81.08 Assessment of Chest Dysphoria in Patients Presenting for Gender-Affirming Surgery

G. Mehra2, E. R. Boskey1, D. Jolly1, O. Ganor1  1Children’s Hospital Boston,Center For Gender Surgery,Boston, MA, USA 2Harvard School Of Medicine,Brookline, MA, USA


Gender variant youth are at risk for developing negative self-concept and low self-worth, which is thought to be related to their increased risk for psychiatric illness, including depression, anxiety, and suicidal ideation. Despite these well-established disparities, significant gaps in knowledge remain in how pre-surgical factors affect psychosocial outcomes for patients receiving gender-affirming surgery. As part of a broader longitudinal study of factors affecting surgical expectations and outcomes among transmasculine patients, baseline measurements of chest dysphoria were assessed.


Transmasculine patients seeking care at a gender surgery center were invited to participate in a longitudinal analysis of surgical expectations and outcomes. Patients were eligible if they were assigned female at birth, identified as transmasculine, and were aged 15 years or older at the time of initial consultation. At enrollment, participants were asked to complete a series of questionnaires as part of a baseline assessment. For those seeking top surgery, these included a validated chest dysphoria scale. Descriptive statistics were performed across individual items to establish baselines for chest dysphoria. Linear regression was used to determine whether experiences of dysphoria varied by chest size, age at presentation, history of binding, and/or testosterone (T) use. 


63 individuals were included in this analysis (average age 19, SD: 4). Demographically, 20% of respondents identified as Black or African American, 83% as White, and 3% as other races. 10% identified as Hispanic or Latino/a/x. Respondents were asked how frequently they experienced chest dysphoria in different settings, and given choices of never, sometimes, frequently, and all the time (coded 0-3). A scale total was also calculated. The most endorsed measures of dysphoria were: “I avoid going to the beach and/or swimming in public places…” (mean 2.3, SD 0.9); “I avoid using locker rooms…” (mean 2.3, SD 0.8); and “I worry that people are looking at my chest” (mean 2.3, SD 0.8). The median response regarding avoidance of locker rooms, beaches, and public swimming was “all the time.” Older age was only associated with increased comfort with, “… looking at my chest in the mirror” (p < .01). Adjusting for chest size and age, current T was associated with lower chest dysphoria (p=.008). In contrast, wanting T and/or having taken T in the past and stopped was associated with higher gender dysphoria (p=.005). A history of chest binding, when controlled for chest size and age, was also associated with greater dysphoria (p=.007).


Patients seeking gender-affirming top surgery endorsed significant levels of chest dysphoria, particularly in public spaces such as locker rooms, beaches, and swimming areas