An article in JAMA Network Open on August 23, 2023 addressed how often gender-affirming surgery (GAS) was performed in the U.S. from 2016 to 2019. During that timeframe the number of surgeries almost tripled.
In 2019 there were 13,011 procedures performed. The greatest number were in patients ages 19 to 30 (52.3%). Patients ages 31 to 40 represented 21.8% of surgeries. Patients ages 12 to 18 represented 7.7% of cases.
Breast and chest surgeries were the most common ones performed (56.6%). Genital reconstruction was performed mainly in older patients (35.1%). Facial and other cosmetic procedures were the least common (13.9%).
The authors believed that the significant increase in rates of surgery was due largely to greater insurance coverage for these procedures.
They also stated that the procedures have an “acceptable morbidity and reasonable rates of perioperative complications.” That is, in the U.S. such procedures are reasonably safe.
The authors did not address concerns about the quality of prior studies. One paper from 2022 was a review of a large number of studies on patient satisfaction with GAS. Those authors noted that 68.7% of studies addressed “patient-centered outcomes,” but “only 1.0% used metrics validated in the transgender population.” However, overall the reports indicated “high patient satisfaction.”
The paper also addressed patient satisfaction, which was based on prior studies. Generally, those papers indicate good patient satisfaction, improved quality of life, and a decrease in gender dysphoria.
Some authorities recommend caution since individual studies include only a small number of patients compared to the number of surgeries performed. Also, in a number of cases the follow-up was as short as 6 months after the procedure.
Also, in one study cited by the JAMA article, 38% of the patients “would change their experience with GAS.” This could be anything from difficulties in arranging for the surgery to untoward outcomes; they were not listed.
Despite these reservations, it does appear that patient satisfaction is generally high after GAS, at least for a period of time. Once there is a larger number of individuals with GAS tested with standardized questionnaires several years post-op, we will have a more definitive answer to the question of whether patient satisfaction with GAS persists in the long run.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
