Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.Transsexual surgeries are almost always aesthetic surgeries, although they are rarely if ever interpreted this way. Following the standards laid out in Sterodimas, Radwanski, and Pitanguy's "Ethical Issues in Plastic and Reconstructive Surgery" [1], plastic surgeons may need to reconsider referring transsexual patients for psychological evaluation as a matter of course. Expert psychological assessment may be necessary, as with all patients requesting cosmetic surgeries. However, to respect patient autonomy, perhaps psychiatric referral should be made on an individual case-by-case basis, as it is with other aesthetic surgeries.
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