Gender-affirming Care: Considerations for and Recommendations from Neurosurgery

Introduction: Gender-diverse, gender-nonconforming, and transgender individuals are more likely to suffer from minority stress and may avoid seeking healthcare due to fear of discrimination or mistreatment. We neurosurgeons must commit to providing these individuals the best care possible, which involves creating population-specific considerations for neurosurgical care.

Methods: A narrative review of pertinent literature was conducted regarding gender-affirming care, particularly in the perioperative period. Our institutional specialists from neurosurgery, plastic surgery, and medicine were consulted to propose best practices to treat gender-diverse patients undergoing neurosurgery. Recommendations from gender-affirming care providers, suggestions from current literature, and challenges identified by neurosurgeons were combined into general, preoperative, intraoperative, and postoperative recommendations for gender-diverse neurosurgery patient care.

Results: General considerations emphasize the importance of trauma-informed care, asking for and using preferred names and pronouns, and shared decision-making about personal care aspects. Those include preoperative discussions about the need of Foley catheter placement, particular in patients with history of bottom surgery; intubation, particularly in patients with history of laryngeal surgery; positioning, particularly prone positioning in patients with history of top surgery; and hormone therapy, where continuation may increase risk of wound complication, pseudoarthrosis, and venous thromboembolism, but cessation may risk compromise of patients’ gender affirmation goals. Intraoperative considerations include widespread OR team communication, with even more focused analysis of patient safety and privacy aspects. Postoperative considerations include offering a private PACU room, and thoughtful practice around concurrent usage antiepileptics, opiates, venous thromboembolism prophylaxis, which may be impacted by hormonal therapy.

Conclusion : Gender-diverse patients may require additional pre-, intra-, and postoperative considerations when undergoing neurosurgery, and in the spirit of health equity and patient-centered care, these considerations must be addressed consistently and compassionately to respect these patients’ person and personhood.