Nikolavsky, Blakely Urological Care for the Transgender Patient

Transgender individuals are becoming more prevalent in society. There are an estimated 700,000 -1,400,000 individuals in the US with gender dysphoria. Many of these patients will undergo medical and surgical transformation. Transgender patients at various stages of their transformation will present to urological clinics for care. It is important for urologists to understand the transition process, and the unique components of caring for transgender patients. Currently, there is inadequate understanding regarding the urologic care of transgender patients amongst general urologists. As the transgender population in the US is growing, the unfamiliarity and discomfort of general urologists with care for these patients may put these patients in danger of being underserved. Hormonally related conditions from the natal sex may still be present.  For example, male to female patients are still at risk for prostate cancer and benign prostatic hyperplasia even after gender affirmation surgery. The types of gender affirmation surgery will be discussed, along with management of common complications (e.i. urethral stricture, fistula, neo-vaginal stenosis, incontinence) and appropriate follow up after surgery.  
While many transgender patients start care at a specialized center, over time as these patients merge into society, these patients will follow up locally with general urologists. Due to their history of transition, these patients have unique needs that may not be familiar to most urologists. Once the transformation is complete and all postoperative needs are met, these patients may require a regularly visit for hematuria workup, stone treatment or BPH consultation. This book is aimed at helping familiarize general urologists with this unique growing population of transgender patients. It will cover how to recognize and evaluate the most common GU complications of gender confirmation surgery, characterize the process of transition, evaluate malignancies after hormonal therapy, identify immediate and long term risks of gender confirmation surgery, and the decision making that goes into the appropriate diagnosis, follow up, or referral.