Gender-affirming surgeries and patient-reported outcomes in South Korea: A multicenter cohort survey

Gender-affirming surgeries (GASs) are becoming common in South Korea; however, patient experiences remain underexplored. This study investigated experiences of transgender and gender-diverse (TGD) individuals who underwent GAS in South Korea. This multicenter study was conducted at 8 institutions between January and October 2024. TGD individuals who underwent at least one GAS were surveyed regarding demographics, type of surgery, and patient-reported outcome measures including satisfaction and self-perceived effects of GAS using a Likert scale. Among the 844 respondents, 382 (45.3%) underwent at least 1 GAS. Surgery rates were the highest among trans men (75.2%) and nonbinary individuals assigned female (59.1%), compared to trans women (31.7%) and nonbinary individuals assigned male (22.0%). The median age at first surgery was 26 years. Most respondents (98.9%) underwent gender-affirming hormone therapy for a median of 5 years. Common procedures included orchiectomy (80.7%) and vulvoplasty (63.6%) in trans women, and mastectomy (99.5%) and hysterectomy (73.7%) in trans men. High satisfaction was reported with gonadectomy (85.1%) and chest/breast surgery (77.8%); satisfaction was relatively low for genital surgeries (62.4%) and voice feminization (56.6%). Participants noted improvements in gender expression (94.2%), quality of life (91.0%), self-esteem (90.2%), mental health (88.9%), and gender congruence (88.4%). In conclusion, satisfaction with GAS was high, especially for gonadectomy and breast/chest surgery. TGD individuals reported that GAS improved gender congruence, gender expression, quality of life, self-esteem, and mental health. To improve the health of TGD individuals in South Korea, accessibility to GAS must be improved.