Needs Assessment of Gender-Affirming Face, Neck, and Voice Procedures and the Role of Gender Dysphoria.

Abstract

To assess the needs of transgender and nonbinary (TNB) adults for gender-affirming face, neck, and voice procedures. Cross-sectional survey. Online, February to May 2022. Primary outcomes included utilization of otolaryngologists and speech-language pathologists; gender dysphoria felt from the face, neck, and voice self-reported on a 0 to 10 numeric rating scale (0 = no dysphoria, 10 = unbearable); and desire for various gender-affirming face, neck, and voice procedures. We used ordinal logistic and linear regression to assess relationships between site-specific dysphoria and the desire for relevant procedures. TNB participants (N = 234) infrequently sought gender-affirming care with speech-language pathologists (23%), facial plastic surgeons (8%), or laryngologists (3%). Participants experienced the strongest dysphoria from the voice (median 7/10), jawline/chin (4/10), and neck (3.5/10). Transmasculine and nonbinary participants typically seeking masculinization (n = 83) frequently desired voice therapy (want = 35%, had = 8%). Transfeminine and nonbinary participants typically seeking feminization (n = 145) frequently desired voice therapy (want = 52%, had = 23%), chondrolaryngoplasty (want = 45%, had = 5%), and hair removal/electrolysis (want = 43%, had = 44%). Many desired at least 1 facial feminization surgery procedure (65%), especially mandible reduction (want = 42%, had = 3%), rhinoplasty (want = 41%, had = 1%), and forehead reduction (want = 37%, had = 4%). Dysphoria ratings were associated with desiring relevant procedures (p < .05 for all), notably voice therapy (odds ratio [OR] = 1.50), chondrolaryngoplasty (OR = 1.46), mandible reduction (OR = 1.38), rhinoplasty (OR = 1.59), and forehead reduction (OR = 1.82). Gender dysphoria from the face, neck, and voice can be severe for TNB people and is associated with the desire for gender-affirming procedures. The high demand yet low reported access to these procedures highlights the need for providers of gender-affirming face, neck, and voice care.