Data Show Gender-Affirming Facial Surgery Was a Standalone Predictor of Higher Psychosocial Health Scores in Transgender Patients

Insurance companies often classify gender-affirming facial surgery as a cosmetic procedure, but a new study provides the first evidence demonstrating the medical basis for transgender patients experiencing gender dysphoria.

When transgender patients pursue gender-affirming facial surgery to treat gender dysphoria, insurers often classify these insurance claims as cosmetic only due to a lack of evidence supporting their medical basis. However, a study conducted by the University of California, Los Angeles (UCLA) provided the first evidence showing the medical basis for gender-affirming facial surgery. Specifically, the surgeries were found to significantly improve quality of life for transgender patients based on psychosocial assessments.

"Access to facial gender-affirming surgeries under health insurance coverage in the United States is more limited than gender-affirming surgeries of other anatomic regions due to a lack of data on mental health quality-of-life outcomes," said the study’s lead author Justine Lee, a Bernard G. Sarnat professor of craniofacial biology and an associate professor of surgery at the David Geffen School of Medicine at UCLA, in a press release. "Our findings have the potential to change health insurance policies for the better for transgender patients."

In order to assess the impact of gender-affirming facial surgery on the quality of life for transgender patients, the researchers compared the results of mental health assessments in 107 patients awaiting facial surgery versus those of 62 patients who had already completed their surgeries, the latter of which were conducted at an average of approximately 6 and a half months following their procedures. Based on the results of this comparison, the researchers found that 7 of 11 patients who had received their gender-affirming facial surgery reported higher scores in their psychosocial health, including in their experience of anxiety, anger, depression, global mental health, positive affect, social isolation, and meaning and purpose.

Based on the data, the researchers observed that gender-affirming facial surgery may be one of the most important procedures in terms of improving the quality of life of patients with gender dysphoria, which is defined as the psychological distress that results from the incongruence between one's sex assigned at birth and one's gender identity, according to the press release.

Notably, the experience of dysphoria was found to be higher among transgender patients who were assigned male at birth, with facial characteristics reported as the most significant source of that dysphoria. Lee explained that in her experience, the majority of patients seeking gender-affirming facial reconstruction are assigned male at birth and identify as either female or nonbinary.

For transgender patients who were assigned male at birth, facial feminization surgery is a procedure they may pursue to support the pursuit of gender-affirming facial characteristics. This type of surgery encompasses procedures that include feminizing the brow bone area, reducing the jaw area, augmenting the cheeks, and reshaping the nose.

Furthermore, the data showed that facial surgery alone was a standalone predictor of higher psychosocial scores among transgender patients, even when considering and adjusting for the effects of factors such as the duration of gender-affirming hormone therapy, whether the patient had undergone previous gender-affirming surgeries, pre-existing mental health diagnoses, and the quality of the patients' social relationships.

"In the future, providers may want to consider incorporating psychosocial assessments over a period of time as a standard of care in the treatment of gender dysphoria," Lee said in the press release.

REFERENCE

After facial feminization surgery, transgender people report better psychosocial health. Los Angeles, CA: University of California – Los Angeles Health Sciences; July 6, 2022. Accessed July 12, 2022. https://www.sciencedaily.com/releases/2022/07/220706165355.htm

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