Surgical Satisfaction, Quality of Life, and Their Association After Gender-Affirming Surgery: A Follow-up Study

TLDR

The study evaluated gender‑affirming surgery outcomes 4–6 years after initial contact and examined how postoperative satisfaction relates to quality of life. A multicenter cross‑sectional follow‑up of 136 GAS recipients (from 546 eligible, 201 responded) measured surgical complications, satisfaction, QoL, gender dysphoria, and psychological symptoms with standardized questionnaires. Satisfaction rates were 94–100%, yet 6% reported dissatisfaction or regret associated with pre‑operative psychological symptoms or complications, and these patients had lower QoL, indicating dissatisfaction predicts poorer psychological and QoL outcomes.

Abstract

We assessed the outcomes of gender-affirming surgery (GAS, or sex-reassignment surgery) 4 to 6 years after first clinical contact, and the associations between postoperative (dis)satisfaction and quality of life (QoL). Our multicenter, cross-sectional follow-up study involved persons diagnosed with gender dysphoria (DSM-IV-TR) who applied for medical interventions from 2007 until 2009. Of 546 eligible persons, 201 (37%) responded, of whom 136 had undergone GAS (genital, chest, facial, vocal cord and/or thyroid cartilage surgery). Main outcome measures were procedure performed, self-reported complications, and satisfaction with surgical outcomes (standardized questionnaires), QoL (Satisfaction With Life Scale, Subjective Happiness Scale, Cantril Ladder), gender dysphoria (Utrecht Gender Dysphoria Scale), and psychological symptoms (Symptom Checklist-90). Postoperative satisfaction was 94% to 100%, depending on the type of surgery performed. Eight (6%) of the participants reported dissatisfaction and/or regret, which was associated with preoperative psychological symptoms or self-reported surgical complications (OR = 6.07). Satisfied respondents' QoL scores were similar to reference values; dissatisfied or regretful respondents' scores were lower. Therefore, dissatisfaction after GAS may be viewed as indicator of unfavorable psychological and QoL outcomes.