BACKGROUND: Various techniques for the surgical treatment of gender incongruence (GI) have been available for years. The spectrum is broad and covers various specialties. In recent years, there has been an increase in the number of clinics offering body-modifying procedures. This has led to a considerable variation in methods in some cases. Although the topic has recently found its way more and more into teaching and the relevant specialist literature, there are still no evidence-based recommendations on the various techniques.
OBJECTIVE: A compendium of established surgical techniques was to be compiled, containing recommendations on indication, performance and aftercare as well as complication management and subjecting them to a consensus-based evaluation.
METHODS: In accordance with \"Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften\" (AWMF) regulations, the guideline was developed at level S2k, i.e., it is consensus based. The guideline group was founded in February 2019 in a formal constituent meeting. A total of 14 medical societies and 2 interest groups were recruited for the guideline work. In the end, two consensus meetings were held, which was due to the large number of recommendations and background texts to be adopted.
RESULTS: The guideline focuses on the choice and applicability of surgical techniques as well as the wishes of those seeking treatment and protection of fertility. There is a wide variety of methods and treatment goals for each individual. Taking into account medical standards, recommendations, and contraindications, an optimal result that minimizes individual suffering can be achieved together with the person seeking treatment.
CONCLUSIONS: The content of the guideline represents a unique compendium of surgical methods, recommendations for the selection of procedures, and common indications in the field of body-modifying surgery for gender incongruence.
UNASSIGNED: HINTERGRUND: Zur operativen Behandlung der Geschlechtsinkongruenz (GI) sind seit Jahren verschiedene Techniken bekannt. Das Spektrum ist breit und erstreckt sich auf verschiedene Fachdisziplinen. In den letzten Jahren ist eine Zunahme an Kliniken zu verzeichnen, die körpermodifizierende Eingriffe anbieten. Dadurch kommt es zu einer teils erheblichen Varianz der Methoden. Obwohl das Thema in der jüngeren Vergangenheit mehr und mehr Einzug in die Lehre und auch entsprechende Fachliteratur gehalten hat, existieren bislang keine evidenzbasierten Empfehlungen zu den verschiedenen Techniken.
UNASSIGNED: Es wurde ein Kompendium der etablierten chirurgischen Techniken erstellt, welches Empfehlungen zur Indikation, Durchführung und Nachsorge sowie zum Komplikationsmanagement enthält und einer konsensbasierten Wertung unterzogen.
METHODS: Gemäß AWMF-Regelwerk (Arbeitsgemeinschaft Medizinisch-Wissenschaftlicher Fachgesellschaften) wurde die Leitlinie auf der Stufe S2k entwickelt, sie ist somit konsensbasiert. Die Leitliniengruppe wurde im Februar 2019 in einem formalen konstituierenden Treffen gegründet. Insgesamt 14 medizinische Fachgesellschaften sowie 2 Interessenverbände konnten für die Leitlinienarbeit gewonnen werden. Schlussendlich wurden 2 Konsensumeetings abgehalten.
UNASSIGNED: Die Leitlinie stellt die Auswahl und Anwendbarkeit der chirurgischen Techniken ebenso in den Mittelpunkt wie die Wünsche der Behandlungssuchenden und auch die Optionen der Fertilitätsprotektion. Es existiert eine breite Vielfalt in den Methoden wie in den Behandlungszielen der jeweiligen Personen. Unter Beachtung medizinischer Standards, Empfehlungen und Kontraindikationen kann so gemeinsam mit der behandlungssuchenden Person ein optimales, den individuellen Leidensdruck minderndes Ergebnis erzielt werden.
UNASSIGNED: Der Inhalt der Leitlinie stellt ein bislang einzigartiges Kompendium zu chirurgischen Methoden, Empfehlungen zur Auswahl der Verfahren und Indikationsstellung für körpermodifizierende Eingriffe bei Geschlechtsinkongruenz dar.

BACKGROUND: Human beings with a difference in sexual development (DSD) often underwent gender reassignment surgery during early childhood. However, the medical decision was often not congruent with the gender identity that affected persons developed later on.
OBJECTIVE: To represent the interests of affected persons, an interdisciplinary guideline in cooperation with support groups was written.
METHODS: The revision of the first version of the guideline, published in 2016, was edited by 18 professional societies and working groups as well as 3 support groups. A literature search was performed for each of the 12 chapters. Recommendations and statements created by the working groups were voted on during four consensus conferences.
RESULTS: The guideline highlights the right of self-determination of affected persons. In this context, new legal requirements are reported. Other than necessary primary diagnostics, medical procedures should be postponed. Most important is the psychological support of parents and patients. Tumor risk of the gonads and protection of fertility are analyzed and discussed in detail.
CONCLUSIONS: The content of the guideline represents a paradigm shift in dealing with human beings with a difference of sexual development. Projects as DSD Care and Empower-DSD help to promote the practical implementation of the guideline\'s recommendations.
UNASSIGNED: HINTERGRUND: Menschen mit einer Variante der Geschlechtsentwicklung wurden lange Zeit im frühen Kindesalter an das männliche oder weibliche Geschlecht angeglichen. Die aus medizinischer Sicht gewählte Angleichung entsprach nicht immer der späteren Geschlechtsidentität der Betroffenen.
UNASSIGNED: Um die Interessen der Betroffenen zu vertreten, wurde eine interdisziplinäre Leitlinie unter Beteiligung von Selbsthilfegruppen erarbeitet.
METHODS: An der Überarbeitung der primär 2016 publizierten Leitlinie arbeiteten 18 Fachgesellschaften bzw. Fachverbände sowie 3 Selbsthilfegruppen mit. Für die 12 Kapitel wurden systematische Literaturrecherchen durchgeführt. Die in den Arbeitsgruppen verfassten Empfehlungen und Statements wurden in 4 Konsensuskonferenzen abgestimmt.
UNASSIGNED: Die Leitlinie stellt das Selbstbestimmungsrecht der Betroffenen in den Mittelpunkt. In diesem Zusammenhang werden auch die neuen gesetzlichen Vorgaben dargestellt. Außer der notwendigen Primärdiagnostik sollen medizinische Maßnahmen eher in den Hintergrund gestellt werden. Wichtig ist besonders die psychologische Unterstützung von Eltern und den Betroffenen selbst. Ausgiebig wird das Tumorrisiko der verschiedenen Formen der Varianten der Geschlechtsentwicklung analysiert und auf die Fertilitätsprotektion eingegangen.
UNASSIGNED: Der Inhalt der Leitlinie stellt ein Paradigmenwechsel im Umgang mit Menschen mit einer Variante der Geschlechtsentwicklung dar. Die Projekte DSD-Care und Empower-DSD fördern die praktische Umsetzung der Leitlinienempfehlungen.

暂无摘要。

The ever-expanding number of transmen as well as their surgeons share an increasing interest in the construction of a neophallus. While the indication for surgery and the positive effect of a phalloplasty on the quality of life, mental health and sexual function has already been thoroughly analysed, there is a lack of data comparing and evaluating the surgical steps. During the consensus conference on the \"choice of flaps for phalloplasty\" at the annual meeting of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels, the current literature was discussed and a consensus on the surgical technique of a phalloplasty was reached. This manuscript publishes jointly developed recommendations on the following topics: choice of flaps for phalloplasty, preoperative diagnostic tests before phalloplasty, urethral construction in the radial forearm flap and anterior lateral thigh flap, preformation of the urethra at the forearm or thigh, venous drainage of the radial forearm flap, innervation of the phallus, staged phalloplasty, coronaplasty and managing the donor site of a radial forearm flap.
 Das Interesse am Aufbau eines Penoids wird von Seiten der stetig wachsenden Zahl an trans Männern wie auch der sie betreuenden Chirurgen zunehmend größer. Während die Indikation zur Operation und die positive Auswirkung der Phalloplastik auf die Lebensqualität, psychische Gesundheit und sexuelle Funktion der Patienten bereits überzeugend nachgewiesen wurde, fehlt es an Daten, die die operativen Teilschritte bewerten und vergleichen. Im Rahmen des Konsensus-Workshops der 43. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße zum Thema „Wahl der Lappenplastik zur Phalloplastik – was ist zeitgemäßer Standard?“ wurde die vorhandene Literatur diskutiert und Empfehlungen zur operativen Technik der Phalloplastik konsentiert. Die Beschlüsse für die folgenden Themen werden hier dargelegt: Auswahl der Lappenplastik zur Phalloplastik, Präoperative Diagnostik vor Phalloplastik, Urethrakonstruktion bei der Radialis- und ALT-Lappenplastik, Präformierung der Urethra am Unterarm oder Oberschenkel, Venöse Drainage der Radialislappenplastik, Innervation des Penoids, „staged“ Phalloplastik, Glansplastik und Versorgung des Hebedefektes nach Radialislappenplastik.

Gender-affirming surgery (GAS) is a rapidly growing field within plastic surgery, and residents and fellows must receive appropriate training. However, there are no standardized surgical training curricula. The objective of this study was to identify core curricula within the field of GAS.
Four GAS surgeons from different academic institutions identified initial curricular statements within six categories: (1) comprehensive GAS care, (2) gender-affirming facial surgery, (3) masculinizing chest surgery, (4) feminizing breast augmentation, (5) masculinizing genital GAS, and (6) feminizing genital GAS. Expert panelists consisting of plastic surgery residency program directors and GAS surgeons were recruited for three rounds of the Delphi-consensus process. The panelists decided whether each curriculum statement was appropriate for residency, fellowship, or neither. A statement was included in the final curriculum when Cronbach α value was greater than or equal to 0.8, meaning that 80% or more of the panel agreed on inclusion.
A total of 34 panelists (14 plastic surgery residency program directors and 20 GAS surgeons representing 28 US institutions) participated. The response rate was 85% for the first round, 94% for the second, and 100% for the third. Out of 124 initial curriculum statements, 84 reached consensus for the final GAS curricula, 51 for residency, and 31 for fellowship.
A national consensus on core GAS curriculum for plastic surgery residency and GAS fellowship was achieved by a modified Delphi method. Implementation of this curriculum will ensure that trainees in plastic surgery are adequately prepared in the field of GAS.

Internationally and within Aotearoa, New Zealand, there has been a substantial increase in the demand for gender affirming healthcare over the past decade. It is likely that this level of referrals to health services will continue in the foreseeable future. The Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa, New Zealand were developed following the recognition that the previous good practice guide required updating to be in step with current practice and international standards. This article presents a summary of the guideline focusing on puberty blockers, hormonal therapies, access to surgery and other gender affirming healthcare. We hope these guidelines will support the development and provision of services providing gender affirming healthcare around the country and provide helpful guidance to all health professionals involved in the care of trans people.

BACKGROUND: In 2011 the WPATH (World Professional Association for Transgender Health) published the 7th version of their \"Standards of Care\" for diagnosis and treatment of transsexual people. In face of further recent peer-reviewed reports of experienced centres on surgical sex reassignment it should be examined whether or not genital sex reassignment in male-to-female transsexuals actually can be based on evidence-based guidelines or standards.
RESULTS: The indication for surgery is widely standardised and evidence-based. Most critical steps of the operation are also founded on grade B recommendations. Most experienced authors rely on penoscrotal pedicled flaps for neovaginal lining. The topic of ideal reconstruction of the vulva, especially the clitoro-labial complex is still a field of debate. Due to the high frequency of further corrective surgeries which exceeds 50% in most experienced centres, some authors prefer a primary 2-step procedure for genital reassignment.
CONCLUSIONS: The indication and principal operative steps in surgical genital reassignment in male-to-female patients rely on evidence-based recommendations. By respecting these recommendations subjective success rates of over 80% can be expected.

Pubertal suppression at Tanner stage 2 should be considered in adolescents with persistent gender identity disorder (GID). Issues related to achievement of adult height, timing of initiating sex steroid treatment, future fertility options, preventing uterine bleeding, and required modifications of genital surgery remain concerns. Concerns have been raised about altering neuropsychological development during cessation of puberty and reinitiation of puberty by the sex steroid opposite those determined by genetic sex. Collaborative assessment and treatment of dysphoric adolescents with persistent GID resolves these concerns and deepens our understanding of gender development.