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Gender Affirming Female To Male Top Surgery: An Effective Treatment For Gender Dysphoria?
Clairissa D. Mulloy, MS1, Jourdain D. Artz, MD1, Silpa Sharma, MPH1,2, Joshua Helm, MS1, Gerhard S. Mundinger, MD FAAP1,3.
1Louisiana State University Health Sciences Center, New Orleans, LA, USA, 2Children's Hopsital of New Orleans, New Orleans, LA, USA, 3Children's Hospital of New Orleans, New Orleans, LA, USA.

PURPOSE:
Hormonal therapy followed by gender affirming surgery (GAS) are seen as definitive treatments for gender dysphoria. Although there is a paucity of long-term follow-up data on GAS patients, recent literature suggests that transgender (TG) individuals may not experience anticipated improvement in quality of life (QoL) measures with dysphoria resolution. This study aims to determine GASís impact on resolution of gender dysphoria as measured by QoL metrics and validated measures of suicidal ideation (SI)/ suicide attempts (SA) in female-to-male (FTM) TG individuals undergoing chest surgery as part of multidisciplinary team (NOLA Transgender) care for TG patients.

METHODS:
Thirty-one FTM patients presenting for GAS masculinizing top surgery completed a preoperative (n=14) and postoperative (n=17) survey related to phase of gender transition, demographics, sexual orientation, gender identity, QoL and SI/SA. The survey included validated questions from multiple sources. All surgeries were performed according to World Professional Association for Transgender Health (WPATH) standards. IRB approval at LSUHSC is currently pending.

RESULTS:
25 patients identified as sexually oriented to men and four as non-binary. Ages ranged from 19-50 years (mean 29). Patients reported onset of gender dysphoria at 3-36 years (mean 10). There was no significant difference between pre-operative and post-operative patients with regard to chest dysphoria, Body Uneasiness Test-A, UCLA loneliness scale, SI/SA, daily pain or emotional distress (WPATH), or BREAST-Q forms. However, significant difference existed in the UGDS-F gender dysphoria scale with mean score of 56.1 and 52.3 in pre-operative and post-operative patients respectively (p-value =0.03).

CONCLUSION:
For patients, goals of GAS FTM top surgery are highly individualized, both physically and psychologically. Consistent with prior research, QoL measures looking at pain, emotional distress, SI and loneliness in our study showed no difference between pre-operative and post-operative patients. Our sample reported mostly positive QoL measures, so these groups may be artificially equated. It is possible that TG individuals seeking GAS shared confounding characteristic(s) that improved overall QoL as compared to TG patients not seeing chest GAS. Postoperative patients experienced significantly improved overall dysphoria on UGDS-F evaluation, however this cross-sectional study did not track longitudinal improvement. As our study only looked at FTM patients undergoing top surgery, these results cannot be generalized to bottom surgery or male-to-female GAS. Despite these study limitations, our data highlight significant positive gender dysphoria outcomes following FTM GAS surgery.


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