Oral Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

A systematic review of PROMS measured health-related outcomes following treatment of gender incongruence. (1586)

Kelsey A Ireland 1 , Nicola R Dean 2
  1. Te Whatu Ora, Christchurch, CANTEBURY, New Zealand
  2. Plastic and Reconstructive Surgery , Flinders Medical Centre , Adelaide , South Australia , Australia

Background:
Gender diverse people experience overall poorer health outcomes when compared to cisgender populations.1  We conducted a systematic review to evaluate the effect of gender affirming medical treatments on health outcomes, measured by patient reported outcome measures (PROMs).  

Methods:
A database search was conducted using PubMed, Web of science, Embase and Psych Info in October 2022. Studies published from 2010 onwards were included for review. Two independent researchers individually conducted study selection and critical appraisal using PRISMA guidelines. PROMs measured health outcomes were divided into those that measured mental health, health related quality of life, gender dysphoria, and sexual health.

Results:
82 studies were included in the final analysis. 36 studies were prospective cohort studies with the remainder comprising of retrospective cohort or cross sectional studies. 41 studies analysed PROM data following gender affirming surgery, 21 following gender affirming hormone treatment and 19 studies following both. A great variation in PROM tools were utilised between studies with 70 different PROMS included throughout the studies. The most commonly utilised PROMs analysing quality of life were The Short Form-36 and the World Health Organisation QOL form. Overall, health related quality of life and mental health outcomes were significantly improved following gender affirming treatments. Both surgery and hormone treatments resulted in decreased gender dysphoria. Sexual health outcomes were mixed, likely relating to the heterogeneity in PROMs utilised in the included studies. 

Conclusion: 
Gender affirming treatment in the form of hormone treatment and/or surgery is associated with improved patient reported quality of life, gender dysphoria, anxiety, and depression in gender diverse people. Further analysis of included studies in the form of meta-analysis will allow further quantification of treatment benefit. Further research using PROMs designed to detect health outcomes relevant specifically to gender diverse people will be beneficial.

  1. 1. Bretherton I, Thrower E, Zwickl S, Wong A, Chetcuti D, Grossmann M, et al. The Health and Well-Being of Transgender Australians: A National Community Survey. LGBT Health. 2021;8(1):42-9.