“Dysphoria? Don’t Know Them”: Applying the Health Belief Model in a Reflexive Thematic Analysis of Masculinizing Top Surgery-Related Content on TikTok

Social media has become an important vehicle for digital health-related communication in recent decades. TikTok-a short form video-sharing application-contains many videos pertaining to masculinizing top surgery (MTS). In line with the health belief model, TikTok content may impact patients' health behaviors by acting on key health belief constructs. However, little is known about what specific content is generated regarding MTS on TikTok. To capture this information, our team utilized a reflexive thematic analysis to systematically describe MTS-related TikTok content on a sample of 250 videos created by 158 unique accounts. We found that our sample received a total of 79.9 million views, 11.9 million likes, 130.9 thousand comments, 581.8 thousand saves, and 176.7 thousand shares. The top five most popular content topics (defined as any topic mentioned within the video) were euphoria, scars, interpersonal support, pain, and nipples. The most common phenomenological themes (defined as the overarching focus of the video) included postoperative process, gender euphoria, and cost. Given the content present in these videos deals heavily with the surgical process, from consultation to full recovery, we suggest that such content may affect viewers' key health behavior motivations by providing information about the benefits of and barriers to treatment, as well as cues to action. We conclude by providing recommendations for research, policy, and practice, including updating patient education materials and advocating for policies that protect access to evidence-based gender-affirming care.