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Top surgery drastically improves quality of life for young transgender people, study finds

The quality of life of young transmasculine people dramatically improves after receiving top surgery — a mastectomy procedure that removes breast tissue — according to a study by Northwestern Medicine.

The study, published in peer-reviewed journal JAMA Pediatrics on Monday, is the first to show that top surgery is "associated with significant improvement in chest dysphoria, gender congruence, and body image in transmasculine and nonbinary teens and young adults," Northwestern Medicine said in a press release. 

The study compared two groups of patients ranging in ages from 14 to 24: one group of 36 patients received top surgery, and a control group of 34 patients received gender-affirming care, but did not get top surgery. Three months after surgery, the patients who had the procedure experienced significantly less chest dysphoria than they had prior to surgery, while patients in the control group experienced around the same levels of chest dysphoria as they had at the start of their care.

"When we compared the outcomes of patients who received gender-affirming top surgery to those who did not, we recognized that surgery significantly improved the quality of life for patients," said Dr. Sumanas Jordan, the director of the gender pathways program at Northwestern Medicine.

"Our bodies are not our destiny" sign
Participant seen holding a sign at the 2022 Queer Liberation March in NYC. Erik McGregor/LightRocket via Getty Images

Prior studies have also shown that chest dysphoria is a pervasive issue for trans and gender non-conforming youth. In a study published by the American Academy of Pediatrics in 2021, researchers at the University of Rochester Medical Center "observed consensus that chest dysphoria is a major source of distress and can be functionally disabling to transmasculine youth."

"This has been well documented in adult patients, but until now it hasn't been well-described in teens and young adults," said Jordan, who is also the lead author of the Northwestern study.

American Civil Liberties Union lawyer Chase Strangio went viral on Twitter Monday after sharing his own experience with top surgery, which he received in his mid-20s. "There is not a day that goes by that I don't think about how it was the best thing I have ever done for my survival," the tweet read. 

"I also had orthopedic knee surgery at 14 and often regret it. But no NYTs pieces about orthopedic regret I see," he added, seemingly referencing a New York Times article published Monday about access to gender-affirming surgeries for trans people.

Anti-LGBTQ+ bills have seen a sharp rise in recent years, with transgender Americans specifically becoming a political talking point. According to Bloomberg Law, "In the 2022 state legislative year, about 60% of all proposed LGBTQ-health related bills aimed to ban or limit transgender-related health care," and the stakes are high.

Access to gender-affirming surgical care can be a life or death issue for trans youth. A study published in the journal Pediatrics found that nearly 51% of female-to-male respondents had attempted suicide, while the average youth suicide rate in the U.S. is 9%, according to a 2022 study by UCLA.

"It is so important to be able to have evidence and treat them not based on politics, but based on science and medicine," Jordan told the Chicago Tribune.

But access to gender-affirming surgery can be a major step in improving quality of life for trans people. An analysis of 56 peer-reviewed works by the What We Know Project found that in 93% of the studies, gender transition improved the overall well-being of trans respondents. 

"Patients who choose gender-affirming top surgery feel better about their bodies, and it enhances their quality of life," Jordan said. "Our hope is that this study will now be used as a resource for teens, young adults and for families who want to learn more about surgical transition options."

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