Surgical satisfaction and quality of life outcomes reported by transgender men and women at least one year post gender-affirming surgery: A systematic literature review

Abstract

Background

Many transgender women and men undergo gender-affirming surgeries. Existing work shows that early surgery outcomes are generally positive, suggesting high surgical satisfaction and positive quality of life outcomes. Less work, however, examines these outcomes in the longer-term.

Aims

To conduct a systematic literature review into the longer-term (i.e., ≥ 1 year) surgical satisfaction and quality of outcomes following various forms of gender-affirming surgery in transgender populations. Specifically, we aim to examine research on such outcomes at least one-year post gender-affirming chest, genital, facial, vocal cord, and Adam’s apple removal surgeries.

Methods

Studies were identified through Google Scholar, PsycINFO, Scopus, and PubMed databases, as well as through Google Scholar search alerts. We considered all studies published until October 2021. Two reviewers extracted data from suitable studies using Covidence. Both reviewers also independently assessed the identified studies’ risk of bias and strength of evidence.

Results

Seventy-nine low quality (e.g., small sample sizes, lack of control/comparison groups) studies suggest that most transgender patients are satisfied with surgical outcomes when assessed at least one-year post-surgery. Low quality research also indicates that transgender women and men typically report positive psychological and sexual wellbeing post-surgery, and similar wellbeing outcomes as those who have not had surgery.

Discussion

To the best of our knowledge, this literature review is the first to critically summarize and evaluate all published studies on the longer-term quality of life outcomes following chest, genital, facial, voice and Adam’s apple removal surgeries for transgender women and men. While the results suggest promising surgical satisfaction and quality of life outcomes following surgery, many studies only draw on small samples, and most studies do not allow for causal conclusions. Further, few studies have compared surgical outcomes between transgender women and men. We conclude by offering concrete suggestions for future research.

Keywords:

• Long-term outcomes
• quality of life; systematic
• review
• surgery
• surgical satisfaction
• transgender

Acknowledgments

The authors would like to thank Samantha Bulowski for assistance with screening articles for inclusion in the present review.

Declaration of interest

The authors have no other conflict of interest to declare.

Notes

1 The authors (who are themselves gender diverse) note that the term “transsexual” is offensive to many transgender people.

Additional information

Funding

This review was supported by Dr. Javier’s Australian Government Research Training Scholarship and 2019/2020 University of Queensland Summer Research Scholarships. Neither funding source did not contribute to the writing of the manuscript nor the decision to submit it for publication.