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Dysphoria, Gender Congruence, and Life Satisfaction following Chest Masculinization Surgery: the Impact of Age, Body Mass Index, and Scar Revision
Calvin R. Schuster, Alexandra J. Davis, Bashar Hassan, Madyson Brown, Danielle Sim, Fan Liang
Department of Plastic and Reconstructive Surgery, Center for Transgender and Gender Expansive Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Background: Patient-reported outcome measures (PROM) are vital for assessing chest-masculinization surgery (CMS) outcomes. Understanding variables that may influence dysphoria, gender congruence, and satisfaction postoperatively can aid in pre-operative counseling and planning.
Methods: In a single-center, cross-sectional study of patients who underwent CMS between December 2017-May 2024, three validated PROMs were administered: the Chest Dysphoria Measure (CDM), Gender Congruence and Life Satisfaction (GCLS) scale, and Transgender Congruence Scale (TCS). Bivariate and multivariable linear regression were conducted with age, race, BMI, testosterone use, and scar revision as covariates.
Results: In total, 46 CMS patients completed the surveys with a mean (standard deviation [SD]) age of 27.6 (7.7). The mean (SD, percent of total possible score) total scores were: 4.5 (3.9, 8.8%) for CDM, 153.3 (17.6, 80.7%) for GCLS, and 51.9 (6.9, 86.5%) for TCS. On the CDM, testosterone use was significantly associated with lower frequency of being gendered as female (?=-0.5, p=0.004) and less difficulty with physical intimacy (p=0.01), while scar revision correlated with greater intimacy-related difficulty (p=0.01). On the GCLS, higher BMI correlated with greater gender-related distress (p=0.01) and lower satisfaction with health overall (p=0.04). Participants who underwent scar revision reported greater discomfort with others’ perception of their gender (p=0.01). Total GCLS and gender congruence subscale scores were negatively correlated with age (p=0.03, p=0.02). On the TCS, older age was associated with lower total score (p=0.03) and lower appearance congruence (p=0.02).
Conclusion: Overall, chest dysphoria was low and gender congruence and life satisfaction were high post-CMS. Findings suggest that older age, higher BMI, and scar revision may be risk factors for diminished psychosocial outcomes, while testosterone use may be protective. Identifying predictors can help guide preoperative counseling, expectation setting, and targeted postoperative support to optimize outcomes.
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