Metoidioplasty and Phalloplasty Gender-Affirming Surgery and Association with Gender Congruence and Life Satisfaction: A Cross-Sectional Study

Purpose: The purpose of this study was to compare the Gender Congruence and Life Satisfaction (GCLS) Scale scores between transgender men and nonbinary individuals assigned female at birth who have had metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) versus those who have not.Methods: We conducted a national cross-sectional survey of individuals considering or post-MaPGAS recruited through social media and a community health center. Data collected included demographics, medical health history, and GCLS scale scores. GCLS scale items evaluate gender congruence across psychological, physical, quality of life, genital, chest, and social domains on a 1-5 Likert scale, with higher values indicating greater gender congruence. The mean GCLS total and subscale scores were compared between groups, and open-ended comments related to gender, mental well-being, and life satisfaction were thematically analyzed.Results: A total of 326 participants, mean age 29.9 years (standard deviation 8.8), identifying primarily as transgender male (n=208, 64%) and White (n=273, 74%) completed the survey. Respondents post-phalloplasty scored the highest on the GCLS scale overall, with a mean score of 3.97/5.00 (p<0.001), and had the highest ratings in three subdomains: genitalia at 3.32 (p<0.001), life satisfaction at 3.81 (p<0.004), and psychological functioning at 4.22 (p=0.002). Respondents who had not undergone MaPGAS had the lowest ratings of gender congruence on the genitalia subscale (mean score=2.82). The open-ended comments frequently cited the COVID-19 pandemic as an exacerbating issue with gender congruence.Conclusion: In this cohort of individuals considering MaPGAS, individuals post-MaPGAS demonstrated higher GCLS scale scores. Individuals post-phalloplasty reported the highest overall GCLS score and majority subscale scores.