top surgery
Examining outcomes of top surgery on chest dysphoria among transgender and non-binary adolescents
About the project
Our project, titled "Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults," was published in JAMA Pediatrics in November 2022.
The study contributes to the growing body of evidence supporting the benefits of gender-affirming care in improving mental health outcomes for transgender and nonbinary youth.
Key aspects about this study:
- This is a nonrandomized prospective cohort study of patients who underwent top surgery between December 2019 and April 2021 and a matched control group who did not receive surgery.
- Patients completed outcomes measures preoperatively and 3 months postoperatively.
- Patients aged 16 to 24 years who presented for gender-affirming top surgery were recruited into the treatment arm.
- Patients in the treatment arm were matched using inverse probability of treatment weighting (IPTW) methods with individuals in the control arm based on age and duration of testosterone therapy.
Patient-reported outcomes were collected at enrollment and 3 months postoperatively or 3 months postbaseline for the control cohort. The primary outcome was the Chest Dysphoria Measure (CDM). Baseline demographic and surgical variables were collected, and descriptive statistics were calculated. IPTW was used to estimate the association of top surgery with outcomes. Probability of treatment was estimated using gradient-boosted machines with covariates of choice.
Results
Our findings indicate that transgender and non-binary individuals designated female at birth who underwent top surgery reported significantly lower levels of chest dysphoria compared to those who had not.
Key findings include:
- 81 patients were enrolled (mean [SD] age, 18.6 [2.7] years); 11 were lost to follow-up.
- 36 surgical patients and 34 matched control patients completed the outcomes measures.
- Weighted absolute standardized mean differences were acceptable between groups with respect to body mass index, but were not comparable with respect to the remaining demographic variables baseline outcome measures.
- Surgical complications were minimal.
- IPTW analyses suggest an association between surgery and substantial improvements in CDM (-25.58 points; 95% CI, -29.18 to -21.98), TCS (7.78 points; 95% CI, 6.06-9.50), and BIS (-7.20 points; 95% CI, -11.68 to -2.72) scores.
These results underscore the importance of access to gender-affirming surgical interventions for eligible adolescents and young adults experiencing chest dysphoria.
Next Work
