Determinants of post-surgical well-being among transgender women: Healthcare accessibility, cultural sensitivity, and social support in India.

Abstract

Background: Gender-affirming surgery (GAS) is a vital component of transgender healthcare, yet post-surgical well-being is shaped by more than surgical outcomes alone. Empirical research on post-GAS healthcare experiences in India remains limited despite policy advancements supporting transgender rights.

Objective: To examine healthcare-related and social factors associated with post-surgical well-being among transgender women in Tamil Nadu, India.

Methods: A convergent mixed-methods design was employed with 200 community-recruited transgender women who had undergone at least one GAS procedure at least six months prior. Snowball sampling was conducted through community organizations and peer referral networks. Validated Likert-scale instruments (α = .80-.88) assessed healthcare accessibility, perceived quality of care, cultural sensitivity, and social support as predictors of post-surgical well-being. Seven semi-structured interviews were analyzed using reflexive thematic analysis.

Results: All four predictors were significantly associated with post-surgical well-being (all p < .01): social support (r = .66), cultural sensitivity (r = .64), perceived quality of care (r = .62), and healthcare accessibility (r = .50). The regression model explained 41% of variance (R ² = .41), with social support (β = .28), perceived quality of care (β = .25), and cultural sensitivity (β = .22) as the strongest predictors. The identified qualitative themes were: bureaucratic vulnerability, linguistic invalidation, spatial exclusion, financial dependency, and chosen-family resilience.

Conclusion: Post-surgical well-being is shaped by the interplay of structural healthcare accessibility, gender-affirming clinical environments, and community-based support. This study provides contextually grounded evidence from South Asia and highlights the need for culturally competent, inclusive healthcare systems to support equitable recovery outcomes following GAS.