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Ramirez et al. Plast Aesthet Res. 2025;12:16 https://dx.doi.org/10.20517/2347-9264.2025.10 Page 3 of 13

Approach
The TIC approach should be kept in mind during preoperative counseling to help foster open patient-
provider communication. Open and frequent conversations on goals for surgery help manage expectations
and build trust. There is a limited body of research on health literacy within the transgender and nonbinary
community; however, recent studies indicate that, although their health literacy levels tend to be lower than
the general population, individuals within this community actively engage in efforts to improve their health
literacy [12,13] . Key facilitators of enhanced health literacy include positive interactions with healthcare
[12]
providers and staff, as well as the use of inclusive forms and processes . Pre-surgical counseling should be
utilized to establish rapport and create a safe, inclusive environment where patients can be presented with
their options in a clear and comprehensible manner. This approach may involve the use of accessible visual
aids (e.g., video, illustration, etc.), written educational materials, multiple follow-up visits to reinforce
information, involving members of the patient’s support network, and employing the teach-back method to
ensure comprehension.

When consulting any individual seeking gender-affirming surgery, it is important to maintain an open
[14]
mind. Based on established principles for gender-affirming care , we recommend three general principles
to best understand what fits the patient and their goals:

1. Unbiased perspective.
2. Present ALL options.
3. Thorough intake.

An unbiased perspective
The harmful effects of implicit bias are well documented. We know that it can further lead to health
[15]
disparities and distrust . Therefore, the initial consultation should be approached with an unbiased
perspective. Removing one’s perspective can foster a more open-ended and honest conversation and help
establish rapport with the patient. It is best to avoid making assumptions about the surgery an individual
may seek based on one’s appearance or identity . Such assumptions can be damaging to the patient, the
[14]
patient-physician relationship, and negatively impact the patient’s satisfaction with the surgical outcome.

Present all options
Many individuals seeking GAS may not be aware of all the options available to them. A qualitative study on
perioperative transgender patient experiences reported that while all of them had done extensive online
research and talked to friends or other individuals who have gone through GAS, the perioperative visit was
considered the most useful source of information regarding understanding, expectations, procedural details,
and complications . Orchiectomy/scrotectomy, PSV, and nullification surgery are not exclusive to non-
[16]
binary or gender-diverse individuals, just as vaginoplasty or vulvoplasty procedures are not exclusively
sought by trans feminine patients. Presenting all options allows folks to select a surgery that serves their best
interest and protects patient autonomy. The author suggests offering a detailed description of each
procedure when presenting the options. Additionally, incorporating illustrations and/or previously
approved example photographs can enhance comprehension.

Thorough intake
Patient history is another important component that influences whether a surgical technique is feasible and
can help better guide patients to a safer and successful outcome. We recommend that a medical and surgical
history be obtained, as well as specific surgical goals and priorities. At this institution, patients complete a
specialized intake form for bottom surgery, which includes gathering baseline information on urinary and