Background : There are few investigations into the effects of gender affirming surgery (GAS) on quality of life (QoL) in transgender populations. The psychometric instruments that have been validated for measuring patient reported QoL were developed using cis-gendered populations and thus do not capture the unique obstacles confronting transgender patients. We developed a novel patient-reported instrument to evaluate the QoL of trans-men undergoing chest reconstruction called the GENDER-Q.
Methods : Qualitative methods consisting of one-on-one and focus group interviews were conducted to construct a QoL instrument pertinent to masculinizing chest surgery. The GENDER-Q consists of three QoL domains addressing feelings of gender identity, physical appearance, and psychosocial well-being. The surveys were then administered prospectively to trans-men undergoing masculinizing inframammary mastectomy with free nipple grafting. Wilcoxon signed-rank tests were used to test for significant differences between the median pre- and post-operative quality of life scores. Cronbach’s alpha was calculated to measure internal validity while the brief version of the WHO QoL survey was given simultaneously for external validity.
Results : 32 trans-men underwent inframammary mastectomy with free nipple grafting and completed surveys pre-operatively and post-operatively (4 to 6 weeks and 1-2 years after surgery). The GENDER-Q detected a statistically significant improvement in median quality of life up to two years after surgery (Figure 1). Similar, though more modest improvements were found using the brief version of the WHO Quality of Life survey (p<0.05). There were no patients that reported regret after surgery and all 32 patients reported that surgery made their lives better. Calculation of Cronbach’s alpha (0.67-0.81) revealed excellent internal validity in all three domains of the GENDER-Q.
Conclusions : The GENDER-Q is the first valid quality of life instrument for trans-men undergoing chest reconstruction and was significantly more sensitive than the brief version of the WHO quality of life survey. Developing additional GENDER-Q sections applicable to facial, chest, and urogenital reconstructive surgery can provide a more comprehensive assessment of the effects of GAS. Large-scale, longitudinal studies using this new instrument to evaluate the effects of GAS are needed to help better establish the many benefits of GAS to influence public policy and broaden access to GAS.