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Gender-Affirming Facial Feminization Surgery Improves Patient-Reported Psychosocial Outcomes
Rachel M. Caprini, BS, Michelle K. Oberoi, BS, BA, Dillon Dejam, BS, BA, Candace H. Chan, BS, Hi'ilani MK Potemra, BS, Justine C. Lee, MD, PhD.
University of California Los Angeles, Los Angeles, CA, USA.

Purpose: Comprehensive, prospective analyses of psychosocial outcomes after gender-affirming facial feminization surgery (FFS) are absent in the literature resulting in a knowledge gap on the effects of FFS on quality of life as well as ramifications in access to care for patients through health insurance coverage. The aim of this work is to determine the effect of gender-affirming FFS on psychosocial outcomes in patients with gender dysphoria by administering 11 validated, quantitative patient-reported outcomes measures.Methods: A prospective cohort study of patients evaluated for de novo gender-affirming FFS (2019-2021) at the University of California Los Angeles was conducted. Patients were prospectively administered 11 psychosocial assessments from the Patient-Reported Outcomes Measurement Information System before (>21 days preoperatively) and after (>90 days postoperatively) FFS. Patients who presented for revision FFS were excluded. Comparison of preoperative and postoperative groups were performed using Chi square analyses, independent t tests, and Mann Whitney U tests. Multivariable linear regression analyses were conducted for each of the psychosocial outcomes scores to assess the effects of the following independent variables: completion of FFS, completion of other gender-affirming surgeries, duration of hormone therapy for medical transition, presence of pre-existing mental health diagnoses, and socioeconomic disparities as defined by type of health insurance (private versus public). Selection of the independent variables for inclusion in the regression model was based on the known effects of each variable on psychosocial functioning in transgender patients.Results: 190 patients (mean age 33.110.6 years) were included. Compared with the preoperative FFS group (n=136), patients who completed FFS (n=54) reported improved scores in 6 of the 11 measures including anxiety (56.88.4 vs. 60.08.2, p=0.02), depression (52.28.7 vs. 56.78.9, p=0.002), positive affect (46.78.6 vs. 42.88.8, p=0.007), meaning and purpose (50.411.2 vs. 46.010.6, p=0.02), global mental health (46.47.1 vs. 43.39.0, p=0.02), and social isolation (51.87.5 vs. 55.27.9, p=0.02). Multivariable analysis to account for the effects of other gender-affirming surgeries, hormone therapy duration, pre-existing mental health diagnoses, and socioeconomic disparities on psychosocial functioning demonstrated that completion of FFS was independently predictive of improved psychosocial outcomes scores in the 6 measures.Conclusions: Gender-affirming facial feminization surgery improves anxiety, depression, positive affect, meaning and purpose, global mental health, and social isolation in patients with gender dysphoria.


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