Gender-Affirming Care in Otolaryngology: A State of the Art Review.

Abstract

Otolaryngologists have provided gender-affirming care to transgender and gender nonconforming (TGNC) individuals for many years, but demand for these services has recently increased substantially as visibility of TGNC communities grows. Furthermore, attention to gender-affirming care in general has sharpened as TGNC individuals' access to healthcare has entered the political sphere. We sought to compile evidence regarding gender-affirming care within otolaryngology, and to review novel surgical and nonsurgical advancements for the treatment of TGNC patients. Data were sought from clinical peer-reviewed primary literature. Searches were conducted in PubMed, Cochrane, Embase, and Scopus. Clinical studies reporting outcomes of gender-affirming interventions, and studies investigating demand for and/or difficulty accessing gender-affirming otolaryngologic care were included. Eighty-three studies met inclusion criteria. TGNC individuals indicate strong desire for gender-affirming therapies for the face and voice, while access remains limited by cost, lack of insurance coverage, and few qualified providers. Surgical interventions for the face and voice have shown objective improvements (ie, vocal frequency and measurements of facial dimensions, respectively), and resulted in high patient-rated satisfaction as measured by validated patient-reported outcome measures and quality of life evaluations, especially for facial and vocal feminization. Non-surgical interventions for the voice have also demonstrated objective and subjective efficacy, alone or in combination with surgery. Gender-affirming care in otolaryngology can make demonstrable improvements in the quality of life and social function of TGNC individuals. Given this evidence, otolaryngologists can and should continue to advance gender-affirming head and neck care.