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Page 2 of 20 Kant et al. Plast Aesthet Res. 2026;13:4

can support the well-being of individuals undergoing gender-affirming genital surgery, from the presurgical period
through long-term recovery. It is also intended to raise surgeons’ awareness of the impact of mental health and
social determinants of health on the perioperative experience and to facilitate the provision of trauma-informed care
and support.

INTRODUCTION
As gender-affirming surgery becomes more widely known and available, the demand for such procedures
has risen accordingly. Where once genital reconstructive procedures such as vulvovaginoplasty,
metoidioplasty, and phalloplasty were available to a select few individuals in only a handful of facilities, they
are now available to a broader cross-section of prospective patients. However, interest in gender-affirming
genital surgeries continues to outstrip demand . The relative scarcity of access is duly reflected in a
[1]
widespread lack of training in and awareness of these surgeries by medical professionals . While significant
[1,2]
improvements have been made in expanding medical education on gender-affirming care, there has been less
attention focused on how mental health providers can support patients through this process - even as
multiple publications emphasize the need for such support . The current standards of care have therefore
[3,4]
evolved to reduce the importance of referral letters in favor of a more holistic assessment and support
process involving a multispecialty team .
[5]

Although the motivations and guidelines for their involvement have changed over the past century, mental
and behavioral health providers have played a central role in assessing prospective patients since the
inception of gender-affirming surgery as a discipline . Behavioral health providers have historically held
[3]
enormous influence over whether or not a patient is eligible for surgery, and in recent years, whether such
surgery will be covered by insurance. However, this history has made many patients distrustful . Patients
[3]
report being fearful of personal disclosure lest the answer to an assessment question lead to a delay or denial
of care, which positions providers and patients at perceived cross-purposes and potentially undermines the
utility of pre-surgical letters of support . This is problematic, as gender-affirming genital surgeries are
[6,7]
resource-intensive and emotionally draining, and patients often experience a need for substantial support
throughout the perioperative and recovery periods. For other complex surgical procedures, such as
transplantation and bariatric surgery, multidisciplinary support is similarly a standard part of pre- and post-
operative care [8-10] . This is sometimes referred to as surgical “prehabilitation”, referring to the fact that the
goal is to identify and address issues that might affect surgical success and recovery before the surgery
occurs .
[11]
Gender-affirming genital surgeries have the potential to dramatically reshape how someone relates to their
body across multiple domains. While the literature reports high rates of satisfaction with these procedures
relative to similar procedures for cisgender patients [12-14] , patients frequently report that the recovery is far
harder than anticipated. Behavioral health providers have an important role in assisting patients through the
preparation and recovery processes, a role that is sometimes complicated by their parallel roles in regulating
access to care.

THE IMPORTANCE OF A MULTIDISCIPLINARY TEAM
True informed consent requires that patients have the best possible understanding of a procedure . While
[1]
surgeons are required to provide this information as part of the formal consent process, they may not
necessarily be skilled at, comfortable with, or have the extensive time to facilitate discussions of the details of
how these procedures may affect the most intimate areas of a person’s life, including their effects on sexuality
and relationships - with both themself and others. Behavioral health providers embedded in