Pre- and Post-Surgery Attitudes on Gender Identity and Expression

Abstract

Introduction: Transgender and gender non-binary (TGNB) patients may choose to receive gender-affirming surgery (GAS) in order to better align their bodies with their gender identities. In this study, we examined the change in patients’ comfort, both with their physical appearance and interpersonal interactions, before and after transfeminine GAS through a validated survey tool. Methods: The study was performed at an academic medical institution’s center for transgender medicine and surgery, assessing the outcomes of patients who had undergone GAS. This included vaginoplasty, facial feminization, or chest feminization surgery. The survey included binary questions related to gender identity and Likert scale interpersonal questions. The pre-surgery mean response to each of the 14 survey questions was compared with the mean response 12 months post-surgery using a two-sample t-test assuming equal variances. Results: Patients receiving transfeminine GAS were administered the survey pre-surgery (398 respondents), 2 weeks post-surgery (263 respondents), 6 months post-surgery (94 respondents), and 12 months post-surgery (68 respondents). The mean responses post-surgery for a majority of the survey questions were significantly closer to 0, meaning that patients disagreed significantly more strongly with the survey questions after receiving gender-affirming surgery, while also showing improvement in patients’ sense of how others perceived them. Conclusion: Patients choose to undergo GAS in order to better align their physical appearance with their gender identity. Our findings indicate that patient’s comfort with others’ perceptions of their gender continues to improve over time after GAS. These findings should contribute to better public understanding of GAS and its medical necessity.