Improved health-related quality of life and gender congruence after gender-affirming mastectomy-a prospective cohort study.

Background: Gender-affirming mastectomy (GAM) is the most common surgical treatment for transgender men and non-binary individuals.

Aim: To prospectively investigate how GAM affects health-related quality of life (HRQoL) and gender congruence in transgender men and non-binary individuals.

Methods: A prospective cohort study including 112 individuals with the diagnosis transsexualism or other gender identity disorder (F64.0 or F64.8 respectively, according to ICD-10) who underwent GAM at our hospital between 2016 and 2021. To measure HRQoL, gender appearance congruence and gender identity acceptance, the Short Form-36 Health Survey (SF-36) and the Transgender Congruence Scale (TCS) respectively, were distributed prior to surgery (baseline), and 12-36 months post-operatively. Paired t-tests were used to assess the difference in mean scores between these measure points and adjusted for multiple testing with Bonferroni correction.

Outcomes: A statistically significant improvement was observed in TCS overall score and subscale appearance congruence, as well as the SF-36 domains related to emotional well-being, vitality and bodily pain.

Results: The response rate was 92.0%. A statistically significant improvement was observed (P < .00625) in the SF-36 domains related to emotional well-being, as well as in the domains vitality and bodily pain, when comparing baseline with 12-36 months postoperatively. The overall TCS score as well as the subscale appearance congruence showed statistically significant improvement (P < .0167), whereas the gender identity acceptance subscale scores were relatively high at baseline and did not show a statistically significant change.

Clinical implications: Gender-affirming mastectomy is a desirable procedure to reduce gender dysphoria and improve HRQoL in transgender men and non-binary individuals.

Strengths and limitations: To our knowledge, this is one of the largest studies to prospectively examine the impact of GAM on HRQoL and gender congruence in transgender men and non-binary individuals. Additionally, the response rate was high, exceeding 90%.A limitation to our study is that the questionnaires used were not originally developed to evaluate effects on HRQoL, appearance congruence and gender identity acceptance after GAM specifically. Also, not all patients who underwent GAM during the study period were included, as some declined to participate.

Conclusion: Gender-affirming mastectomy is associated with improved HRQoL and increased congruence between gender identity and appearance in transgender men and non-binary individuals.