Sustained Impact of Top Surgery on Chest Dysphoria in Transmasculine and Nonbinary Adolescents and Young Adults.

PURPOSE: There is limited prospective research evaluating the impact of gender-affirming top surgery on transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB). This study is a 12-month follow-up to our prior work demonstrating the positive impact of top surgery on chest dysphoria, gender congruence, and body image in TGNB AYA DFAB at 3 months.

METHODS

This is a multicenter, nonrandomized prospective matched control study of patients aged 13-24 years who underwent top surgery between December 2019 and April 2021 compared to a matched nonsurgical control group. Patient-reported outcomes were obtained preoperatively and at 3 and 12 months postoperatively. Additional responses were collected at study closeout (18-39 months postsurgery). Outcome measures were Chest Dysphoria Measure (CDM), Transgender Congruence Scale (TCS), and Body Image Scale (BIS). Analyses included inverse probability of treatment weighting with linear mixed effects models.

RESULTS

Surgical intervention was associated with improved CDM, TCS, and BIS scales at 12 months: CDM (-17.86; 95% confidence interval -21.97 to -13.74), TCS (+6.29; 4.39-8.19), and BIS (-7.9; -12.65 to -3.16). Improvements were sustained at study closeout. Subgroup analyses for patients of 18 years or younger yielded similar results.

DISCUSSION: We present the first and largest prospective matched control study evaluating quantitative outcomes of top surgery in TGNB AYA DFAB, demonstrating meaningful improvements in body image, chest dysphoria, and gender congruence 12 months after surgery and at study closeout. Surgical intervention is a part of the armamentarium for the treatment of gender dysphoria, and its effectiveness is persistent in this age group.