Quality of Life and Perceived Social Support Before and After Sex Reassignment Surgery

Gynecological gender-affirming surgeries: what are the motivations and experiences? A qualitative study

BACKGROUND

Although many transmasculine individuals undergo 1 or more gynecological surgeries (ie, hysterectomy, oophorectomy, tubectomy, or colpectomy), little has been published about motivation, subjective experiences, and the effect on dysphoria and quality of life.

AIM

The aim of this study was to acquire an in-depth understanding of patients' motivations and experienced outcomes of gynecological gender surgery.

METHODS

In this qualitative study, in-depth semi-structured interviews were conducted. Nine participants were included who were: on the waiting list for their first gynecological surgery (n = 2), or who had either undergone gynecological surgery as part of their transitioning (ie, hysterectomy) and were on the waiting list for another gynecological procedure (ie, colpectomy, n = 2), or who had undergone gynecological surgery and did not wish to undergo any further surgeries (n = 5). In-depth semi-structured interviews were conducted. Topics discussed were motivation to opt for a specific surgery, expectations, and experiences. Thematic analysis was carried out to compose themes from the interview transcripts using the concepts of body image and gender affirmation as a theoretical lens.

OUTCOMES

The primary outcomes of this study were composed themes based on thematic analysis of the interview transcripts.

RESULTS

Three subthemes were identified, displaying how gynecological surgeries could contribute to gender affirmation: body representation matching oneself; achieving functional congruence; and enabling further surgical transition.

CLINICAL IMPLICATIONS

This study offers valuable insights for healthcare professionals in patient counseling and shared decision-making and provides a foundation for developing patient-reported outcome measures tailored to transmasculine individuals.

STRENGTHS AND LIMITATIONS

To our knowledge, this is the first qualitative report to study the motivations for and outcomes of gynecological gender-affirming surgeries in such depth; however, the results cannot be directly applied to other settings without considering the local context, including factors such as legislation and insurance policies.

CONCLUSION

This study highlights how gynecological surgeries, unlike more visible gender-affirming procedures like chest surgeries, address internal conflicts related to the masculine identity by altering the body's functioning, thereby playing an important role in the process of gender affirmation.

Do hormones and surgery improve the health of adults with gender incongruence? A systematic review of patient reported outcomes

BACKGROUND

Gender diverse people in Australia have higher levels of psychological stress, suicidal ideation and suicide attempts and have poorer self-reported health than cisgender people.

OBJECTIVES

To determine if adults who experience gender incongruence have improved health-related quality of life and mental health with gender affirming treatment (hormone therapy and surgery), compared with no treatment.

DATA SOURCES

PubMed, Web of Science, Embase and Psych Info.

REVIEW METHODS

A systematic review of peer-reviewed publications in English from January 2010 to October 2022. Studies were included where: participants were treated with gender affirming surgery or hormone therapy for minimum 3 months and; validated patient reported outcome measures of health-related quality of life or mental health were reported. Quality of evidence assessment was undertaken using the Let Evidence Guide Every New Decision evaluation tool.

RESULTS

Eighty-one publications were included for analysis. The systematic review indicated that there were significant improvements in the domains of mental illness, gender dysphoria, body image and health-related quality of life following gender affirming medical treatment as measured by a variety of patient reported outcomes. Meta-analysis showed significant improvement in body image (z = 4.47, P < 0.001) and health-related quality of life for psychological (z = 1.99, P = 0.047) and social relationships (z = 3.09, P = 0.002) following gender affirming surgery.

CONCLUSIONS

There is evidence that hormones and surgery as a collective for adults with gender incongruence has therapeutic value and should be considered for funding within Australia's healthcare systems. The development and implementation of patient-reported outcome tools tailored for purpose (GENDER Q) will facilitate future research.

Qualitative Study on the Real Experiences of Patients with Meige Syndrome Based on the Individual and Family Self-Management Theory

Objective

This study aimed to analyze the real experiences of patients with Meige Syndrome, which is an idiopathic dystonia, during the perioperative period and to explore the practical application and effectiveness of Individual and Family Self-Management Theory (IFSMT) in improving patient experiences.

Methods

A qualitative descriptive research methodology was employed to elucidate the intricate psychological and social experiences encountered by patients with Meige Syndrome throughout the perioperative phase. This study conduct face-to-face, one-on-one, semi-structured interviews with 16 Meige Syndrome patients to gain an in-depth understanding of the patients' true feelings and needs. Interview data were organized and analyzed using Colaizzi's method, and themes were refined in conjunction with IFSMT to reveal patients' self-management practices and influencing factors.

Results

Through in-depth analysis using Colaizzi's method and the application of IFSMT to the perioperative experiences of patients with Meige Syndrome, and reported according to COREQ standards, three core themes were identified: (1) Context Dimension (specific disease factors, physical and social environmental factors, personal and family factors), (2) Process Dimension (knowledge and beliefs, self-regulation and self-efficacy, social facilitation), and (3) Outcome Dimension (proximal and distal outcomes of self-management behaviors).

Conclusion

This study demonstrates that IFSMT has significant application value in the perioperative experiences of patients with Meige Syndrome. Enhancing patients' knowledge, beliefs, self-regulation abilities, and social support can promote effective self-management behaviors, thereby improving their quality of life and health status. Additionally, the study reveals the complexity of self-management in perioperative patients, emphasizing the importance of interdisciplinary collaboration and comprehensive interventions in enhancing patient experiences. Future research can further explore how to apply these theories in clinical practice to optimize perioperative management and rehabilitation processes for patients with Meige Syndrome.

"I Had Attained the Identity I Had Long Desired": A Grounded Theory Study of Experiences of Transgender Men in Türkiye

Transgender individuals form a distinct community that often experiences marginalization within society. This marginalization is particularly pronounced in patriarchal countries, where transgender men encounter various challenges across psychological, medical, legal, and social domains during their transition. The study design to conduct a thorough analysis of the life experiences and perspectives of transgender men in Türkiye. It involved 15 participants and the collected data were subsequently analyzed using the constant comparative method, a key technique within grounded theory methodology. The coding process resulted in three main themes: "Realizing gender identity", "Impact of social support sources", and "The nature of being visible", and six sub-themes were formed, the core category being "… Despite the numerous challenges encountered along the way, when I gazed into the mirror, I realized I had attained the identity I had long desired". Transgender individuals in the study expressed encountering emotional, physical, and psychological challenges throughout their personal journeys. However, despite these difficulties, they reported experiencing a sense of satisfaction and contentment upon reaching the end of their transition process. It is recommended to implement counseling services specifically tailored for transgender individuals and their families and incorporate transgender-related content into the training programs of professionals working with transgender individuals.

"Escaping the Gender Prison"-Transgender Men's Experience Before and After Hysterectomy: A Qualitative Study

This study aimed to examine the experiences of female-to-male transgendered individuals (FtMs) who underwent gender-affirming hysterectomy (GAH) and to investigate patients' perceptions of GAH and their expectations and support needs from healthcare professionals before and after the surgery. The study used a phenomenological approach and a qualitative research method. Data were collected through in-depth interviews. The sample was selected using diversity sampling, which is one of the deliberate sampling methods. The study included 20 FtMs with a GAH in Turkey between February 2022 and 2023. As a result of the study, participants identified three main themes: experiences with body and gender identity, experiences with health professionals and systems, and mental and physical recovery from surgery. FtMs individuals reported less distress and more happiness after undergoing a hysterectomy. The participants expected health professionals and society to raise awareness, normalize the process, and improve legal procedures. They advocated for legal regulations that address reproductive deprivation and identity issues without surgery and the ability to freeze oocytes before hysterectomy. This study sheds light on the experiences of transgender FtMs before and after GAH. These findings can potentially improve gender-affirming healthcare, particularly in our country.

Perceived social support mediates cancer and living meaningfully intervention effects on quality of life after breast cancer surgery

Aim: To explore the role of perceived social support in enhancing psychological resilience and quality of life in postoperative breast cancer patients.Materials & methods: The Managing Cancer and Living Meaningfully (CALM) intervention was used to improve indicators such as psychological resilience in breast cancer patients, while the role of perceived social support in this was assessed.Results: The intervention group exhibited significant improvements compared with the control group in psychological resilience (F = 9.059, p < 0.01). The analysis showed that increased social support in the control group partly mediated the link between psychological resilience and quality of life.Conclusion: CALM improves overall well-being, indicating that incorporating it into standard care for post-mastectomy patients can positively impact their mental health.

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide: A Systematic Review

Importance

Gender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy.

Objective

To identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation.

Evidence Review

In this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080).

Findings

In total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate.

Conclusions and Relevance

In this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.

The Fall of the Nation's First Gender-Affirming Surgery Clinic

Johns Hopkins Hospital established the first gender-affirming surgery (GAS) clinic in the United States in 1966. Operating for more than 13 years, the clinic was abruptly closed in 1979. According to the hospital, the decision was made in response to objective evidence claiming that GAS was ineffective. However, this evidence directly contradicted many contemporaneous studies and faced immediate criticism from the scientific community. Despite this resistance, it took the hospital nearly 40 years to resume performing GAS. Scientific evidence-imbued in scandal, bias, and moralism-was instrumentalized to serve broader institutional interests. The burgeoning field of plastic surgery tethered and then untethered GAS from its auspices in response to poor technical outcomes and transphobia. No longer serving surgeons' interests, the clinic was marginalized to "barely minimal facilities" in 1974, five years before GAS was formally banned. Over the next 5 years, the clinic co-inhabited space with the Department of Obstetrics and Gynecology. Simultaneously, the Department of Obstetrics and Gynecology navigated scandals related to reproductive technology (namely, the Dalkon Shield [A.H. Robins] controversy) until the clinic space was demolished in 1979. The study that informed the GAS ban was preferentially funded in keeping with the political economy of biomedical research. This article presents a spatial argument for how the closure of the nation's first GAS clinic was not based in empirical data alone but was manipulated to fuel political and institutional agendas.