QS3: Does Top Surgery Reduce Chest Dusphoria in Trans/Non-binary Adolescents and Young Adults

Purpose: Top surgery (i.e. mastectomy) has been shown to improve gender dysphoria and quality of life in adult transmasculine patients. However, even as an increasing number of adolescents and young adults present for gender-affirming surgery, the impact of top surgery on this population is not well described. Minor patients require parental consent and often face more stringent insurance restrictions. This prospective study aims to increase the body of evidence for gender-affirming top surgery in adolescents and young adults. We will measure the change in self-reported gender dysphoria, gender congruence, body image, and chest dysphoria. Methods: This is a prospective, multi-institutional study. Transmasculine and non-binary, designated female at birth, patients between the age of 13-25 years presenting for top surgery consultation were recruited from: Northwestern Memorial Hospital, The University of Illinois at Chicago, or Ann & Robert H. Lurie Children’s Hospital of Chicago. Patients completed four patient-reported outcomes measures at three time points: pre-operative baseline, three-months postoperative, and one-year postoperative. The questionnaires employed included the Transgender Congruence Scale (TCS), the Utretcht Gender Dysphoria Scale (UGDS), the Chest Dysphoria Measure (CDM), and the Body Image Scale (BIS). Preliminary interim analysis of mean change scores between pre- and three-month postoperative surveys was performed using paired, two-sided t-tests with confidence level at 95%. Results: Thirty nine patients have been enrolled to date. At interim analysis, ten patients, mean age 18.6±2.9, range 15-24 years, had completed 3-month follow-up. Eight identified as transmasculine, one non-binary/genderqueer, and one identified as ‘other.’ Mean change from baseline to three-months of the TCS appearance congruence sub-scale was 7.3 points (p = 0.002), mean change of the internal congruence sub-scale was 0.1 points (p = 0.859), and total score scale was 7.4 points (p = 0.002). The UGDS demonstrated a mean change of -2.1 points at three-months (p = 0.099). The Chest Dysphoria Measure demonstrated mean change of -28.3 points at three-months (p < 0.001). The BIS total score mean change was -12.3 points at three-months (p = 0.011). Among the BIS subscales, the primary sexual characteristics score had a mean change of -5.5 points (p=0.003), secondary sexual characteristics had a mean change of -4.0 points (p = 0.047) and neutral characteristics had a mean change of -1.6 points (p = 0.259) at three months. Conclusion: Our preliminary findings demonstrate that gender-affirming chest surgery improves chest dysphoria, appearance congruence, and overall gender congruence in transmasculine and non-binary adolescents and young adults. We anticipate that the final data will inform clinical practice guidelines for transgender and non-binary patients seeking mastectomy and chest masculinization.