Global Interest in Gender Affirmation Surgery: A Google Trends Analysis.

Abstract

Sir: Recent studies estimate the prevalence of transgender individuals in the global population to be between 0.4 and 1.3 percent, with a 10- to 100-fold increase in the past decade.1 As there has been an increase in the proportion of transgender individuals undergoing gender affirmation surgery,2 it would be expected that information on these procedures would be increasingly sought by patients, their families, and providers. Social media and the Internet play a significant role in the dissemination of information for the transgender population.3 However, there has been no study to date to determine the overall public interest in gender affirmation operations. Here, we report for the first time on an analysis of Google Trends data on global interest in transgender surgery. Google Trends search parameters were set to capture all global queries from January of 2004 to February of 2018. Search terms covered a broad range of search queries that relate to both male-to-female (MTF, transwomen) and female-to-male (FTM, transmen) individuals. Terms used in the analysis were common terms and procedure-specific terms, including “transgender surgery,” “gender reassignment surgery,” “sex reassignment surgery,” “top surgery,” “bottom surgery,” “FTM bottom surgery,” “MTF bottom surgery,” “FTM phalloplasty,” “MTF vaginoplasty,” “RFF phalloplasty,” “ALT phalloplasty,” and “metoidioplasty.” Our findings show that interest in a number of common search terms for transgender surgery are increasing over time. Online interest in a majority of search terms demonstrated an upward trend, with some terms exhibiting a marked increase in recent years. Figure 1 illustrates the top five search term trends. The overall search volumes for terms varied on a magnitude of 2000 times between common terms and procedural terms (Fig. 2). This may be because the general terms are better at capturing broader information on surgical options, whereas technical terms become increasingly more relevant to those interested in pursuing specific procedures. Interest in procedure-specific search terms, though less commonly searched than general terms, is also increasing over time. The influence of politics and the media was evident in the trends in search volumes. Major spikes in search volumes correlated with media coverage of celebrity events, such as Caitlyn Jenner in Vanity Fair,4 and political announcements, such as Donald Trump’s ban on transgender people in the military.5Fig. 1.: Most common search term trends. Top five search term trends were compared with each other from January of 2004 to February of 2018. The majority of search terms exhibited an upward trend.Fig. 2.: Median aggregate search volumes. Median aggregate search volumes of all search terms were compared with each other from January of 2004 to February of 2018. The overall search volumes for terms varied on a magnitude of 2000 times between common terms and procedural terms. RFF, radial forearm flap; ALT, anterolateral thigh.Our data trends are consistent with currently available data on gender affirmation surgery trends in the United States.2 There are some limitations to the use of Google Trends; Google user data are deidentified, which may result in sampling bias, as Internet users include potential patients, physicians, and the general public. Nonetheless, Google Trends is a convenient and potentially powerful tool for examination of the public interest in health care trends and provides data to predict the demand for health services. Overall, this study emphasizes the importance of online searches in understanding public interest in surgical procedures. Future efforts may be aimed toward preparing for the increasing need for qualified surgeons for gender-affirming procedures caused by an increase in demand and use of search data to localize areas where providers of gender-affirming care are needed. DISCLOSURE The authors have no financial disclosures to declare in relation to this article. No external funding was obtained for this article. Jacson K. Shen, B.A.Nicole A. Seebacher, Ph.D.The University of Sydney School of MedicineSydney, Australia Shane D. Morrison, M.D., M.S.Division of Plastic SurgeryDepartment of SurgeryUniversity of Washington School of MedicineSeattle, Wash.