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Long Term Outcomes After Gender Affirming Surgery: 40 Year Follow Up Study
Rachel Hee Young Park, MD, Yi-Ting Liu, BA, Ankhita Samuel, MD, Margot Gurganus, MD, Thomas Gampper, MD, Sean Corbett, MD, Amit Shahane, PhD, John T. Stranix, MD.
University of Virginia, Charlottesville, VA, USA.

Purpose: Gender dysphoria is a condition that often leads to significant patient morbidity and mortality. Although gender affirming surgery (GAS) has been offered for more than half a century with clear significant short-term improvement in patient wellbeing, few studies have evaluated the long term durability of these outcomes. This study aims to investigate the long term effect of GAS and patient satisfaction. Methods: Chart review identified 97 patients who were seen for gender dysphoria at a tertiary care center from 1970-1990 with comprehensive preoperative evaluations. These evaluations were used to generate a matched follow-up survey regarding their GAS, appearance, and mental/ social health for standardized outcome measures. Of 97 patients, 15 agreed to participate in the phone interview and survey. Preoperative and postoperative body congruency score (BCS), mental health status, surgical outcomes and patient satisfaction were compared. Results: Both transmasculine and transfeminine groups were more satisfied with their body postoperatively with significantly less dysphoria. BCS for chest, body hair, and voice improved significantly in 40 years postop settings with average scores ranging from 84.2 to 96.2. Body congruency scores for genitals ranged from 67.5 to 79 with free flap phalloplasty showing highest scores. Long term overall BCS was 89.6, compared to that of hormone treatment only scenario (21.2). Improved mental health outcomes persisted following surgery with significantly reduced suicidal ideation and reported resolution of any mental health comorbidity secondary to gender dysphoria. Conclusion: Gender-affirming surgery is a durable treatment that improve overall patient well-being. High patient satisfaction, improved dysphoria, and reduced mental health comorbidities persist decades after GAS without any reported patient regret.


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