Hormonal status and gender identity do not change aesthetic preferences for top surgery

Chest masculinization surgery (CMS) is becoming increasingly common, especially in the nonbinary population. However, variations in CMS preferences between this group and the transgender population remain undefined. Additionally, it is unknown if concurrent testosterone use may correlate with differing aesthetic preferences. Therefore, we aimed to identify whether aesthetic preferences vary among patients undergoing CMS based on gender identity and hormonal treatment status.

Patients undergoing masculinizing top surgery participated in an institutional survey identifying their aesthetic preferences through two modified photos representing normal and high BMI. A total of 115 patients completed the survey with 98 non-binary and transgender male patients meeting inclusion criteria. Patients were compared by gender and hormonal status.

Among participants, 32 were non-binary on hormonal therapy, 33 were non-binary without hormonal therapy, and 33 were transgender males on hormonal therapy. Comparisons among transgender males on hormonal therapy and non-binary individuals on and off hormonal therapy revealed no differences in preferences for mean nipple diameter for an example individual with a normal BMI (P=0.64) or an example individual with a high BMI (P=0.42). Preference for the straight scar type remained consistent across all groups for both normal (P=0.88) and high BMI (P=0.28) examples.

Despite our study population's diversity, hormonal status and gender identity did not correlate with aesthetic preferences. Individual aesthetic preferences should not be implied by gender identity or hormone status and instead may be better understood with a more systematic and collaborative decision-making process.