INTRODUCTION:The thyroid cartilage, an androgen-sensitive structure, enlarges during puberty in individuals assigned male at birth, often resulting in a pronounced neck protuberance. This feature can exacerbate gender dysphoria in transfeminine patients. Chondrolaryngoplasty, commonly known as tracheal shave, is a procedure incorporated into facial feminization surgery (FFS) to address this issue. This study reports on the implementation of an endoscopic-assisted chondrolaryngoplasty technique, its safety, and the outcomes observed. METHODS:The authors conducted a retrospective review of chondrolaryngoplasty cases at our center, examining patient outcomes and procedural safety. The analysis included a breakdown of concurrent gender-affirming surgeries performed. An endoscopic-guided technique was utilized, and its procedural steps were documented in a video. RESULTS:In the past five years, 32 patients received chondrolaryngoplasty at our facility. Postoperative complications were minimal, with no infections, wound separations, or surgical site complications reported. Only one patient experienced temporary hoarseness, which resolved within 6 weeks without intervention. The procedure was frequently combined with other surgical interventions, with the average patient undergoing 3 additional procedures, the most common being augmentation mammaplasty, brow lifting, and frontal bone reduction. CONCLUSIONS:Tracheal shave is an effective surgical technique for alleviating gender dysphoria in transfeminine patients. Keys to its success include the accurate identification of thyroid cartilage, especially in patients with enlarged cricoid cartilages, intraoperative coordination with anesthesia for laryngoscopic vocal cord visualization, sub-perichondrial cartilage excision to minimize the risk of bleeding and damage near the vocal cords, and carefully layered closure to optimize scar healing.

BACKGROUND:Several advances have been made to increase access to gender-affirming procedures across the country, yet it remains unknown whether these benefits are experienced disproportionately across demographics. The purpose of this study was to investigate the epidemiologic trends of gender-affirming surgery across the country over the past six years, as well as to analyze the racial and ethnic disparities in immediate postoperative complications for patients undergoing gender-affirming surgery nationwide. METHODS:Retrospective cohort study was conducted of gender-affirming procedures performed in the United States between 2015 and 2020 across 719 hospitals participating in the National Surgical Quality Improvement Program. Age at surgery, type of reconstruction, and postoperative complications were compared across demographic groups. RESULTS:During the study interval, 4491 patients underwent gender-affirming surgery, including 71.1% (n=3221) masculinizing procedures and 28.3% (n=1270) feminizing procedures. Over the last five years, there has been a fourfold increase in gender-affirming surgery, from 299 per million to 1029 per million cases performed in the United States (p<.001). Transmasculine patients were ten years younger than transfeminine patients (p<.001). While masculinizing procedures were the most common across all demographics, Black and Hispanic patients were significantly more likely to undergo feminizing procedures than White patients (p<.001). Black patients were significantly older than White patients at the time of surgery. Black patients were significantly more likely than White patients to experience postoperative surgical complications (p=.039). CONCLUSIONS:Racial and ethnic disparities exist in gender-affirming surgery preference, timing, and postoperative outcomes.

Introduction There is no consensus regarding perioperative hormone replacement therapy (HRT) for gender-affirming surgery (GAS). Common concerns for continuing perioperative HRT included risk of deep vein thrombosis (DVT) or hematoma. However, discontinuing HRT is not risk free and may cause mood swing or increased anxiety. Our study aimed to investigate current patterns of HRT before GAS worldwide. Methods The first stage of Delphi technique was implemented by sending a 27-item survey to all surgeons (total n = 150; 94 plastic surgeon, 35 urologist, and 21 gynecologists) of the World Professional Association for Transgender Health who perform GAS. Survey themes included the hormone type, duration, and usage of DVT prophylaxis. Results Overall survey response rate was 34% (total n = 51; 8 urologists, 35 plastic surgeons, and 8 gynecologists). The majority of surgeons are US-based (n = 39, 76%). The most common HRTs are in injection form (n = 28, 55%). The majority of surgeons do not stop HRT before GAS and do provide DVT prophylaxis to all patients <1 week after GAS. The most common procedure that surgeons discontinue HRT is feminizing bottom surgery (43%). For surgeons who discontinue HRT before GAS, there is a wide variation on discontinuation schedule. Conclusions There is considerable variation in perioperative HRT patterns for GAS. Further research is needed to develop a data-driven consensus guideline to provide high quality of care for transgender and nonbinary patients.

Introduction Lipedema is a relatively common, frequently misdiagnosed, chronic condition often treated by liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL), are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aims to assess the efficacy and safety of liposuction in patients with lipedema. Methods Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with postoperative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, 2 articles used both PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity. Results A total of 2,542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). Results for TTL, PAL, and WAL led to significant improvements in pain reduction (P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for studies that utilized TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%). Conclusion Liposuction techniques, including TTL, PAL, and WAL, result in significant symptom improvement in lipedema patients with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. This is the first meta-analysis investigating liposuction data in lipedema treatment.

ABSTRACT:Migraine headaches are a significant global health concern, frequently managed with varying levels of success. Compression of the greater occipital nerve (GON) is hypothesized to contribute to pathology in some migraine patients, making extracranial nerve decompression surgery a potential intervention for refractory cases. However, accurate methods to image the GON along its tortuous course still need to be explored. Our group has developed magnetic resonance imaging sequences to track the GON. Yet, many challenges were met, which included navigating the GON's complex anatomy, understanding anatomical variants, and designing advanced magnetic resonance imaging sequences and coils to image the posterior scalp. Addressing these hurdles is vital to capture and understand GON pathology and guide potential interventions.

Due to multiple factors, transgender and gender diverse (TGD) individuals are more likely to experience suicidal ideation, engage in intentional injury, and attempt suicide than cisgender individuals. Lack of access to healthcare among TGD individuals may contribute to adverse physical and mental health outcomes. Few institutions of higher education include gender-affirming care in their student health insurance plans, neglecting to provide equitable care for their entire student body and further ostracizing TGD people. By including all-encompassing, gender-affirming student health insurance, institutions of higher learning have the opportunity to preserve TGD individuals' physical and mental health and promote student well-being.

PURPOSE: Chondrolaryngoplasty, or tracheal shave, is a consistent facet of facial feminization surgery (FFS). This procedure involves debulking of the laryngeal prominence of the thyroid cartilage. The present study describes technical aspects of performing this surgery safely and investigates the outcomes and complications of this procedure. METHODS: A retrospective analysis of patient records was conducted to assess the outcomes of chondrolaryngoplasty performed at our center. Vital intraoperative measures for ensuring patient safety were identified. RESULTS: Over five years, 31 patients underwent chondrolaryngoplasty. One patient reported a noticeable scar 81 days post-surgery. None of the patients noted hoarseness, altered vocal tonality, or other subjective postoperative symptoms. There were no instances of postoperative infections, wound separation, or surgical site complications. Only one patient underwent chondrolaryngoplasty as a standalone procedure; the remainder received it in conjunction with other FFS. The key safety measures include precise identification of the thyroid cartilage, intraoperative pinpointing of the true vocal cord location both before and after cartilage reduction using endoscopy, and excising the thyroid cartilage sub-perichondrially rather than supra-perichondrially. A layered closure is recommended for optimal scar healing. CONCLUSION: Chondrolaryngoplasty is a reliable and safe procedure in facial feminization. Through meticulous endoscopic assessment and precise dissection, it offers significant feminizing outcomes with minimal associated risks.

Occipital nerve decompression is effective in reducing headache symptoms in select patients with migraine and occipital neuralgia. Eligibility for surgery relies on subjective symptoms and responses to nerve blocks and Onabotulinum toxin A (Botox) injections. No validated objective method exists for detecting occipital headache pathologies. The purpose of the study is to explore the potential of high-resolution Magnetic Resolution Imaging (MRI) in identifying greater occipital nerve (GON) pathologies in chronic headache patients. The MRI protocol included three sequences targeting fat-suppressed fluid-sensitive T2-weighted signals. Visualization of the GON involved generating 2-D image slices with sequential rotation to track the nerve course. Twelve patients underwent pre-surgical MRI assessment. MRI identified four main pathologies that were validated against intra-operative examination: GON entanglement by the occipital artery, increased nerve thickness and hyperintensity suggesting inflammation compared to the non-symptomatic contralateral side, early GON branching with rejoining at a distal point, and a connection between the GON and the lesser occipital nerve. MRI possesses the ability to visualize the GON and identify suspected trigger points associated with headache symptoms. This case series highlights MRI's potential to provide objective evidence of nerve pathology. Further research is warranted to establish MRI as a gold standard for diagnosing extracranial contributors in headaches.

PURPOSE: Gender-affirming mastectomy is a crucial procedure for transmasculine individuals seeking to alleviate gender dysphoria. However, many surgeons refuse to operate on obese patients. While common practice, research to support this guideline is lacking. METHODS: This study is a retrospective analysis of the impact of BMI on postoperative complications in patients undergoing gender-affirming mastectomy. Patients were classified as normal, overweight, Class I obese, Class II obese, and Class III obese. Additionally, patients with obesity were organized as metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO). Patients were monitored for postoperative complications for 30 days after surgery. RESULTS: 644 patients were included (187 normal, 175 overweight, 130 Class I obese, 75 Class II obese, and 77 Class III obese). Univariate analysis revealed a difference in total hematoma rates (p = 0.037). Upon multivariate analysis, BMI was not associated with an increased risk of any complications. Diabetes was associated with increased rates of total hematoma (Odds ratio (OR): 6.33, 95% CI: 1.76 - 22.84, p = 0.005), and hematoma requiring evacuation (OR: 5.36, 95% CI: 1.20 - 23.97, p = 0.028). Of the 282 obese patients, 240 patients had MHO, while 42 had MUO. MUO patients had a higher incidence of total hematoma (p = 0.005). In a logistic regression, MUO was associated with an increased risk of hematoma formation (OR: 3.60, 95% CI: 1.01 - 12.87, p = 0.048). CONCLUSION: BMI alone should not exclude patients from receiving gender-affirming mastectomy, but other factors, such as pre-existing comorbidities, should be considered.

Concrete, data-driven guidelines for breast cancer screening among the transgender and gender diverse (TGD) population is lacking. The present study evaluates possible associations of gender-affirming hormone therapy (GAHT) on incidental breast pathology findings in trans-masculine patients to inform decision making about breast cancer screening. This was a retrospective cohort study of patients who had gender-affirming mastectomy or breast reduction at a single center from July 2019 to February 2024. A total of 865 patients met the inclusion criteria. Gender-affirming testosterone therapy and length of exposure were evaluated to seek differences in post-operative pathology findings. The median age at the time of surgery was 27 years [interquartile range (IQR) 21–30]. Most participants identified as female to male (658, 75.6

Background Feminizing top surgery, or mammaplasty augmentation, has multiple variables that surgeons can adjust to work synergistically with patient anatomy including plane of implant placement, pocket size, and inframammary fold (IMF) location. In the gender diverse population receiving this procedure to reduce symptoms of gender dysphoria, surgeons should be aware of differing anatomy and surgical approaches for feminizing top surgery. Methods A retrospective chart review was conducted using our institution's electronic health record between December 2019 and May 2023 with a minimum follow up period of 12 months. Inclusion criteria included transgender women, nonbinary patients, and all patients who did not identify as cis-gender women and who underwent feminizing top surgery. Demographic data including age, race, ethnicity, and gender were collected. Complication rates were recorded for hematoma, infection, seroma, wound dehiscence, hypertrophic scar, minor contour abnormalities, implant asymmetry, and revision surgery. Results Our surgeons' subfascial approach, which uses 2 equations to calculate dissection pocket dimensions and determine placement of pocket and incision based on desired implant base diameter and projection, was performed on 140 gender-diverse patients and resulted in a hematoma rate of 4.29%, an infection rate of 2.86%, and a seroma rate of 1.42% with good cosmetic outcomes, as evidenced by our low rates of minor contour abnormalities (5.71%) and implant asymmetry (1.43%). Only 5 patients (3.57%) required revision surgery. Conclusions Bilateral breast augmentation with round implants in a subfascial plane using a concealed IMF incision following equations to determine the dissection pocket size and new IMF position and incision position is a reproducible technique that results in good aesthetic outcomes and minimizes complications.

PURPOSE: The purpose of this study was to elucidate modifiable and unmodifiable risk factors for complications after neovaginal reconstruction. METHODS: The ACS NSQIP database was queried for gender-affirming neovaginal reconstruction performed between 2015 and 2020. RESULTS: During the study interval, 1506 patients underwent gender-affirming bottom surgery, of which 17.2% (n=259) underwent neovaginal reconstruction. Patient undergoing neovaginal reconstruction had a median age of 32.0 years. Incidence of neovaginal reconstruction has been significantly increasing from 11.3 to 46.5 per million procedures (p<.001). Median operative duration was 276 minutes, and patients remained admitted for 5.0 postoperative days. Overall adverse event rate was 14.7%. Most common complications included dehiscence (7.3%), bleeding requiring transfusion (3.5%), superficial incisional infection (2.3%), and urinary tract infection (1.9%). Among these patients undergoing neovaginal reconstruction, 26.6% (n=69) underwent penectomy and orchiectomy. Undergoing concurrent penectomy/orchiectomy significantly increased operative time (p<.001, 366 vs 250 minutes) and increased postoperative length of stay (p<.001, 6.0 vs 3.0 days). Dehiscence was significantly associated with history of smoking cigarettes within the past year (p=.033, AOR=5.6) and concurrent penectomy (p=.050, AOR=2.9). Bleeding requiring transfusion was significantly associated with hypertension (p=.010, AOR=20.4) and older age at surgery (p=.050, AOR=1.5 per +5 years). CONCLUSION: Dehiscence after vaginoplasty is associated with cigarette smoking, and excessive bleeding after vaginoplasty is associated with hypertension and older age at surgery.

Background:Gender-affirming surgery is a medically necessary treatment for transgender and gender diverse patients experiencing gender dysphoria. Preliminary data demonstrate an association between gender-affirming surgery and improved mental health outcomes. Penile inversion vaginoplasty is the most frequently performed feminizing bottom surgery in transwomen. Importantly, complications associated with penile inversion vaginoplasty are not uncommon and can be life-threatening. Surgeons and other members of the health care team must be aware of these potential harms. However, there is a paucity of high-quality evidence reported in the literature about the management and breadth of complications regarding feminizing bottom surgery.Case:A healthy 37-year-old woman who was assigned male at birth underwent gender-affirming orchiectomy, penile inversion vaginoplasty, and vulvar reconstruction. During routine vaginal packing removal in the postoperative period, there was an acute arterial bleed in the neovaginal canal, and hemostasis was achieved in the operating room.Conclusions:We review the associated periprostatic anatomy and describe several practice improvements to mitigate postoperative complications.

Migraine surgeons have identified six "trigger sites" where cranial nerve compression may trigger a migraine. This study investigates the change in headache severity and frequency following nerve block of the occipital trigger site. This PRISMA-compliant systematic review of five databases searched from database inception through May 2020 is registered under the PROSPERO ID: CRD42020199369. Only randomized controlled trials utilizing injection treatments for headaches with pain or tenderness in the occipital scalp were included. Pain severity was scored from 0 to 10. Headache frequency was reported as days per week. Included were 12 RCTs treating 586 patients of mean ages ranging from 33.7 to 55.8 years. Meta-analyses of pain severity comparing nerve blocks to baseline showed statistically significant reductions of 2.88 points at 5 to 20 min, 3.74 points at 1 to 6 weeks, and 1.07 points at 12 to 24 weeks. Meta-analyses of pain severity of nerve blocks compared with treatment groups of neurolysis, pulsed radiofrequency, and botulinum toxin type A showed similar headache pain severity at 1 to 2 weeks, and inferior improvements compared with the treatment groups after 2 weeks. Meta-analyses of headache frequency showed statistically significant reductions at 1 to 6-week follow-ups as compared with baseline and at 1 to 6 weeks as compared with inactive control injections. The severity and frequency of occipital headaches are reduced following occipital nerve blocks. This improvement is used to predict the success of migraine surgery. Future research should investigate spinous process injections with longer follow-up.

Background: Migraine surgery at 1 of 6 identified "trigger sites" of a target cranial sensory nerve has rapidly grown in popularity since 2000. This study summarizes the effect of migraine surgery on headache severity, headache frequency, and the migraine headache index score which is derived by multiplying migraine severity, frequency, and duration. Materials and Methods: This is a PRISMA-compliant systematic review of 5 databases searched from inception through May 2020 and is registered under the PROSPERO ID: CRD42020197085. Clinical trials treating headaches with surgery were included. Risk of bias was assessed in randomized controlled trials. Meta-analyses were performed on outcomes using a random effects model to determine the pooled mean change from baseline and when possible, to compare treatment to control. Results: 18 studies met criteria including 6 randomized controlled trials, 1 controlled clinical trial, and 11 uncontrolled clinical trials treated 1143 patients with pathologies including migraine, occipital migraine, frontal migraine, occipital nerve triggered headache, frontal headache, occipital neuralgia, and cervicogenic headache. Migraine surgery reduced headache frequency at 1 year postoperative by 13.0 days per month as compared to baseline (I-2 = 0%), reduced headache severity at 8 weeks to 5 years postoperative by 4.16 points on a 0 to 10 scale as compared to baseline (I-2 = 53%), and reduced migraine headache index at 1 to 5 years postoperative by 83.1 points as compared to baseline (I-2 = 2%). These meta-analyses are limited by a small number of studies that could be analyzed, including studies with high risk of bias. Conclusion: Migraine surgery provided a clinically and statistically significant reduction in headache frequency, severity, and migraine headache index scores. Additional studies, including randomized controlled trials with low risk-of-bias should be performed to improve the precision of the outcome improvements.

PURPOSE: To assess patient reported outcomes of gender-affirming care (GAC) using the Vanderbilt Mini Patient Reported Outcome Measures—Gender (VMP-G), a newly validated psychometric instrument. METHODS: VMP-G assesses four scales: quality of life, self-concept, satisfaction, and gender dysphoria. Scores range from 20 to 100, with higher scores representing superior patient-reported outcomes. Patients seeking GAC at Vanderbilt University Medical Center from 10/11/2021 to 9/21/2022 were included. RESULTS: A total of 200 patients completed VMP-G. The median age was 29 (IQR 24-36). Fifty-three percent of patients underwent gender-affirming surgery (GAS). In bivariate and linear regression analyses, patients who underwent GAS scored higher on all scales compared to patients without GAS (p<0.001). After adjustment, patients with a history of GAS scored 12.3 higher on VMP-G compared to patients without a history of GAS (p<0.01). In subset analyses, GAS was associated with improved patient-reported outcomes in White, Non-White, Binary and Non-binary and patients under age 21 (p<0.05). After GAS, patients under age 21 reported similar outcomes, compared to patients older than 21 (p>0.05). No outcome differences were reported between patients who underwent top versus bottom surgery (p=0.2). CONCLUSION: Using a validated GAS-specific measure, we found surgery meaningfully improves patients’ self-reported outcomes including gender dysphoria.

PURPOSE: The purpose of this study was to analyze the racial and ethnic disparities in immediate postoperative complications for patients undergoing gender-affirming surgery nationwide over the past six years. METHODS: The ACS NSQIP database was queried for gender-affirming procedures from 2015 through 2020. Surgical complications, related readmission, and related reoperation were analyzed across racial and ethnic demographics. RESULTS: During the study interval, 3625 patients underwent gender-affirming surgery. Black patients were older than White patients at the time of surgery (p<.001). Black patients were more likely than White patients to undergo postoperative surgical complications (p=.039), including dehiscence (p<.001). Black patients were more likely than White patients to require postoperative related readmission (p=.002) and postoperative related reoperation (p=.001). Hispanic patients were more likely than White patients to experience dehiscence (p=.003) and related reoperation (p=.019). Black patients were more likely than Hispanic patients to require related readmission (p=.031). There were no postoperative complications that were higher in White patients compared to Black and Hispanic patients (p all ≥.050). On multivariate regression analysis controlling for age (p=.038), BMI (p=.029), undergoing top surgery (p=.412), and undergoing bottom surgery (p=.263), patient with Black race were more likely to have postoperative surgical complications (p=.014, AOR=2.1). CONCLUSION: Black and Hispanic patients are significantly more likely than White patients to experience adverse events in the immediate postoperative period after undergoing gender-affirmation surgery.

Magnetic resonance diffusion tensor imaging (DTI) can detect microstructural changes in peripheral nerves. Studies have reported that the median nerve apparent diffusion coefficient (ADC), a quantification of water molecule diffusion direction, is sensitive in diagnosing carpal tunnel syndrome (CTS). Five databases were searched for studies using ADC to investigate CTS. Apparent diffusion coefficient (measured in mm2/s) were pooled in random-effects meta-analyses. Twenty-two studies met criteria yielding 592 patients with CTS and 414 controls. Median nerve ADC were measured at the level of the distal radioulnar joint (CTS ADC: 1.11, 95% CI: 1.07-1.15, I2 = 54%; control ADC: 1.04, 95% CI: 1.01-1.07, I2 = 57%), pisiform (CTS ADC: 1.39, 95% CI: 1.37-1.42, I2 = 0%; control ADC: 1.27, 95% CI: 1.23-1.31, I2 = 59%), hamate (CTS ADC: 1.40, 95% CI: 1.36-1.43, I2 = 58%; control ADC: 1.27, 95% CI: 1.25-1.28, I2 = 47%), and as an combination of several measurements (CTS ADC: 1.40, 95% CI: 1.37-1.47, I2 = 100%; control ADC: 1.39, 95% CI: 1.24-1.53, I2 = 100%). Median nerve ADC is decreased in individuals with CTS compared to controls at the levels of the hamate and pisiform. ADC cut-offs to diagnose CTS should be established according to these anatomic levels and can be improved through additional studies that include use of a wrist coil.

Migraines affect approximately one billion individuals worldwide. Implanted nerve stimulator devices can provide relief to some individuals who have chronic migraines refractory to other treatments. This study defines the change in headache pain severity and headache frequency following implanted nerve stimulator treatment in chronic migraineurs. A PRISMA-compliant systematic review of six databases was performed to identify all clinical trials treating at least 10 chronic migraineurs with an implanted nerve stimulator. Inverse variance random effects meta-analyses were performed to define the relative change in headache pain severity and headache frequency as compared to baseline. Nine studies met criteria, including 5 randomized controlled clinical trials and 4 uncontrolled clinical trials, and treated 559 individuals. Among studies that reported gender, 306 females and 154 males were treated. Mean patient ages ranged from 45 to 50 years. All included studies targeted the greater occipital nerve with an implanted nerve stimulator. Implanted nerve stimulator treatment reduced pain severity at 1 month by 36.42% (95%-CI: 28.35-44.49, I2 = 55%) and 3 months by 50.04% (95%-CI: 39.67-60.42%, I2 = 26%). Implanted nerve stimulators reduced headache frequency by 49.86% (95%-CI: 31.49-68.23, I2 = 92%) at 1 to 3 months and 27.43% (95%-CI: 17.68-37.18, I2 = 63%) at 6 to 97 months. Implanted nerve stimulator devices provide clinically and statistically significant improvements in headache severity and frequency in individuals with chronic migraines.

INTRODUCTION:Limited literatures used validated instruments to evaluate patient-reported outcomes (PROs) for transgender and gender-diverse population undergoing gender-affirming surgeries (GASs). This study aimed to evaluate PROs using a newly validated psychometric instrument, Vanderbilt Mini Patient-Reported Outcome Measures-Gender (VMP-G). METHODS:Vanderbilt Mini Patient-Reported Outcome Measures-Gender assesses 4 scales: quality of life, self-concept, satisfaction, and gender dysphoria. Scores range from 20 to 100, with higher scores representing superior PROs. Descriptive analysis was performed, and outcomes were compared in different races/ethnicities, gender identities, age, types of GAS, and time. Patients seeking GAS at Vanderbilt University Medical Center from October 11, 2021, to October 11, 2022, were included. Data were collected anonymously via the Research Electronic Data Capture survey tool at preoperative or postoperative clinic visits. RESULTS:A total of 207 patients completed VMP-G. Average age was 31.8 years (SD, ±11.5 years). Fifty-three percent of patients were postoperative GAS. In bivariate and linear regression analyses, postoperative patients scored higher on all scales compared with preoperative patients ( P < 0.001). After adjustment, postoperative patients scored 12.5 higher on VMP-G compared with preoperative patients ( P < 0.01). In subset analyses, GAS was associated with improved PROs in White, non-White, binary, and nonbinary and patients younger than 21 years ( P < 0.05). After GAS, patients younger than 21 years reported similar outcomes, compared with patients older than 21 years ( P > 0.05). No PROs differences were reported between patients who underwent top versus bottom surgery ( P = 0.2). Postoperative patients reported low rates of regret (2.8%). Scores on the VMP-G were sustained even 1 year after GAS. Each month after GAS was associated with a score improvement of 0.02 in the gender dysphoria domain after adjusting for patient demographics ( P = 0.02). CONCLUSIONS:Using a validated GAS-specific measure, we found that surgery sustainably improves patients' self-reported outcomes including gender dysphoria.