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Medical School Launches First Ever Transgender Surgery Training Program In The US

Discussion in 'Medical Students Cafe' started by Nada El Garhy, Aug 12, 2017.

  1. Nada El Garhy

    Nada El Garhy Golden Member

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    Medical school launches first ever transgender surgery training program in the US amid huge surge in demand - and they already have 4 patients a WEEK

    • Mount Sinai Center for Transgender Medicine and Surgery opened early 2016
    • It has launched a program to train doctors to perform transgender surgeries
    • The program will train one new surgeon and one new psychiatrist a year
    • At Mount Sinai there are roughly 500 people on the waiting list for surgeries because there are so few who can perform them
    • Dr Jess Ting is currently the few surgeons in New York fully trained to perform these surgeries
    The surge in demand for transgender surgeries in the United States has triggered a New York City hospital to launch a program to train doctors to perform gender reassignment procedures.

    Mount Sinai's Center for Transgender Medicine and Surgery opened early last year in Manhattan and has since operated on roughly 350 patients.

    Dr Jess Ting, the center's director of surgery, said the team operates on nearly four patients a week.

    But even still, transgender patients experience disproportionate health inequities: only about five hours of medical school training are spent covering issues related to their health.

    In an effort to address those inequities, the center has created two year-long fellowships to train a new transgender surgeons and psychiatrists to be able to work with these individuals.

    The new program comes as the Trump administration prepares to roll back protections for transgender Americans.

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    Mount Sinai's Center for Transgender Medicine and Surgery (pictured) opened early last year in Manhattan and has since operated on roughly 350 patients

    During 2016 more than 3,200 surgeries were performed to help transgender patients feel more like themselves.

    That number showed a a 19 percent increase in vaginoplasties, phalloplasties, top surgery and contouring operations, but the waiting list for the surgeries is still incredibly long.

    Surgeons in the field claim that figure is a conservative estimate - and would likely three times higher if all hospitals had a uniform way of documenting such surgeries.

    At Mount Sinai there are roughly 500 patients awaiting gender confirmation surgery.

    Dr Ting explained that this is because he is the only surgeon with the expertise to perform these surgeries.

    'There's only so many patients I can see at a time,' Dr Ting told Daily Mail Online.

    So in July the team launched the country's first transgender surgery fellowship which lasts for one year.

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    Dr Bella Avanessian is the school's first fellow, and completed her residency in plastic surgery before entering the field of gender reassignment surgery

    During the fellowship the participants will assist and perform surgery, teach residents and medical students and conduct transgender-related research.

    Dr Bella Avanessian is the first surgical fellow, and came to Mount Sinai after completing a residency in plastic surgery.

    Male to female genital surgery is called vaginoplasty; female to male genital surgery is called phalloplasty. There are various techniques and ways to perform each procedure.

    'I decided to switch to gender confirmation surgery because I felt it would be more impactful in a city with 500 plastic surgeons and no transgender surgeons,' Dr Ting explained.

    'And the surgeries are beautiful and intricate and complicated. It's so satisfying technically and aesthetically to be able to be able to change someone's life so much. It's a privilege.'

    The fellowship will train one new surgeon who can perform the gender confirmation surgeries each year.

    By the time Dr Avanessian finishes her year, Dr Ting said she will be very sought after since there are no other specially-trained surgeons in the field.



    Forty percent of transgender adults have attempted or seriously thought about suicide, a rate which is nine times higher than the general population.

    So to go along with the surgical fellowship, Mount Sinai also launched a psychiatry fellowship directed by Dr Hansel Arroyo.

    Plastic surgeons often partner with other experts to provide comprehensive care, such as doctors who specialize in hormone therapy or urology and with mental health professionals who help patients through the emotional aspects of their transition.

    'Transgender patients face a great deal of discrimination, ' Dr Ting explained.

    'Many doctors won't take care of transgender patients or if they are willing, don't know how. These fellowships will train the next generation of surgeons and psychiatrists to improve healthcare disparities in the transgender community.'

    Dr Matthew Dominguez is the first fellow and came into the program following completion of his residency in General Adult Psychiatry.

    Across the country more hospitals are beginning to offer gender reassignment operations.

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    Dr Matthew Dominguez (pictured right with Dr Arroyo) is the first psychiatric fellow, he completed his residency in General Adult Psychiatry

    In 2016, Boston Medical Center became the first hospital in Massachusetts to offer the surgery, and at the University of Maryland Medical Center in Baltimore surgeons normally complete two of the operations a week. Other hospitals that offer the surgeries are the University of Michigan Medical Health system and the Hahnemann University Hospital in Philadelphia.

    The Mount Sinai Icahn School of Medicine is the first and only to offer a program to train people specifically to perform gender reassignment surgeries.

    Though the growth in transgender medicine is giving hope to patients and experts in the field, some wonder whether it will continue under the new administration.

    Medicaid insurance coverage of sex reassignment surgeries could be rolled back in the coming months.


    WHAT ARE VAGINOPLASTY AND PHALLOPLASTY FEMALE-MALE GENITAL SURGERY?

    Male to female genital surgery is called vaginoplasty; female to male genital surgery is called phalloplasty. There are various techniques and ways to perform each procedure.

    A phalloplasty is the construction of a penis using skin flaps from the thigh, groin or abdomen, and scrotum construction using the labia. Nerves can be connected to a reconstructed urethra, and the clitoris can be repositioned to sit at the base of the penis.

    Sexual intercourse is possible post-surgery, sometimes using a prosthesis to create an erection, though some patients say that is not necessary.

    A vaginoplasty is a far less costly and far more successful procedure than the female to male procedure.

    In the surgery, the testicles and most of the penis are removed while the urethra is shortened.

    The skin of the penis is then inverted and used to create a vagina.

    In some procedures a neoclitoris is also created with that skin from the tip of the penile glans which allows for sensation.

    The prostate meanwhile is not removed during the surgery, though it does shrink because of the hormones that are taken during the transition process.

    After the surgery, patients spent three days in the hospital and must not do any strenuous activities for two weeks.

    At 12 weeks, the patient can have sex again and in most cases those who have had the surgery report that they are able to experience orgasms.

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