignment is a long, complex and costly process. The expert commission must carefully consider to whom to allow a change lasting several years. The share of trans men and women in the population is relatively balanced. Initially, the requests of women who wanted to be men prevailed, then the numbers leveled off. In the last 5 years, the share of the F-M transition has been growing again. Conclusion: In the Czech Republic, transgender people are provided with quality medical care with excellent results and a generous system of reimbursement from public health insurance. Gender reassignment is permissible on the basis of approval of the diagnosis and prognosis by the Expert Commission of the Ministry of Health of the Czech Republic, and most interventions are fully covered by the health insurance company. Surgical transition is a bit easier from man to woman, when it does not bring so many complications. In gynecological F-M surgery, laparoscopic techniques, especially TLH, pushed out procedures with an abdominal or vaginal approach. Performing a colpectomy is limited by the experience and equipment of the workplace.

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