Review flags neurosurgical issues in gender dysphoria care

A new review in the Chinese Neurosurgical Journal says neurosurgeons need better training on the neurological, perioperative and psychosocial issues tied to gender dysphoria and gender-affirming care. The authors argue that more awareness could improve safety, communication and surgical outcomes for transgender patients.

Why it matters: - Gender dysphoria care often involves surgery, hormone therapy and mental health support, so neurosurgeons may encounter neurological and perioperative issues that affect patient safety. - The review says limited awareness among neurosurgeons can make management less effective for patients with gender dysphoria. - Better training could improve communication, reduce stigma and support more evidence-based surgical care.

What happened: - Dr. Rajdeep Brahmachari and Dr. Chandrasekaran Kaliaperumal of the Royal Infirmary of Edinburgh reviewed the literature on neurological considerations in gender dysphoria care. - The review appeared in Volume 12 of the Chinese Neurosurgical Journal on Sept. 9, 2026. - The paper is titled “Gender reassignment and neurosurgical implications: a narrative review.” - The DOI is 10.1186/s41016-026-00447-5.

The details: - Gender dysphoria is described as distress from a mismatch between sex assigned at birth and gender identity. - The review says transgenderism is a broader term that may or may not include distress. - The condition has become more common, especially among children and adolescents. - Treatment options include gender-affirming hormone therapy, psychotherapy and surgery. - The authors reviewed published studies from public databases and other sources. - Brain features in transgender individuals reportedly resemble their self-identified gender more than their assigned gender. - Reported findings include increased cortical thickness and weaker connections in regions involved in body perception. - Gender-affirming hormone therapy can increase gray matter density and volume. - The review links hormone therapy to higher risk of headache, meningioma, prolactinoma, intracranial hypertension, stroke and epilepsy. - Patients may avoid surgery because of stigma, social isolation and prejudice. - The review recommends inclusive language, documenting the duration of pre-surgical hormone therapy and recording preferred gender identity and pronouns before surgery. - Patients should be told the benefits and risks of surgery and encouraged to seek mental health advice when needed. - Preoperative risks include viral and bacterial infections. - Higher rates of stress, anxiety and depression among transgender individuals may increase smoking, alcohol use and drug abuse, raising perioperative risk. - Transgender individuals are also more likely to have metabolic disorders such as diabetes and insulin resistance. - Hormonal therapy may interact with anti-seizure medications, corticosteroids and neuromuscular blockers. - The review says neuromuscular monitoring is warranted when neuromuscular blocking agents are used. - Intraoperative risks are especially important in patients with HIV because antiviral drugs may interact with hypnotics, anxiolytics and antibiotics. - Hematological changes from gender-affirming hormone therapy may affect blood transfusion planning. - Respiratory risks can arise in trans men who use breast-binder garments. - Intubation can be a concern in trans women who have had laryngeal surgery. - Urinary catheterization requires special care in people who have had gender-affirming surgery. - Private rooms can improve privacy and comfort after surgery. - Wound and scar care, along with preferred names and pronouns, can reduce psychosocial stress. - A multidisciplinary pain-management approach may improve surgical outcomes.

Between the lines: - The review frames gender dysphoria care as a neurosurgical issue as much as a psychiatric or endocrine one. - Its practical focus suggests the biggest gap is not just medical knowledge, but patient experience, staff training and perioperative planning. - The paper also implies that standardized hospital practices could reduce avoidable complications and improve trust in surgical settings.

What's next: - The authors call for proactive training for neurosurgeons and healthcare personnel. - The review suggests that broader awareness of neurological and psychosocial issues could improve outcomes for patients with gender dysphoria. - More evidence-based guidance may help neurosurgical teams plan for hormone therapy, anesthesia, infection risk and postoperative care.

The bottom line: - The review argues that safer, more respectful neurosurgical care for transgender patients depends on better education, better communication and better perioperative planning.