Top surgery improves dysphoria in nonbinary, transmasculine youth
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Gender-affirming top surgery was associated with improved chest dysphoria, gender congruence and body image satisfaction in transmasculine and non-binary patients aged 12 to 24 years, according to a study published in JAMA Pediatrics.
The study was a collaboration between numerous departments at three Chicago-area institutions: Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago and the University of Illinois Chicago.
Sumanas W. Jordan, MD, PhD, associate professor in the division of plastic and reconstructive surgery at Feinberg School of Medicine and one of the study’s authors, told Healio that the work was inspired by the authors’ patients and their families, and clarified that the study began in late 2019 before recent political incidents surrounding transgender care.
“All of the evidence that we had surrounding gender-affirming care in trans youth pointed to a benefit, but there was no prospective, controlled study of gender-affirming top surgery,” Jordan said. “It is important to conduct research to place our interventions in context, particularly in a vulnerable population.”
In the nonrandomized, multicenter, prospective, control-matched study, Jordan and colleagues recruited 36 surgical patients from their institutions who were already presenting as transmasculine or nonbinary and had been cleared for surgery. This group was compared with 34 control patients who were not seeking surgery and were matched on age and testosterone use. Both groups then completed written responses to questions in line with the Chest Dysphoria Measure questionnaire, as well as the Transgender Congruence Scale and Body Image Scale (BIS) questionnaire.
According to the resulting data, chest dysphoria decreased by 25.58 points in the surgery group (95% CI, –29.18 to –21.98), while gender congruence increased by 7.78 points (95% CI, 6.06-9.5) in the same group. Body image dissatisfaction in that group also decreased by an average of 7.2 points (95% CI, –11.68 to –2.72).
Complications were minimal, according to the researchers, with one hematoma, two seromas and one nipple loss. No incidences of infection or delayed wound healing were reported.
Limitations of the study included the exclusion of 11 patients due to attrition, as well as the possibility of sampling bias due to the fact that patients in the treatment group may have had greater socioeconomic status and parental support.
The study illustrated that transgender youth “deserve our care and our consideration,” according to Jordan.
“All of our patient care is conducted with thoughtfulness and collaboration with adolescent medicine and mental health,” Jordan said. “We are also obligated to conduct research to inform future care and to bring transgender health out of the dark, where it has been kept for too long.”
Jordan said transgender health is an evolving field.
“We do the best we can for the patients in the moment that they present to us,” Jordan said. “We are obligated to continue to provide high quality, patient centered care while establishing best practices.”