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. 2026 Mar 1;283(3):528-534.
doi: 10.1097/SLA.0000000000006489. Epub 2024 Aug 13.

Patient-Reported Preoperative Depression as a Predictor of Psychosocial Outcomes After Gender-Affirming Facial Feminization Surgery

Jeremiah M Taylor  1 , Nghiem H Nguyen  1 , Kelly X Huang  1 , Miles J Pfaff  2 , Kavitha Ranganathan  3 , Rebecca C Rada  4   5 , Mark S Litwin  5   6   7   8 , Marco A Hidalgo  5   9 , Justine C Lee  1   5
Affiliations

Patient-Reported Preoperative Depression as a Predictor of Psychosocial Outcomes After Gender-Affirming Facial Feminization Surgery

Jeremiah M Taylor et al. Ann Surg. .

Abstract

Objective: To understand psychosocial functioning before and after gender-affirming facial feminization surgery (FFS) as well as identify predictors of postoperative psychosocial functioning.

Background: Few investigations have rigorously explored the impact of gender-affirming FFS on psychosocial functioning in transgender and gender non-binary (TGNB) individuals. This knowledge gap hinders the identification of methods to optimize mental health quality-of-life outcomes after FFS and carries repercussions for access to care.

Methods: Adult TGNB participants awaiting gender-affirming FFS were prospectively enrolled and administered Patient-Reported Outcomes Measurement Information System (PROMIS) instruments assessing anxiety, anger, depression, global mental and physical health, positive affect, emotional support, social isolation, companionship, and meaning and purpose before and 3-6 months after FFS. Paired t tests compared preoperative and postoperative scores. Multivariable linear models identified predictors of postoperative psychosocial outcomes.

Results: Among the domains, psychosocial scores improved for anxiety, depression, global mental health, social isolation, and positive affect after FFS. When accounting for potential variables contributing to postoperative psychosocial scores, including other gender-affirming surgeries, hormone therapy duration, and private versus public insurance type, we found that preoperative depression scores independently predicted the variance in all other postoperative scores with global mental health (β=-0.52, 95% CI: -0.58 to -0.31 P <0.001), anxiety (β=0.40, 95% CI: 0.21-0.51, P <0.001), and meaning and purpose (β=-0.52, 95% CI: -0.78 to -0.42 P <0.001) as the strongest models.

Conclusions: This study suggests that gender-affirming FFS improves psychosocial functioning; however, such improvements are highly influenced by the baseline psychological functioning of each individual. These findings indicate that preoperative psychological functioning may be a potential avenue for improving outcomes after FFS via perioperative psychological interventions.

Keywords: facial feminization surgery; facial gender-affirming surgery; gender dysphoria; gender nonbinary; gender-affirming surgery; reconstructive surgery.

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Conflict of interest statement

J.C.L. is supported by the National Institutes of Health/National Institute for Dental and Craniofacial Research R01 DE028098 and R01 DE029234. J.C.L. is a medical education consultant for Stryker. The remaining authors report no conflicts of interest.

References

    1. Besson G, Barragan-Jason G, Thorpe SJ, et al. From face processing to face recognition: comparing three different processing levels. Cognition. 2017;158:33–43.
    1. Crouzet SM. Fast saccades toward faces: face detection in just 100 ms. J Vis. 2010;10:1–17.
    1. Dobs K, Isik L, Pantazis D, et al. How face perception unfolds over time. Nat Commun. 2019;10:1258.
    1. Cooper K, Russell A, Mandy W, et al. The phenomenology of gender dysphoria in adults: a systematic review and meta-synthesis. Clin Psychol Rev. 2020;80:101875.
    1. Van De Grift TC, Cohen-Kettenis PT, Steensma TD, et al. Body satisfaction and physical appearance in gender dysphoria. Arch Sex Behav. 2016;45:575–585.