Anesthetic Considerations for Gender-Affirming Airway and Facial Procedures

Approximately 0.6% of the United States population identifies as transgender or gender nonbinary. The term transgender refers to a person who experiences incongruence between their sex at birth and their gender identity. The care of the transgender patient is complex, often requiring the expertise of various medical and surgical specialties. The prevalence of gender-affirming surgery is increasing as societal acceptance and cultural norms are shifting. While gender-affirming procedures include a variety of body systems, airway and facial procedures are of particular importance to anesthesia providers. Anesthetic concerns for masculinization and feminization procedures of the airway and face include bleeding, injury to the airway, and other perioperative challenges. Transgender procedures of the airway and face often require advanced airway techniques. Following airway surgery, patients are at an increased risk for tracheal stenosis or perforation, glottic stenosis, vocal cord damage or dysfunction, and/or dysphagia. Additionally, transgender patients may undergo hormone therapy to achieve their gender goals. Providers should be aware of the implications associated with administration of hormones such as thromboembolic events, cardiovascular effects, and changes in various laboratory values. A knowledge of novel surgical procedures, medical therapies, and the psychosocial implications associated with transition is essential for the safe, comprehensive, and holistic care of the transgender patient.