Skeletal Manifestations of Gender-Affirming Medical Interventions for Aiding in the Preliminary Identification of Trans Individuals

Because of systemic discrimination, transgender individuals are at greater risk of being the victims of violence and of homicide. Accurate post-mortem identification from skeletonized remains of transgender individuals must be incorporated into a new standard for forensic anthropological analyses. A critical component of any investigation is the assessment of skeletal remains for evidence of gender-affirming care. A systematic review of the current medical literature was conducted to compile in one document descriptions of changes that could be used by forensic anthropologists to recognize skeletal manifestations resulting from gender-affirming surgeries, including facial feminization surgery (FFS), shoulder width reduction surgery, and limb-lengthening procedures. These skeletal changes, when present bilaterally and without evidence of healed trauma, serve as key indicators of a person’s transgender identity postmortem. Recognizing common patterns in bone structure alterations due to gender-affirming interventions will assist in identifying transgender individuals and providing closure for families. By integrating markers from gender-affirming care practices into forensic investigations, this research contributes to more inclusive and rigorous forensic investigations.