Gender-affirming surgeries and patient-reported outcomes in gender binary versus non-binary and genderqueer-identifying individuals

Background: Approximately 25%–50% of transgender and gender diverse (TGD) individuals identify as non-binary and/or genderqueer (NBGQ), yet understanding of the role of genital gender-affirming surgeries (GAS) and the overall outcomes of gender-affirming treatment in this group is limited. Aim: Comparing the choice of gender-affirming surgical treatments and patient-reported outcomes between binary and NBGQ TGD individuals. Methods: We conducted a cross-sectional online survey including 171 participants who completed at least 80% of their medical transition and had undergone GAS (based on self-report). Participants were grouped as binary transgender (n = 151) or NBGQ (n = 20) based on self-reported gender identity. Main outcomes included the propensity for genital GAS in NBGQ individuals compared to binary peers. Patient-reported outcomes, such as gender congruence, body satisfaction, life satisfaction, self-esteem, and mental health, were compared between groups. Analyses were conducted accounting for potential confounding factors including age, sex assigned at birth, and level of social support. Results: NBGQ individuals reported a lower likelihood of having received genital GAS compared to binary-identifying participants (55.0% vs. 84.1%; OR = 0.23; p =.002), also after correcting for confounding factors, such as sex assigned at birth (OR = 0.28; p =.03; 95% CI 0.09–0.90). Patient-reported outcomes indicated poorer post-treatment body satisfaction and gender recognition, self-esteem, life satisfaction, and mental health in the NBGQ group (small to large effect sizes). Discussion: The study emphasizes the differences in treatment characteristics of NBGQ individuals undergoing gender-affirming surgical care, related to both surgeries received and (poorer) patient-reported outcomes. These findings underscore the importance of individualized and equitable care in TGD healthcare to improve overall health outcomes.