Female to Male Mastectomy in 245 Transgender Patients: A Prospective Study of Demographics, Patient Satisfaction, and Outcomes Using a Novel, Validated "TRANS"-Questionnaire (TRANS-Q)

Background:  Despite an increase in awareness and interest regarding transgender surgery, there is a dearth of research examining this patient population. We have developed a novel assessment tool, the TRANS-Q, a comprehensive, gender-specific questionnaire to assess patient demographics, sexual orientation, mental health concerns, self-reported physical attractiveness and barriers to healthcare.  We have subsequently validated the study provide our results.

Methods:  Following IRB approval, a prospective assessment tool, TRANSQ, was distributed pre- and post-operatively from August 2015 to May 2016 to individuals who went on to have female to male mastectomy (FTMM).  Statistical analysis was performed using SPSS (Chicago, IL, USA; IBM Corp).     

Results:  245 patients were surveyed pre- and post-operatively, with 146 having completed both for a response rate of 60%.  The average age for all patients was 26.7 years (17.7 – 61.6) and the mean follow-up was 6.2 months.  There were statistically significant improvements post-operatively in personal satisfaction with shape and symmetry of chest and appearance of chest, with and without clothes, as well as significant improvements in patient comfort and confidence during sexual activity.  98% of patients reported that they were either satisfied or very satisfied with the procedure, and 99% stated that surgery was the right decision for them.  An overwhelming majority (95%) stated that they would encourage individuals in similar circumstances to undergo the procedure.  Pre-operatively, 46.7% of patients were interested in having additional genital surgery and this decreased slightly to 42.3% post-operatively.  The mean interest in additional genital surgeries was not statistically different post-operatively (3.2 vs 3.3; p > 0.5).  66% and 22.8% of individuals reported having contemplated or attempted suicide, respectively, pre-operatively.  This improved to 38.5% and 8.1%, respectively, post-operatively (p < 0.001).  80.5% of patients reported depressive episodes pre-operatively vs 49.3% post-operatively (p < 0.001). Patients reporting anxiety attacks pre-operatively decreased from 66.5% to 40.8% post-operatively (p < 0.001).  However, depression and anxiety severity, on scale of 1- 10, was not statistically different post-operatively.  There was a significant reduction in the number of patients reporting chronic pain post-operatively, with a reduction from 27.3% to 9.4% (p = 0.009).  Following, validation we achieved a Cronbach's alpha of 0.81 and modified the survey accordingly to remove invalid items.

Conclusion: While awareness and interest in transgender surgery continue to grow, there are many unanswered questions regarding the impact on the individual of pursuing surgery.  This study is the first of its kind to pre- and post-operatively survey genetic females who went on to pursue FTMM.  We have demonstrated a diverse patient population in regards to age, sexual orientation and barriers to care.  We hope that reports such as this will bring light to the growing field of transgender survey and the barriers that patients face when seeking gender confirmation surgery.  We are in the process of continuing to enroll patients in this prospective study using the validated questionnaire while conducting a longitudinal analysis of patients already included to allow for more rigorous and long-term data analysis.