Facial Feminization Surgery and Mental Health Resource Utilization: A Retrospective Institutional Review.

OBJECTIVE

This study aims to assess the effects of facial feminization surgery (FFS) on mental health resource utilization among patients with gender dysphoria within an integrated multicenter health care system.

STUDY

DESIGN

A retrospective database review.

SETTING

An equal-access, integrated health care system.

METHODS

We retrospectively analyzed the medical records of Kaiser Permanente Northern California patients who underwent FFS from 2016 to 2021 on utilization of mental health services in a large integrated health care system. Full FFS was defined as all 3 facial thirds. We compared average quarterly utilization for 12 to 24 months before FFS with quarterly utilization during 12 to 24 months of follow-up. Patients who did not have continuous coverage for at least 12 months before and 12 months after FFS were excluded.

RESULTS

A total of 699 FFS cases were performed between 2016 and 2021, of which 478 cases were included (35.6 ± 12.3 years old, 207 [43.3%] had full FFS). Wilcoxon matched-pairs signed-rank tests comparing pre-FFS and post-FFS utilization counts showed statistically significant reductions in the number of mental health-associated visits. Age and comorbid mental health diagnoses were significant predictors of mental health resource utilization in the pre-FFS period. A comorbid mood or anxiety disorder was a predictor of changes in resource utilization following FFS.

CONCLUSION

To our knowledge, this endeavor is the first utilization study of FFS conducted in the United States. FFS was associated with significantly lower utilization of mental health services in the 12-month post-FFS period compared to the 12-month pre-FFS period.