Perioperative care for transgender patients demands specialized, affirming, informed practice, experts say

Editor's Note

New clinical guidelines emphasize that safe and equitable perioperative care for transgender and gender-diverse (TGD) patients hinges on affirming communication, tailored medical assessments, and culturally competent practice. According to a peer-reviewed article published in the June issue of Nursing, perioperative teams must adopt evidence-based, inclusive approaches to better serve the estimated 1–1.4 million TGD individuals in the US—a population disproportionately affected by healthcare discrimination and poor outcomes.

The article outlines comprehensive guidelines that address every phase of perioperative care, from patient identification and communication to intraoperative and postoperative management. The authors stress that TGD patients often avoid care due to past experiences of harassment, misgendering, and inadequate treatment. These disparities are linked with elevated rates of depression, HIV, substance use, and suicide. In surgery, TGD patients face heightened clinical risks, including complications tied to hormone therapy, anatomical differences from gender-affirming procedures, and psychological distress. Failing to recognize these factors can result in substandard care, with long-term impacts on patient trust and safety.

Respectful patient identification—including the use of affirmed names and pronouns—is central to reducing harm and fostering trust. The authors recommend trauma-informed communication strategies, such as introducing one’s own pronouns and minimizing misgendering. They also urge clinicians to avoid “deadnaming” and to verify preferred terminology alongside legal documentation.

Medical considerations are equally critical. Preoperative assessments should include a detailed gender history, current hormone therapy, and relevant surgical procedures. The article notes that standard risk assessment tools may not apply accurately to TGD patients and advises comparing lab results using affirmed gender reference ranges if hormone therapy has been ongoing for 6 months or more. Pregnancy testing should be considered in transgender men with retained reproductive anatomy.

Intraoperatively, clinicians must anticipate airway challenges resulting from facial procedures or hormone-related anatomic changes, and take precautions with estrogen patches due to thromboembolism risks. Gender-affirming surgeries, such as vaginoplasty or phalloplasty, may also impact urinary catheterization, requiring early consultation with urology.

Postoperatively, multimodal pain management strategies are recommended, with attention to hormone effects, potential substance use, and psychosocial support. The article advocates for involving patients’ chosen support networks and using interdisciplinary care models similar to those in transplant or bariatric surgery to improve outcomes.

Finally, the authors emphasize the need for ongoing institutional and individual cultural competency training, noting that affirming care begins with self-awareness, education, and a commitment to dismantling bias. Hospitals should integrate trans-specific education into clinical training programs to ensure readiness and reduce disparities in surgical care for this patient population.