Racial and Ethnic Disparities in Utilization of Top and Bottom Gender Affirming Surgeries Among Eligible Transgender...

Introduction: Gender-affirming surgery (GAS) is a critical step for many transgender individuals seeking alignment between their physical appearance and gender identity. However, disparities in access to GAS across racial and ethnic groups remain inadequately addressed. This study aims to examine racial and ethnic disparities in access to top and bottom gender-affirming surgeries. Methods: A retrospective cohort analysis was conducted using the TriNetX database (2014-2024). Patients aged 18+ with a diagnosis of gender dysphoria who completed at least 6 months of hormone therapy were included. Patients were identified using ICD-10 and CPT codes and stratified by race and ethnicity: African American, Asian, Native Hawaiian, American Indian, Hispanic, and White. Propensity score matching adjusted for demographic and clinical variables. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to compare the likelihood of undergoing top or bottom surgery at 6 months and 1-year posteligibility. A P value <.05 was considered significant. Results: At 6 months posteligibility, African American patients had significantly lower odds of undergoing top (OR = 0.876, P = .0480) and bottom surgeries (OR = 0.399, P = .0111) compared to White patients. Hispanic patients also had lower odds for top (OR = 0.873, P = 0.0014) and bottom surgeries (OR = 0.872, P = 0.0314). In contrast, Asian patients had higher odds of receiving top (OR = 1.267, P = .0079) and bottom surgeries (OR = 1.333, P = 0.0007). These disparities remained evident at the 1-year mark, with African American and Hispanic patients continuing to experience reduced surgical access relative to White patients. Conclusion: Significant racial and ethnic disparities persist in GAS access. Targeted interventions are needed to promote equitable surgical care for transgender individuals.