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Gender Mastectomy And Depression, Anxiety, And Body Image In Transgender Men: A Single-center Prospective Study
Megan Lane, MD, Michael J. Kirsch, MS, Emily C. Sluiter, BS, Jennifer B. Hamill, MPH, William M. Kuzon, MD, PhD, Paul S. Cederna, MD, Robert H. Gilman, MD, Edwin G. Wilkins, MD.
University of Michigan, Ann Arbor, MI, USA.

Purpose: There are few prospective studies examining gender-affirming surgery (GAS) with validated instruments. In this study, we report the effect of gender mastectomy on anxiety, depression, body image, and psychosocial functioning in a prospective manner with instruments validated in the general as well as transgender populations.
Methods: Patients undergoing gender mastectomy were administered the PHQ-9, GAD-7, Body Image Quality of Life Index (BIQLI), BREAST-Q Psychosocial and Sexual Functioning subscales, and the BODY-Q Nipple and Chest subscales preoperatively and six months postoperatively. In addition, the BREAST-Q Satisfaction with Decision subscale was administered postoperatively. Paired Studentís T-tests were utilized for analysis.
Results: This is an ongoing investigation. A total of 32 individuals have completed this study to date. The mean PHQ-9 score preoperatively was 8.12 and postoperatively was 4.96(P=0.003). The mean preoperative and postoperative GAD-7 scores were 7.71 and 4.00 respectively(P=0.0004). There were significant improvements in both psychosocial and sexual functioning related to chest appearance(P=<0.0005). Satisfaction with contour and nipples significantly improved(P=<0.0005). Global psychosocial functioning as measured by the BIQLI significantly improved(P=2.1x10-10). Patients had a mean satisfaction with decision score of 93.2.
Conclusions: Trans men undergoing gender mastectomy had significant reductions in levels of anxiety and depression, as well as improvements in body image and psychosocial functioning. Patients were extremely satisfied with their decisions to undergo surgery. Although this study is limited by sample size and its single-center nature, the results suggest significant benefits with GAS and highlight the need for further evaluation in a multi-center consortium.


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