XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Sex Reassignment in H.I.V. Positive True Transsexual Gender Dysphorics

Wilson, Neal A., M.D.

Clinical Assistant Professor of Surgery, Plastic Surgery Wayne State University 3011 W. Grand Blvd., Suite 571-5 Detroit, MI 48202

Ten years ago, the problem arose when sex reassignment surgery was initiated on a 22 year old whose H.I.V. serology came back positive on the morning of surgery and whose Western Blot was not available. Surgery was cancelled and the matter referred to the hospitals Ethics Committee. The decision of this committee was that it would be unethical to deny sex reassignment surgery.

A series of 11 patients, 10 of whom underwent reassignment surgery. Patient age at presentation was 19 to 45 years, median late twenties. All had fulfilled the Harry Benjamin guidelines before surgery.

Nine of the patients had been positive for H.I.V. at presentation to this office, the mean time of positivity at presentation being three years. The CD4 count at surgery varied for 50-1827, but most were in the 400 range. All denied intravenous drug abuse. Three were positive for Hepatitis B, and two were positive for Hepatitis C.

The average time from presentation to reassignment surgery was 12 years.

The average follow up for the in-state patients was 4 years; the out of state patients did not return after surgery for follow up. One death occurred 32 years after sex reassignment surgery. The remaining 9 operated on have survived from 1 year to 11 years (mean 4.7 years). The patient with the inter-operative problems has survived 11 years; the patient with the CD4 of 51 has survived 9 years.

The one patient who died had a CD4 of 330 at presentation, 301 pre-operative and 156 with night sweats while afebrile immediately post-op. The unoperated patient survived 5 years from presentation despite intense therapy.

In the absence of devastating intra-operative complication unconnected with the HIV status, it would appear that H.I.V. positive patients tolerate sex reassignment surgery well and survive 1-11 years, with a median of 4 years. Late complication included 3 patients with uretheral stenosis, all of whom responded to dilation and catheterization.

Since this abstract, 3 more H.I.V. positive patients have been re-assigned, two without incident, the third with considerable problems with infective destruction of the reconstruction associated with low CD4 (120), age (50+) and a viral load of 2473 RNA.