Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience

Background  An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods  A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results  Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth ( n  = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs ( n  = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5 ± 3.6 years, primarily estrogen ( n  = 39). Most patients ( n  = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy ( n  = 32, 48%). The most common surgeries completed or desired were facial feminization surgery ( n  = 15, 22%), vaginoplasty ( n  = 15, 22%), mastectomy ( n  = 11, 16%), and orchiectomy ( n  = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p  = 0.010). Conversely, patients who were AFAB were more likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p  < 0.021). Conclusion  Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy.