Development and Validation of the Quality of Life and Facial Feminization Perception Questionnaire for Transgender Women 216

Purpose: The aim of this study was to develop and psychometrically validate an original Spanish-language, culturally grounded patient-reported outcome measure for assessing quality of life and facial feminization perception in transgender women undergoing facial feminization surgery. Methods: This cross-sectional instrument development and validation study was conducted between December 2023 and March 2025 among adult Spanish-speaking transgender women in Chile. Questionnaire development followed the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines and included a systematic literature review, participatory co-construction with transgender women and clinicians, expert content validation, pilot testing, and statistical validation. Exploratory factor analysis using polychoric correlations and maximum likelihood estimation was performed. Internal consistency was assessed using Cronbach’s alpha (α). Results: A total of 216 transgender women participated. Exploratory factor analysis confirmed a stable three-factor structure explaining 59.61% of the total variance. The final instrument, the Quality of Life and Facial Feminization Perception Questionnaire for Transgender Women (FFQL-216), demonstrated high overall internal consistency (α = 0.8943). The three dimensions demonstrated excellent to strong reliability (α = 0.8659–0.9158): Dimension 1 (Personal importance of body and facial feminization; 10 items), Dimension 2 (Discrimination and social limitations related to facial perception; 8 items), and Dimension 3 (Facial perception of femininity and social validation; 5 items). Qualitative findings reinforced the psychosocial relevance of facial feminization surgery. Conclusions: The FFQL-216 was found to be a valid, reliable, and culturally appropriate instrument for assessing quality of life and facial feminization perception among Spanish-speaking transgender women in Chile, supporting its use in clinical practice and research.