Experience of Chest Dysphoria and Masculinizing Chest Surgery in Transmasculine Youth

We conduct a qualitative study of the lived experience of chest dysphoria in transmasculine youth and their thoughts about or experiences with MCS. BrightcoveDefaultPlayer10.1542/6217582973001PEDS-VA_2020-013300 Video Abstract OBJECTIVES: Transmasculine individuals, those assigned female sex at birth but who identify as masculine, have high rates of suicidal behavior and often suffer from chest dysphoria (discomfort and distress from unwanted breast development). Growing numbers of transmasculine youth are pursuing definitive treatment with masculinizing chest surgery (MCS), and adult studies reveal marked benefits of MCS, although little is known about the impact of chest dysphoria on transmasculine youth or the optimal timing of MCS. In this study, we aimed to explore youth experiences of chest dysphoria and the impact of MCS. METHODS: Transmasculine youth aged 13 to 21 were recruited from a pediatric hospital–based gender clinic. Participants completed a semistructured qualitative interview exploring the experience of chest dysphoria and thoughts about or experiences with MCS. Interview transcripts were coded by 3 investigators employing modified grounded theory, with the median interrater reliability at κ = 0.92. RESULTS: Subjects (N = 30) were a mean age of 17.5 years, and 47% had undergone MCS. Youth reported that chest dysphoria triggered strong negative emotions and suicidal ideation, caused a myriad of functional limitations, and was inadequately relieved by testosterone therapy alone. All post-MCS youth reported near or total resolution of chest dysphoria, lack of regret, and improved quality of life and functioning. CONCLUSIONS: We observed consensus that chest dysphoria is a major source of distress and can be functionally disabling to transmasculine youth. MCS performed during adolescence, including before age 18, can alleviate suffering and improve functioning. Additional research is needed to develop patient-reported outcome measures to assess the impact of chest dysphoria and MCS.

[1]  S. Monstrey.  World Professional Association for Transgender Health , 2021, The SAGE Encyclopedia of Trans Studies.

[2]  L. Clark,et al.  Impact of Early Medical Treatment for Transgender Youth: Protocol for the Longitudinal, Observational Trans Youth Care Study , 2019, JMIR research protocols.

[3]  Jason R. Rafferty.  Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents , 2018, Pediatrics.

[4]  Amy K. Syvertsen,et al.  Transgender Adolescent Suicide Behavior , 2018, Pediatrics.

[5]  L. Clark,et al.  Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults: Comparisons of Nonsurgical and Postsurgical Cohorts , 2018, JAMA pediatrics.

[6]  Melody F. Scheefer,et al.  Quality of life improvement after chest wall masculinization in female-to-male transgender patients: A prospective study using the BREAST-Q and Body Uneasiness Test. , 2018, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[7]  M. Murad,et al.  ENDOCRINE TREATMENT OF GENDER-DYSPHORIC/GENDER-INCONGRUENT PERSONS: AN ENDOCRINE SOCIETY CLINICAL PRACTICE GUIDELINE. , 2017, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[8]  Michael J. Frederick,et al.  Chest Surgery in Female to Male Transgender Individuals , 2017, Annals of plastic surgery.

[9]  S. Peitzmeier,et al.  Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study , 2017, Culture, health & sexuality.

[10]  J. Fuld,et al.  P257 Understanding the effects on lung function of chest binder use in the transgender population , 2016, Thorax.

[11]  D. Vanderlaan,et al.  Self-Harm and Suicidality in Children Referred for Gender Dysphoria. , 2016, Journal of the American Academy of Child and Adolescent Psychiatry.

[12]  T. Scholz,et al.  Sexual reassignment surgery in female-to-male transsexuals: an algorithm for subcutaneous mastectomy. , 2015, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[13]  C. St. Amand,et al.  Effects of Testosterone Treatment and Chest Reconstruction Surgery on Mental Health and Sexuality in Female-To-Male Transgender People , 2014 .

[14]  D. Metzger,et al.  Clinical management of youth with gender dysphoria in Vancouver. , 2014, The Journal of pediatrics.

[15]  J. R. Green,et al.  Transsexual Surgery Follow-Up: Status in the 1990s , 2012 .

[16]  D. Davies,et al.  Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience. , 2012, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[17]  H. Feldman,et al.  Children and Adolescents With Gender Identity Disorder Referred to a Pediatric Medical Center , 2012, Pediatrics.

[18]  Johanna Olson,et al.  Management of the transgender adolescent. , 2011, Archives of pediatrics & adolescent medicine.

[19]  E. Whallett,et al.  Transgender patient satisfaction following reduction mammaplasty. , 2009, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[20]  A. D’augelli,et al.  Transgender youth and life-threatening behaviors. , 2007, Suicide & life-threatening behavior.