title: [Sex reassignment surgery in transsexuals].
abstract: BACKGROUND
  Rikshospitalet (The National Hospital) treats all transsexual patients in Norway. 50-70 patients are referred annually for assessment and about 20 of these are diagnosed as transsexual. Approximately 15 confirmed transsexuals, who have received hormone treatment, are referred to sex reassignment surgery per year. This article describes diagnosis and treatment of transsexualism with an emphasis on surgery.
  
  
  METHODS
  The article is based on a non-systematic review of the literature and our own clinical experience.
  
  
  RESULTS
  Patients are evaluated for sex reassignment surgery after at least one year of psychiatric evaluation and an additional year of endocrine treatment. Male-to-female patients are evaluated for breast augmentation if hormone therapy has given unsatisfactory results. Thereafter, genital surgery can be performed, i.e. the testis and corpus cavernosum are removed and a neovagina and neoclitoris are constructed. Female-to-male patients have the possibility to undergo breast reduction, hysterectomy, salpingoophorectomy and construction of a neopenis. If the patient responds well to male hormones, the clitoris can be straightened and reconstructed as a small neopenis with an erectile function (metaidoioplasty). Alternatively, phalloplasty is performed using the local groin flap or a microvascular free flap.
  
  
  CONCLUSIONS
  Sex reassignment surgery mainly consists of operations on breasts and genitalia.
authors.affiliation: Plastikkirurgisk avdeling, Oslo universitetssykehus, Rikshospitalet 0027 Oslo, Norway. kim.tonseth@rikshospitalet.no
authors.forename: Kim Alexander
authors.initials: KA
authors.lastname: Tønseth
authors.forename: Therese
authors.initials: T
authors.lastname: Bjark
authors.forename: Gunnar
authors.initials: G
authors.lastname: Kratz
authors.forename: Annika
authors.initials: A
authors.lastname: Gross
authors.forename: Rolf
authors.initials: R
authors.lastname: Kirschner
authors.forename: Thomas
authors.initials: T
authors.lastname: Schreiner
authors.forename: Trond H
authors.initials: TH
authors.lastname: Diseth
authors.forename: Ira
authors.initials: I
authors.lastname: Haraldsen
mesh_terms: D018427:Breast Implants; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D016462:Mammaplasty; D017060:Patient Satisfaction; D010413:Penis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D014189:Transsexualism / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery