Getting to the bottom of it: Comparative medical and psychological risk for gonadectomy among individuals with and without presurgical psychological assessment.

Background: Presurgical psychological assessments (PPA) can be helpful in assessing for psychological risk factors and identifying medical risk factors that may impede recovery from surgery. Transgender and gender diverse (TGD) individuals seeking medically-necessary, gender-affirming hysterectomy and orchiectomy are recommended to undergo a PPA, yet individuals undergoing this surgery for other medical reasons are not. The present study sought to investigate comparative risk profiles among TGD individuals who underwent a PPA prior to hysterectomy or orchiectomy for gender affirmation compared to cisgender and TGD individuals who underwent hysterectomy or orchiectomy for other medical reasons without a formal assessment. Methods: Retrospective chart review was conducted on 195 patients at an integrated health care system. Medical, psychological, and overall risk scores were tabulated and mean ranks were compared among TGD patients with PPA (n = 43), TGD patients without PPA (n = 27), and cisgender patients (n = 125), none of whom underwent PPA. Results: Significant mean rank differences were found for overall and psychological risk, yet the mean rank scores for TGD patients with PPA group did not differ significantly from the cisgender group. No differences in medical risk scores among the groups were found. Eighty-six percent of TGD individuals with PPA were classified as having good prognosis for surgery. Conclusions: TGD patients who underwent a PPA tended to have low overall risk for surgical outcome, indicating that PPA may not have been necessary for these patients and instead served as an unwarranted barrier to medically-necessary care. It is recommended that health care systems, providers, and third-party payors align requirements for PPA for gonadectomy with the recommendations of the World Professional Association of Transgender Health Standards of Care 8 to remove barriers to medically-necessary care, particularly for surgeries with low complication rates, like hysterectomy and orchiectomy.