Effects of Gender-Affirming Surgery on Interoceptive Awareness

The inability to correctly identify or appraise internal bodily stimuli, interoceptive awareness (IA), has been shown to be reduced in individuals with body-image dissatisfaction and mental health conditions such as depression and PTSD. IA has not been investigated in relation to gender dysphoria in the transgender and gender diverse (TGD) population, and how this may change in relation to gender-affirming procedures. This study aims to assess pre- and postoperative IA in patients who underwent gender-affirming chest surgery using the Multidimensional Assessment of Interoceptive Awareness (MAIA-2), a previously validated survey.

The MAIA-2 survey was administered preoperatively and then repeated at 1 week, 1 month, and 3 months postoperatively to patients who underwent gender-affirming chest surgery between December 2021 and April 2023 at a single institution. The survey was administered once more in September 2024 to collect long-term data. A paired-samples t test was used to compare postoperative mean values to preoperative baselines and obtain P-values. Significance was set as P<0.05.

Twenty-three patients completed the 1-week postoperative survey, 18 patients through 1 month, 16 patients through 3 months, and 13 patients filled out the entire survey set with an average long-term follow-up period of 2.10 years postsurgery. For overall IA, there were significant improvements at each survey interval when compared to preoperative scores. There was a significant increase in the trusting subcategory score at 1 week sustained to long-term follow-up, in the not-distracting score at 1 week and 3 months, and in the not-worrying score at 1 month, sustained to long-term follow-up. There was a nonsignificant upward trend in the attention regulation and self-regulation categories.

Gender-affirming chest surgery significantly improves IA early in the postoperative period, sustained to long-term follow-up, demonstrating increased mind-body congruity within TGD patients. Our findings add to the growing body of literature on IA, provide new insight into the postoperative experiences of individuals undergoing gender-affirming surgery, and support providers in more effectively advocating for gender-affirming care.