General Health and Psychosocial Functioning After Facial Feminization Surgery – A Nationwide Cross-Sectional Analysis of the TransPop Study

Rishub Karan Das, MD, Brian C Drolet, MD, Salam Al Kassis, MD, Galen Perdikis, MD

Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

INTRODUCTION

Facial feminization surgery (FFS) uses craniomaxillofacial techniques to feminize the face which can alleviate gender dysphoria in gender diverse individuals.

However, insurance coverage for these procedures is variable due to limited evidence on health and psychosocial outcomes after FFS.

We used the TransPop Study, the first nationally representative US transgender population health survey, to evaluate the influence of FFS on general health and validated metrics of psychosocial functioning.

MATERIALS / METHODS

• A cross-sectional analysis of the TransPop Study was conducted in line with STROBE guidelines.

• Outcomes of interests included demographics, health status, and validated measures of psychological distress (Kessler 6 scale), Satisfaction with Life, and General Health

• Sociodemographic and outcome differences between the FFS and non- FFS groups were evaluated using weighted Pearson χ2 tests with Rao- Scott correction, with an α<0.05.

• Covariates controlled for included age, race, education, hormone therapy, and other gender-affirming surgeries

• All analyses were conducted in Stata Version 17

RESULTS

Study Outcomes by Receipt of Facial Feminization Surgery (FFS)

Outcome

Prevalence of FFS
Completed College/Graduate School

Received Hormone Therapy
Received Other Gender-Affirming Surgeries

Serious Psychological Distress

Life Satisfaction Good/Excellent General Health

96.4 (76.8-99.6)

78.9 (67.9-86.9)

p-value

— <0.001

<0.001 <0.001

<0.05

<0.001 <0.05

• National estimate of 5.7% transgender adults (assigned male at birth) received facial feminization surgery

• FFS receipt was associated with higher educational attainment, hormone therapy use, and receipt of other gender-affirming surgeries

• Rates of serious psychological distress were lower in gender diverse adults who received FFS

• Life satisfaction, defined as a score of ≥5 on the Satisfaction With Life Scale (range: 1–7), was higher with FFS receipt

• Those who received FFS were more likely to describe their general health as ”Good” or ”Excellent”

  CONCLUSION

• Nationally representative study demonstrates that receipt of FFS is associated with improvements in serious psychological distress, life satisfaction, and general health

• Extends existing data by providing nationally representative estimates instead of convenience sample-based data and incorporate multidimensional assessments of well- being