National polling data indicate that Americans support the right of transgender persons to undergo gender-affirming surgery (GAS). It remains unknown whether public perceptions of GAS differ depending on patient subpopulations, anatomical site, or insurance coverage and whether the public widely believes that transgender people will regret GAS.
Methods:
We built a Qualtrics™ survey derived from an online validated 2017 Ipsos survey and distributed it to American adults through Amazon Mechanical Turk. Associations of demographic characteristics with perception of GAS were determined using multinomial logistic regression.
Results:
Respondents (n=312) were predominantly non-Hispanic White (69.2%), held a bachelor's degree (64.7%), and reported an annual income of $25,000 to $74,999 (64.4%). Approximately half of respondents identified as socially liberal (50.3%); 34.0% as socially conservative; and 15.7% as neither. Respondents supported a right to GAS independent of anatomy and insurance. Support for transgender children (62%) was less than for adult transgender men (84%) and women (83%). Despite supporting a right to GAS, respondents agreed that transgender adults (67%) and children (74%) would regret GAS. Education was the strongest predictor of support for GAS rights. Socially conservative respondents were significantly more likely than nonideological or liberal respondents to believe that transgender people would regret GAS.
Conclusion:
This large online sample of American adults with diverse ideologies demonstrated support for GAS independent of anatomical site and insurance. Support of GAS for transgender children is robust, although lower than support for adults. Despite broad support, most laypersons believe that transgender people would regret GAS.
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References
1.
FloresAR, HermanJL, GatesGJ, et al.How Many Adults Identify as Transgender in the United States?. The Williams Institute: Los Angeles, CA; 2016.
2.
ReisnerSL, PoteatT, KeatleyJ, et al.Global health burden and needs of transgender populations: A review. Lancet, 2016; 388(10042):412–436; doi: 10.1016/s0140-6736(16)00684-x
3.
AlmazanAN, KeuroghlianAS. Association between gender-affirming surgeries and mental health outcomes. JAMA Surg, 2021; 156(7):611–618; doi: 10.1001/jamasurg.2021.0952
4.
ColemanE, BocktingW, BotzerM, et al.Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend Health, 2012; 13(4):165–232; doi: 10.1080/15532739.2011.700873
5.
Owen-SmithAA, GerthJ, SineathRC, et al.Association between gender confirmation treatments and perceived gender congruence, body image satisfaction, and mental health in a cohort of transgender individuals. J Sex Med, 2018; 15(4):591–600; doi: 10.1016/j.jsxm.2018.01.017
6.
AgarwalCA, ScheeferMF, WrightLN, et al.Quality of life improvement after chest wall masculinization in female-to-male transgender patients: A prospective study using the BREAST-Q and Body Uneasiness Test. J Plast Reconstr Aesthet Surg, 2018; 71(5):651–657; doi: 10.1016/j.bjps.2018.01.003
7.
BränströmR, PachankisJE. Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study. Am J Psychiatry, 2020; 177(8):727–734; doi: 10.1176/appi.ajp.2019.19010080
8.
de VriesALC, RichardsC, TishelmanAC, et al.Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274: Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents. Int J Transgend Health, 2021; 22(3):217–224; doi: 10.1080/26895269.2021.1904330
9.
MuradMH, ElaminMB, GarciaMZ, et al.Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf), 2010; 72(2):214–231; doi: 10.1111/j.1365-2265.2009.03625.x
10.
HermanJL, BrownTNT, HaasAP. Suicide Thoughts and Attempts Among Transgender Adults: Findings from the 2015 U.S. Transgender Survey. The Williams Institute: Los Angeles, CA; 2019.
11.
BakerKE.The future of transgender coverage. N Engl J Med, 2017; 376(19):1801–1804; doi: 10.1056/NEJMp1702427
12.
ZaliznyakM, JungEE, BreseeC, et al.Which U.S. States' Medicaid Programs provide coverage for gender-affirming hormone therapy and gender-affirming genital surgery for transgender patients?: A state-by-state review, and a study detailing the patient experience to confirm coverage of services. J Sex Med, 2021; 18(2):410–422; doi: 10.1016/j.jsxm.2020.11.016
13.
NgaageLM, KnightonBJ, BenzelCA, et al.A review of insurance coverage of gender-affirming genital surgery. Plast Reconstr Surg, 2020; 145(3):803–812; doi: 10.1097/prs.0000000000006591
14.
JamesSE, HermanJL, RankinS, et al.The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality: Washington, DC; 2016.
15.
Terris-FeldmanA, ChenA, PoudrierG, et al.How accessible is genital gender-affirming surgery for transgender patients with commercial and public health insurance in the United States? Results of a patient-modeled search for services and a survey of providers. Sex Med, 2020; 8(4):664–672; doi: 10.1016/j.esxm.2020.08.005
16.
MartinS, SandbergES, ShumerDE. Criminalization of gender-affirming care—Interfering with essential treatment for transgender children and adolescents. N Engl J Med, 2021; 385(7):579–581; doi: 10.1056/NEJMp2106314
17.
TurbanJL, LooSS, AlmazanAN, et al.Factors leading to “Detransition” among transgender and gender diverse people in the United States: A mixed-methods analysis. LGBT Health, 2021; 8(4):273–280; doi: 10.1089/lgbt.2020.0437
LandénM, WålinderJ, HambertG, et al.Factors predictive of regret in sex reassignment. Acta Psychiatr Scand, 1998; 97(4):284–289; doi: 10.1111/j.1600-0447.1998.tb10001.x
26.
LawrenceAA.Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Arch Sex Behav, 2003; 32(4):299–315; doi: 10.1023/a:1024086814364
27.
BustosVP, BustosSS, MascaroA, et al.Regret after gender-affirmation surgery: A systematic review and meta-analysis of prevalence. Plast Reconstr Surg Glob Open, 2021; 9(3):e3477; doi: 10.1097/gox.0000000000003477
28.
Hadj-MoussaM, OhlDA, KuzonWMJr. Feminizing genital gender-confirmation surgery. Sex Med Rev, 2018; 6(3):457–468.e2; doi: 10.1016/j.sxmr.2017.11.005
29.
DjordjevicML, BizicMR, DuisinD, et al.Reversal surgery in regretful male-to-female transsexuals after sex reassignment surgery. J Sex Med, 2016; 13(6):1000–1007; doi: 10.1016/j.jsxm.2016.02.173
AhlerDJ.Self-Fulfilling Misperceptions of Public Polarization. J Polit, 2014; 76(3):607–620; doi: 10.1017/s0022381614000085
32.
ArceneauxK.Cognitive biases and the strength of political arguments. Am J Pol Sci, 2012; 56(2):271–285; doi: 10.1111/j.1540-5907.2011.00573.x
33.
CliffordS.Linking issue stances and trait inferences: A theory of moral exemplification. J Polit, 2014; 76(3):698–710; doi: 10.1017/s0022381614000176
34.
MortensenK, HughesTL. Comparing Amazon's Mechanical Turk platform to conventional data collection methods in the health and medical research literature. J Gen Intern Med, 2018; 33(4):533–538; doi: 10.1007/s11606-017-4246-0
35.
BardosJ, FriedenthalJ, SpiegelmanJ, et al.Cloud based surveys to assess patient perceptions of health care: 1000 Respondents in 3 days for US $300. JMIR Res Protoc, 2016; 5(3):e166; doi: 10.2196/resprot.5772
36.
BucknorA, ChristensenJ, KamaliP, et al.Crowdsourcing public perceptions of plastic surgeons: Is there a gender bias?. Plast Reconstr Surg Glob Open, 2018; 6(4):e1728; doi: 10.1097/gox.0000000000001728
37.
PeerE, VosgerauJ, AcquistiA. Reputation as a sufficient condition for data quality on Amazon Mechanical Turk. Behav Res Methods, 2014; 46(4):1023–1031; doi: 10.3758/s13428-013-0434-y
38.
U.S. Census Bureau. Suitland, MD; 2020. Available from: data.census.gov [Last accessed: July1, 2022].
39.
The GenIUSS Group. Best Practices for Asking Questions to Identify Transgender and Other Minority Respondents on Population-Based Surveys. The Williams Institute: Los Angeles, CA; 2014.
JonesRP, JacksonN, OrcesD, et al.Despite Partisan Rancor, Americans Broadly Support LGBTQ Rights. The Public Religion Research Institute (PRRI): Washington, DC; 2021.
42.
ColemanE, RadixAE, BoumanWP, et al.Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health, 2022; 23(Suppl 1):S1–S259; doi: 10.1080/26895269.2022.2100644
43.
CoffmanKB, CoffmanLC, EricsonKMM. The size of the LGBT population and the magnitude of antigay sentiment are substantially underestimated. Manage Sci, 2017; 63(10):3168–3186; doi: 10.1287/mnsc.2016.2503
44.
Fetner TU.S.attitudes toward lesbian and gay people are better than ever. Contexts, 2016; 15(2):20–27; doi: 10.1177/1536504216648147
45.
KellyJA.Popular opinion leaders and HIV prevention peer education: Resolving discrepant findings, and implications for the development of effective community programmes. AIDS Care, 2004; 16(2):139–150; doi: 10.1080/09540120410001640986
46.
LiL, GuanJ, LiangLJ, et al.Popular opinion leader intervention for HIV stigma reduction in health care settings. AIDS Educ Prev, 2013; 25(4):327–335; doi: 10.1521/aeap.2013.25.4.327
47.
CaseyLS, ChandlerJ, LevineAS, et al.Intertemporal differences among MTurk workers: Time-based sample variations and implications for online data collection. SAGE Open, 2017; 7(2):2158244017712774; doi: 10.1177/2158244017712774
48.
LevayKE, FreeseJ, DruckmanJN. The demographic and political composition of Mechanical Turk samples. SAGE Open, 2016; 6(1):2158244016636433; doi: 10.1177/2158244016636433
49.
FeldmanS, JohnstonC. Understanding the determinants of political ideology: implications of structural complexity. Polit Psychol, 2014; 35(3):337–358; doi: 10.1111/pops.12055
50.
CliffordS, JewellRM, WaggonerPD. Are samples drawn from Mechanical Turk valid for research on political ideology?. Res Politics, 2015; 2(4):2053168015622072; doi: 10.1177/2053168015622072
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