Stesura Seveso Archivio Italiano di Urologia e Andrologia 2025; 96(1):13709 1 EDITORIAL COMMENT ON Submitted 6 February 2025; Accepted 6 February 2025 In Arch Ital Urol Androl, Zeki Bayraktar presented the results of a review of all published research on the quality of life, satisfaction, patient-reported outcomes, and short- and long-term problems of patients who had gender-affirming surgery (GAS) (1). According to the Author, transgender people who have GAS virtually completely lose their sexual function and irreversibly lose their reproductive function, and their urinary function is also severely compromised (1). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), gender dysphoria has been defined as a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months (2). Strong desires to be of the other gender and to be treated as such (or any alternative gender different from one's assigned gender) are linked to gender dysphoria (2). On the basis of these considerations, is clear that transgender people experience an impairment in quality of life in terms of clinically significant distress or impairment in social, occu- pational, or other important areas of functioning (3, 4). Gender dysphoria-related distress might include anxiety, sadness, low self-esteem, self-harm, suicidality, or trauma reactions, including hypervigilance, brought on by social mistreatment. These facts make it abundantly evident that gender dysphoria is a mental illness that needs specialized care because it has a major detrimental influence on social and familial life. Gender dysphoria is not only a psychological issue but is a com- plicated mental illness that typically affects individuals and their families. Transgender individuals may need gender- affirming surgery in a number of situations to enhance their overall quality of life. All urologists certified to do this type of surgery must attend to these patients' requirements and works to enhance their quality of life. These crucial aspects of treating gender dysphoria are not included in Zeki Bayraktar's paper. 1) The lack of recognition of high volume and highly qualified centres; 2) The lack of agreement among surgeons regard- ing surgical procedures and the management of complications; and 3) The absence of a long-lasting and beneficial part- nership between patient associations and the Uro-andological Scientific Society are the unmet needs for bettering the care of transgender individuals who need gender-affirming surgery. In conclusion, it is clear that gender dysphoria is a complicated mental illness that requires specific treatment such as sev- eral times gender-affirming surgery. The question not is: “So, what is the reason for this insistence on GAS?” but “How we can improve the management of gender-affirming surgery in terms of quality of care, patients’ satisfaction and quality of life?” REFERENCES 1. Bayraktar Z. Urogenital and extra genital mutilation in gender-affirming surgery: Are we violating primum non nocere?. Arch Ital Urol Androl 2025; 97:13324. 2. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association. 2022. 3. Turban JL, Beckwith N, Reisner SL, Keuroghlian AS. Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry 2020; 77:68-76. 4. Cai T, Verze P, Bjerklund Johansen TE. The Quality of Life Definition: Where Are We Going? Uro. 2021; 1:14-22. Urogenital and extra genital mutilation in gender-affirming surgery: Are we violating primum non nocere? Tommaso Cai 1, 2, Alessandro Palmieri 3 on behalf of Italian Society of Andrology 1 Department of Urology, Santa Chiara Regional and Teaching Hospital, Trento, Italy; 2 Institute of Clinical Medicine, University of Oslo, Oslo, Norway; 3 Department of Neurosciences and Reproductive and Odontostomatological Sciences, Urologic Unit, Università Federico II, Naples, Italy. DOI: 10.4081/aiua.2025.13709 DECLARATIONS Ethical approval: Not applicable. Availability of data and material: Not applicable. Competing interests: None. Funding: Not applicable. Authors' contributions: T.C and A.P. writing. Acknowledgments: Not applicable. Correspondence Tommaso Cai - ktommy@libero.it Department of Urology, Santa Chiara Regional Hospital, Trento, Italy Alessandro Palmieri - info@alessandropalmieri.it Department of Urology, Federico II University, Naples, Italy