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Navigating Crowdfunding As A Novel Mechanism To Support Gender Affirmation Surgery
Brooke Wangler, BS1, Yida Cai, BA2, Lesley Summerville, BS, ScM2, Anand Kumar, MD2.
1Case Western Reserve University, Cleveland, OH, USA, 2Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Purpose: Transgender surgery and gender affirming procedures have increased over the past decade. While increasing coverage for these procedures have occurred following the passing of the Affordable Care Act (ACA), patients may still have financial barriers for receiving these procedures. Novel funding mechanisms such as crowdfunding have emerged as a resourceful safety net for these patients. We hypothesize that crowdfunding for gender affirming surgery could be a viable source of funding for surgical procedures. The aim of this study is to evaluate the success and characteristics of funding campaigns using publicly available data on recent crowdfunding campaigns. 
Methods: Crowdsourcing campaigns for "Top Surgery" on the website GoFundMe.org were identified during the year 2019. Variables of interest included general demographic data, campaign success, campaign web traffic, dollars received, social engagement with campaign, percent funded and details about campaign design. In addition to descriptive statistics, univariate models were used to identify factors associated with successful crowdfunding campaigns. 
Results: 98 campaigns listed under "Top Surgery" were identified in 2019 and included in the study. 56 campaigns (57.1%) were trans male top surgery, 24 (24.5%) nonbinary, 2 (2.0%) were trans female and 1 (1.0%) an intersex mal, while the other 15 campaigns (15.3) did not report the nature of the top surgery. The average age for individuals seeking funding was 22.5 years (SD = 4.8 years) and of the campaigns that reported their ethnicity, the majority were white (21 campaigns, 60% of 35 campaigns reporting). 32 campaigns (32.7%) met their fundraising goals, receiving an average of $4,824.81 (SD: $3,460.15) compared to unsuccessful campaigns, which received an average of $3,126.47 (SD: $2,355.60). Successful campaigns requested significantly less funds than unsuccessful campaigns ($4,517.90 vs $6,724.44, p = 0.001) but raised significantly more (p = 0.002). Successful campaigns also received more average donors (98 donors vs 72 donors, p = 0.018), however the average donation did not differ between successful and unsuccessful campaigns ($49, SD = $29.86). Age, sex assigned at birth and ethnicity did not affect success of the campaign (p > 0.05), although identified gender did(p = 0.019). Factors like number of campaign photos, length of campaign description, social media shares, tags and comments was not associated with success. However, followers was significantly associated with campaign success (99 follows vs 75 follows, p = 0.032), community photos was associated with unsuccessful campaigns (0.3 average photos vs 0.06, p = 0.04).
Conclusion: Despite expansion of coverage for transgender surgery under the ACA, crowdfunding for transgender top surgery is remains a highly utilized safety net financial resource for mostly young, binary trans men.  Although the majority of crowdfunding campaigns for transgender top surgery do not achieve their funding goals, successful campaigns are associated with lower fundraising goals, higher individual donations and followers. Future studies will expand on the types of campaigns analyzed to better understand the economic factors behind fundraising for different types of gender affirming procedures.


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