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Comparing Gender Congruency In Nonsurgical Versus Postsurgical Top Surgery Patients: A Prospective Survey Study
Shirley Shue, MD, Jing Xu, BS, Garrick Gu, BA, Dalton Mourao, BS, Nathan Hawley, BS, D. Alexander Morrison, BS, Janice F. Lalikos, MD, Joyce K. McIntyre, MD.
University of Massachusetts, Worcester, MA, USA.

PURPOSE:
Gender dysphoria, when left untreated, can lead to reduced quality of life and increased rates of depression and suicide. Current treatments include hormone replacement therapy (HRT) and gender affirming surgeries. Prior studies on top surgery have only evaluated patients who underwent surgical treatment; none have evaluated why some patients choose not to undergo surgery. To our knowledge, our study is the first to compare body satisfaction in transgender patients who undergo top surgery versus those who do not. We hypothesize that gender congruency is higher in those who have had top surgery and that financial burden is the most common reason people choose not to undergo this procedure.
METHODS:
Self-reported transgender subjects who are at least 15 years of age and have undergone at least 6 months of HRT are recruited. Those with a history of gender affirming facial or bottom surgeries are excluded. Subjects who have undergone gender affirming top surgery (double mastectomy or breast augmentation) at least 6 months ago were assigned into the surgery arm, and those undergoing HRT alone were assigned to the hormone therapy arm. All subjects completed an anonymous survey, which includes a gender congruency scale (GCS), a series of questions regarding recent discrimination, and potential barriers and complications related to surgery. The BREAST-Q is also administered to surgical patients. Mann Whitney test is used to compare survey responses between the two study arms.
RESULTS:
37 eligible subjects completed the survey. The surgery arm consists of 15 subjects (13 FtM and 2 MtF) and the hormone arm consists of 22 subjects (15 FtM and 7 MtF). Within the hormone arm, 82% (18/22 subjects) stated a desire for surgery, and 36% (8 subjects) declared a barrier to surgery, with cost being the most common barrier. Subjects in the surgery arm answered significantly more positive scores on 8 out of 9 questions of the GCS on a 5-point scale regarding their gender congruency (p<0.05) [figure 1]. The most significant difference was observed in how others perceived their gender identity, where the surgery group rated significantly higher by a median score of 2 points (p<0.0001). No significant differences were found between the two groups in the 3 questions regarding to acceptance of their gender identity (p>0.07).
CONCLUSION:
Top surgery, in addition to HRT, significantly improves gender congruency compared to those who do to receive surgery. Our data further supports that top surgery can markedly improve someone’s life. Unfortunately, barriers including cost and access continue to be a problem for some.


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