We hope the study will inform physicians and parents as they assess a youth’s readiness for gender-affirming medical or surgical treatment.
Study: Top surgery significantly improves quality of life in transmasculine and nonbinary teens and young adults
Teen patient: “I just felt very uncomfortable in my body, and knew there were medical options to make me feel less uncomfortable.”
CHICAGO, Ill. – Sept. 26, 2022 – A new Northwestern Medicine study published in JAMA Pediatrics is the first of its kind to show that gender-affirming top surgery (mastectomy) is associated with significant improvement in chest dysphoria, gender congruence and body image in transmasculine and nonbinary teens and young adults. The study compared teen patients with an average age of 18 who received top surgery with members of a control group who did not receive surgery.
“When we compared the outcomes of patients who received gender-affirming top surgery to those who did not, we recognized that surgery significantly improved the quality of life for patients,” said Sumanas Jordan, MD, PhD, plastic surgeon and director of the Northwestern Medicine Gender Pathways Program. “This has been well documented in adult patients, but until now it hasn’t been well described in teens and young adults. We hope the study will inform physicians and parents as they assess a youth’s readiness for gender-affirming medical or surgical treatment.”
The research findings were no surprise to study participant Hunter Martin, who was 16 years old when he received gender-affirming top surgery from Dr. Jordan through Northwestern Medicine’s Gender Pathways Program.
When Martin was 12 years old, he told his parents he identified as a trans man. He asked to begin hormone therapy to help his body develop masculine features and to prevent the changes of female puberty. At the time, his parents said they needed more information to weigh the risks and benefits of medical changes to their child’s body.
“Back then, my parents said I could express myself however I wanted in terms of clothing, and they said I could cut or dye my hair any way that I wanted to. But medical stuff seemed dangerous to them,” Martin said. “My mom wanted to see research that demonstrated the safety of medical interventions.”
Although he publicly lived life as a boy, Martin’s breast development caused chest dysphoria, which medical professionals define as physical and emotional discomfort caused by unwanted breast development. He began binding his breasts each day.
“It’s like wearing an itchy sweater or a too-tight pair of shoes,” he said. “It doesn’t usually ruin your day, but it’s going to continue to become more uncomfortable until you are able to take it off and exist without it. On days when you have a lot of inconveniences piling up, that sweater feels that much itchier and those shoes feel that much tighter, and it plagues you. It adds onto other problems that you’re facing.”
Now 18, Martin is thankful for the support of a therapist, who helped him communicate with his parents so they could understand his feelings.
“At the time, it was difficult for me, because I didn’t really see my parents’ point of view. I just felt very uncomfortable in my body, and knew there were medical options to make me feel less uncomfortable. I didn’t necessarily feel rejected, but I felt discouraged. Now I realize that my parents weren’t unsupportive, they just hadn’t had the experience of having a trans child before.”
By high school, Martin’s parents educated themselves about transgender issues and sought resources to help them support their son. When Martin was 16 years old, they agreed to support him as he pursued top surgery to create a masculine chest.
During his first visit to the Northwestern Medicine Gender Pathways Program, Martin was invited to be part of Dr. Jordan’s study. He immediately agreed in hopes that his experience would help inform others.
“I think it’s important to contribute to science whenever you can, especially if you have an experience that is unique or under-researched,” Martin said. “I hoped that by contributing to this study I could prove to other parents like my mom, who wanted to be supportive, that medical and surgical transition is healthy and safe and extremely helpful for people who choose to go down that path.”
Today, he’s a college sophomore who is thankful for the support he received from his parents and from the Gender Pathways Program.
“I feel like I've finally been able to experience life for what it is,” Martin said. “It's not necessarily perfect all the time, but I don't have to deal with hardships that other people wouldn't have to, just because of my gender.”
Dr. Jordan said the study’s results confirm what patients have been telling her and her colleagues for many years.
“Patients who choose gender-affirming top surgery feel better about their bodies, and it enhances their quality of life,” Dr. Jordan said. “Our hope is that this study will now be used as a resource for teens, young adults and for families who want to learn more about surgical transition options.”
Manager, Media Relations - Northwestern Memorial Hospital