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Trans, nonbinary youth experience chest dysphoria; linked with depression, anxiety

Transgender and nonbinary adolescents and young adults designated female at birth experience chest dysphoria, and this is associated with depression and anxiety. To deal with this, top surgery may need to be performed.

Photo by Kamaji Ogino from Pexels.com

Transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB) experience chest dysphoria, and this is associated with depression and anxiety. To deal with this, top surgery may need to be performed.

This is according to a study – “Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults” by Mona Ascha, Daniel C. Sasson, Rachita Sood, et al – that appeared in JAMA Pediatrics.

For this study, the researchers did a nonrandomized prospective cohort study of patients who underwent top surgery between December 2019 and April 2021, and a matched control group who did not receive surgery. Patients completed outcomes measures preoperatively and three months postoperatively. This study took place across 3 institutions in a single, large metropolitan city. Patients aged 13 to 24 years who presented for gender-affirming top surgery were recruited into the treatment arm. Patients in the treatment arm were matched with individuals in the control arm based on age and duration of testosterone therapy.

From the patients considered, 81 patients were enrolled, while 11 were lost to follow-up. Thirty-six surgical patients and 34 matched control patients completed the outcomes measures. Weighted absolute standardized mean differences were acceptable between groups with respect to body mass index, but were not comparable with respect to the remaining demographic variables baseline outcome measures. Surgical complications were minimal.

More importantly, the inverse probability of treatment weighting analyses suggest an association between surgery and substantial improvements in Chest Dysphoria Measure (CDM) (–25.58 points; 95% CI, –29.18 to –21.98), Transgender Congruence Scale (TCS) (7.78 points; 95% CI, 6.06-9.50), and and Body Image Scale (BIS) (–7.20 points; 95% CI, –11.68 to –2.72) scores.

This means that top surgery in TGNB DFAB AYA – which is is associated with low complication rates – is “associated with improved chest dysphoria, gender congruence, and body image satisfaction in this age group.”

“Findings from this study can help dispel misconceptions that gender-affirming treatment is experimental and support evidence-based practices of top surgery. Our retrospective review demonstrated associations between chest dysphoria and anxiety and depression; top surgery can improve chest dysphoria, thereby leading to improvements in quality of life,” the researchers stated. “Our results also corroborate studies that gender-affirming therapy improves mental health and quality of life among TGNB youth.”

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