The Effects of Perioperative Gender-affirming Hormone Therapy on Facial Feminization Surgery Adverse Events, Facial Features Addressed, and Esthetic Satisfaction: A Multimodal Analysis.

VTE incidence was numerically higher in patients who stopped GAHT perioperatively compared to those who continued it.

• 602 patients stopped GAHT, of whom 3 VTEs were recorded (0.49%)
• 925 patients continued GAHT perioperatively, with only 1 VTE recorded (0.11%)
• Study heterogeneity was low (I2 = 0%)
• Limited VTE sample size precluded meta-analytic conclusions
• 11 articles were included in the systematic review and meta-analysis

GAHT duration did not significantly impact the incidence of all-cause complications or specific surgical complications in the retrospective cohort.

• All-cause complications were not significantly associated with GAHT duration (P = 0.478)
• Wound infection incidence was not significantly associated with GAHT duration (P = 0.283)
• Hematoma incidence was not significantly associated with GAHT duration (P = 0.283)
• VTE incidence was not significantly associated with GAHT duration (P = 1.0)
• Analysis was conducted via retrospective review of the senior author's FFS cohort

Tracheal shaving and mandibuloplasty were the only FFS procedures significantly less associated with longer GAHT duration.

• Tracheal shaving was significantly less associated with higher GAHT duration (P = 0.002)
• Mandibuloplasty was significantly less associated with higher GAHT duration (P = 0.003)
• These findings suggest GAHT may produce soft tissue and bony changes that reduce the need for these specific procedures
• No other facial procedures showed a statistically significant association with GAHT duration

FFS revision rate was not significantly associated with GAHT duration.

• The association between GAHT duration and FFS revision rate did not reach statistical significance (P = 0.06)
• This finding was derived from the retrospective review of the senior author's FFS cohort
• The result suggests GAHT duration does not meaningfully predict the need for surgical revision

A 'one-protocol-fits-all' approach to perioperative GAHT management is not appropriate given the diversity of patients seeking gender-affirming care.

• The authors concluded that a shared provider-patient decision-making process is warranted
• The analysis examined risks and benefits of perioperative GAHT continuation
• The study identified a paucity of data to definitively assess the safety or harm of continuing GAHT perioperatively
• Both systematic review/meta-analysis and retrospective cohort review methodologies were used to inform this conclusion