While most transgender people are satisfied with gender-affirming surgery (GAS), some are disappointed and regret their decision. The latter group may struggle with psychological issues and poor quality of life, a recent study in the Journal of Sex & Marital Therapy suggests.
Along with cross-sex hormone therapy, GAS is performed to transition people with gender dysphoria from their birth gender to the gender with which they identify. Such surgery may involve the genitals, such as vaginoplasty (creation of a vagina) or phalloplasty (creation of a penis). Other procedures can target the breasts, face, voice, and Adam’s apple so that the patient will feel more masculine or feminine.
Past research has shown high satisfaction rates with GAS, but the experiences of those who feel disappointment or regret have not been widely studied. The current paper explored this angle further.
The scientists worked with 51 transmen and 81 transwomen who underwent GAS in the Netherlands, Belgium, and Germany. The participants ranged in age from 17 to 63 years with an average of 36 years. They had had one or more of the following surgeries at least five years earlier:
- Mamma (breast) augmentation
- Thyroid cartilage reduction
- Facial surgery
- Vocal cord surgery
- Uterus extirpation
[Note: An alternative to phalloplasty, metoidioplasty uses a hormonally enlarged clitoris to create a small neophallus with urethra. Patients may stand to urinate, but they cannot penetrate a sexual partner.]
The participants completed a satisfaction questionnaire for each individual procedure they had received, along with other questionnaires used to assess levels of experienced gender dysphoria, psychological symptoms, quality of life, happiness, and overall feelings at a particular moment.
Feminizing surgeries had satisfaction rates ranging from 96% to 100%, except for the sole patient who had vocal cord surgery. Vaginoplasty, mamma augmentation, and vocal cord surgery resulted in the most complications.
Forty-nine male-to-female patients underwent mastectomy; of these, 94% were satisfied with their results. All 15 patients who had phalloplasty said they were satisfied. However, the most complications were reported for these two procedures.
Overall, eight patients – five transwomen and three transmen – were disappointed or had minor regrets. These feelings stemmed from long-term pain, as well as functional or cosmetic outcomes. This group was more likely to have more psychological symptoms and less positive feelings about life. But they did not regret transitioning overall.
The researchers pointed out that despite its higher rate of complications, phalloplasty still had a 100% satisfaction rate. It’s possible that these patients had more thorough discussions with surgeons, psychologists, and sexologists before surgery, helping them understand what to expect.
The authors noted that those who were dissatisfied at follow-up tended to have psychological symptoms and life dissatisfaction when the study began. “In the light of our findings, this could imply that individuals with more psychological symptoms at baseline may be at risk for poorer experienced outcomes of GAS,” they wrote. “Although technical outcomes are important, psychological characteristics can influence how individuals cope once disappointing situations occur.”
They suggested that future research focus on the objective and subjective outcomes desired by GAS patients. They also suggested surveying the participants again in five years to see how overall feelings may change in time.
Journal of Sex & Marital Therapy
Van de Grift, Tim C., et al.
“Surgical Satisfaction, Quality of Life, and Their Association After Gender-Affirming Surgery: A Follow-up Study”
(Full-text. Published online: May 4, 2017)
The Philadelphia Center for Transgender Surgery
“Details of phalloplasty & metoidioplasty”