Children's Hospital Los Angeles, Los Angeles, California.
University of Southern California, Los Angeles.
JAMA Pediatr. 2018 May 1;172(5):431-436. doi: 10.1001/jamapediatrics.2017.5440.
Transmasculine youth, who are assigned female at birth but have a gender identity along the masculine spectrum, often report considerable distress after breast development (chest dysphoria). Professional guidelines lack clarity regarding referring minors (defined as people younger than 18 years) for chest surgery because there are no data documenting the effect of chest surgery on minors.
To examine the amount of chest dysphoria in transmasculine youth who had had chest reconstruction surgery compared with those who had not undergone this surgery.
DESIGN, SETTING, AND PARTICIPANTS: Using a novel measure of chest dysphoria, this cohort study at a large, urban, hospital-affiliated ambulatory clinic specializing in transgender youth care collected survey data about testosterone use and chest distress among transmasculine youth and young adults. Additional information about regret and adverse effects was collected from those who had undergone surgery. Eligible youth were 13 to 25 years old, had been assigned female at birth, and had an identified gender as something other than female. Recruitment occurred during clinical visits and via telephone between June 2016 and December 2016. Surveys were collected from participants who had undergone chest surgery at the time of survey collection and an equal number of youth who had not undergone surgery.
Outcomes were chest dysphoria composite score (range 0-51, with higher scores indicating greater distress) in all participants; desire for chest surgery in patients who had not had surgery; and regret about surgery and complications of surgery in patients who were postsurgical.
Of 136 completed surveys, 68 (50.0%) were from postsurgical participants, and 68 (50.0%) were from nonsurgical participants. At the time of the survey, the mean (SD) age was 19 (2.5) years for postsurgical participants and 17 (2.5) years for nonsurgical participants. Chest dysphoria composite score mean (SD) was 29.6 (10.0) for participants who had not undergone chest reconstruction, which was significantly higher than mean (SD) scores in those who had undergone this procedure (3.3 [3.8]; P < .001). Among the nonsurgical cohort, 64 (94%) perceived chest surgery as very important, and chest dysphoria increased by 0.33 points each month that passed between a youth initiating testosterone therapy and undergoing surgery. Among the postsurgical cohort, the most common complication of surgery was loss of nipple sensation, whether temporary (59%) or permanent (41%). Serious complications were rare and included postoperative hematoma (10%) and complications of anesthesia (7%). Self-reported regret was near 0.
Chest dysphoria was high among presurgical transmasculine youth, and surgical intervention positively affected both minors and young adults. Given these findings, professional guidelines and clinical practice should consider patients for chest surgery based on individual need rather than chronologic age.
出生时被指定为女性但性别认同处于男性谱系的跨性别男性青年，在乳房发育后（胸部不适）通常会感到相当大的痛苦。由于缺乏关于将未成年人（定义为 18 岁以下的人）转介进行胸部手术的专业指南，因为没有数据记录胸部手术对未成年人的影响。
检查已经接受过胸部重建手术的跨性别男性青年与未接受过该手术的青年相比，胸部不适的程度。
设计、地点和参与者：本研究采用一种新的胸部不适测量方法，在一家大型城市医院附属门诊诊所进行，该诊所专门为跨性别青年提供护理，收集了关于跨性别男性青年和年轻人使用睾丸激素和胸部不适的调查数据。对于接受过手术的人，还收集了关于后悔和不良反应的额外信息。合格的青年年龄在 13 至 25 岁之间，出生时被指定为女性，并且性别被认定为女性以外的其他性别。招募工作在 2016 年 6 月至 12 月期间通过临床就诊和电话进行。调查是在调查时收集的，接受过胸部手术的参与者和未接受过手术的参与者人数相等。
所有参与者的主要结果是胸部不适综合评分（范围为 0-51，得分越高表示痛苦越大）；未接受手术的患者对胸部手术的渴望；以及接受过手术的患者对手术和手术并发症的后悔。
在 136 份完成的调查中，68 份（50.0%）来自术后参与者，68 份（50.0%）来自非手术参与者。在调查时，术后参与者的平均（SD）年龄为 19（2.5）岁，非手术参与者的平均（SD）年龄为 17（2.5）岁。未接受过胸部重建的参与者的胸部不适综合评分平均（SD）为 29.6（10.0），明显高于接受过该手术的参与者的平均（SD）评分（3.3 [3.8]；P <.001）。在非手术组中，64 名（94%）认为胸部手术非常重要，青年开始接受睾丸激素治疗与接受手术之间，胸部不适每月增加 0.33 分。在术后组中，手术最常见的并发症是乳头感觉丧失，无论是暂时的（59%）还是永久性的（41%）。严重并发症很少见，包括术后血肿（10%）和麻醉并发症（7%）。自我报告的后悔率接近 0。
接受手术前的跨性别男性青年胸部不适程度较高，手术干预对未成年人和年轻人都有积极影响。鉴于这些发现，专业指南和临床实践应根据个人需要而不是年龄来考虑为患者进行胸部手术。
