Evaluating the current research landscape in gender-affirming surgery

Research on gender-affirming surgery (GAS) is essential to advancing and optimizing surgical techniques, understanding long-term outcomes, and reducing health disparities. Multidisciplinary collaboration is crucial for optimal outcomes after GAS, but whether published studies reflect the multidisciplinary nature of clinical care is unknown. We sought to evaluate which specialties are publishing the most, the most published types of GAS, and the current trends in GAS research in order to elucidate the rapid growth of GAS.

We conducted a cross-sectional study of all GAS research articles published on PubMed from March 2010, the year the Affordable Care Act was implemented, to 2022. For each article, we recorded senior author specialty, type of GAS investigated, year of publication, journal name, and funding source.

Of the 764 articles analyzed, the most were published on FFS (20.9 %) and vaginoplasty (20.6 %), with the fewest on metoidioplasty (2.88 %) (p < 0.01). There was an 86-fold increase in articles published from 2010 to 2022 (p < 0.01) and the number increased significantly for all GAS types except gender-affirming breast augmentation. Ninety percent of articles were not funded. Plastic surgeons produced the most publications on GAS (51 %), had the greatest increase of any surgical specialty (linear model slope = 0.18, p < 0.01), and produced the most articles on every type of GAS, with the exception of metoidioplasty, for which urologists published 81.8 % of articles.

Research on GAS has increased significantly since the passage of the Affordable Care Act. Given that plastic surgeons published the most and had the greatest increase in publications amongst all specialties may reflect the fact that plastic surgeons comprise 79.5 % of gender-affirming surgeons in the United States. GAS is a rapidly expanding surgical field given its significant increase in publications over the past decade.