Quality of life survey to assess the psychosocial benefits of gender affirming surgery in female-to-male transgender patients

While a number of public health studies focus on mental health and HIV in transgender populations, there is a disproportionately smaller number of investigations into the benefits of surgery. Various psychometric instruments... [ view full abstract ]

While a number of public health studies focus on mental health and HIV in transgender populations, there is a disproportionately smaller number of investigations into the benefits of surgery. Various psychometric instruments have been developed (e.g. WHOQOL-100, Short Form [36] Health Survey) to measure patient reported quality of life. However, a major limitation of these studies is that they rely on instruments designed for the general population that do not address the unique psychosocial stressors confronting transgender patients. Chest reconstruction for female-to-male (FTM) transgender patients involves bilateral simple mastectomies to remove female breast tissue combined with free nipple grafting to resize and reposition the nipples to fit the typical male aesthetic dimensions. Alteration of the chest can have large implications for how transgender patients perceive themselves, how they dress, and how they interact with those around them. Thus, there is an urgent need for a tool that can be used to evaluate psychosocial outcomes and quality of life as they relate to surgical outcomes and the post-operative experience.

To design and validate a quantitative survey that specifically assesses issues important to FTM patients before and after chest reconstruction surgery. [ view full abstract ]

To design and validate a quantitative survey that specifically assesses issues important to FTM patients before and after chest reconstruction surgery.

FTM transgender patients at the University of California, San Francisco (UCSF) Center for Excellence in Transgender Care and San Francisco General Hospital community health center who had and had not undergone chest... [ view full abstract ]

FTM transgender patients at the University of California, San Francisco (UCSF) Center for Excellence in Transgender Care and San Francisco General Hospital community health center who had and had not undergone chest reconstruction surgery were qualitatively interviewed individually and in focus groups to guide construction of quantitative pre- and post-operative surveys based on a five-point Likert scale. A preliminary quantitative survey was administered to patients. The survey was then further modified based on structured interviews eliciting feedback from a multidisciplinary team of patients, primary care and mental health providers, and plastic surgeons. The final surveys were administered to all FTM transgender patients who met the WPATH criteria for gender affirming surgery and elected to have chest reconstruction performed at UCSF. A validated WHO Quality of Life (WHOQOL-BREF) survey was administered simultaneously for comparison. Wilcoxon signed-rank tests were used to test for significant differences in the median pre- and post-operative scores for each section of the surveys. Cronbach’s alpha and Pearson Correlation Coefficients were calculated to assess internal reliability and convergent/discriminant validity, respectively, within and between each section of the survey.

The final versions of the newly designed pre- and post-operative quality of life surveys had 29-items, consisting of three sections measuring patients’ satisfaction and perception of masculinity, confidence around others,... [ view full abstract ]

The final versions of the newly designed pre- and post-operative quality of life surveys had 29-items, consisting of three sections measuring patients’ satisfaction and perception of masculinity, confidence around others, and overall aesthetic as it relates to their chest. The brief version of the WHO Quality of Life survey consisted of four sections measuring physical health, psychological well being, social relationships, and patients’ interactions with their environment.

Among the 11 FTM transgender patients surveyed thus far, 70% were Caucasian and the median age was 32.5 (range 22-50) years. All patients underwent bilateral simple mastectomy with free nipple grafting. Only one patient (9%)... [ view full abstract ]

Among the 11 FTM transgender patients surveyed thus far, 70% were Caucasian and the median age was 32.5 (range 22-50) years. All patients underwent bilateral simple mastectomy with free nipple grafting. Only one patient (9%) experienced a major complication, i.e. readmission and return to the operating room for hematoma evacuation. Ultimately, the patient was pleased with his results and reported a significant improvement in his quality of life after surgery. The survey detected statistically significant median quality of life improvements in all three sections of our survey (p<0.005). While comparable statistically significant improvements were found using the WHO Quality of Life survey (p<0.05), qualitative feedback revealed that patients perceived the WHO survey as an inappropriate, sometimes offensive tool for evaluating topics important to them. The median time to complete the pre- and post-operative surveys was 10 minutes. Calculation of Cronbach’s α (0.67-0.81) and the Pearson Correlation Coefficient for each section revealed excellent internal validity.

This newly constructed quality of life survey appears to be feasible and valid for FTM transgender patients undergoing gender affirming surgery via chest reconstruction. Although this evaluation is based on a small sample size... [ view full abstract ]

This newly constructed quality of life survey appears to be feasible and valid for FTM transgender patients undergoing gender affirming surgery via chest reconstruction. Although this evaluation is based on a small sample size thus far, these findings lay the foundation for larger, multicenter studies that can more thoroughly investigate the psychosocial benefits and unmet needs regarding gender affirming surgery. The use of more pertinent quality of life measures such as this one can be expected to help better establish the many benefits of gender affirming surgery and influence public policy to broaden access to a larger population of transgender individuals.