Age Context in High-Engagement X Posts About Gender-Affirming Surgery: A Content Analysis

Area of Science:

• Plastic Surgery
• Social Media Analysis
• Medical Ethics

Background:

• Gender-affirming surgery (GAS) is increasingly integrated into craniofacial practice.
• Social media significantly influences patient expectations regarding GAS.
• Public discourse often conflates care for minors with adult procedures, creating potential misunderstandings.

Purpose of the Study:

• To analyze the content and tone of social media posts regarding gender-affirming surgery.
• To investigate the prevalence of age-specific discussions (minors vs. adults) in online GAS discourse.
• To understand how age ambiguity in social media affects the perception of GAS.

Main Methods:

• A descriptive cross-sectional content analysis of 600 high-engagement posts on X (formerly Twitter) from November 2023.
• Classification of posts based on age-group focus, author type, content type, and engagement metrics.
• Statistical analysis to determine the tone (supportive, critical, neutral) and its association with age focus.

Main Results:

• Most posts (60.5%) lacked age specification; 38% referenced minors, and <2% referenced adults.
• The overall tone was predominantly critical (56.8%).
• Posts referencing minors were significantly more likely to be critical (OR=3.45) than those without age specification. Adult-focused posts were rare and more balanced.

Conclusions:

• Age ambiguity is prevalent in online discussions of gender-affirming surgery.
• Negative sentiment on social media regarding GAS is largely concentrated in posts discussing minors.
• Craniofacial surgeons should be aware that social media narratives encountered by adult patients may be skewed by discussions focused on minors.