Mental Health, Gender Dysphoria, and Quality of Life in Trans Individuals Following Top Surgery: Protocol for a Prospective Cohort Study.

Existing research on top surgery outcomes has significant methodological limitations that this study aims to address.

• Most existing studies have been retrospective rather than prospective.
• Prior studies have generally not used validated outcome measures.
• Nonbinary individuals have largely been excluded from existing research.
• The authors state these limitations restrict 'the robustness of the existing research.'

The study is designed as a longitudinal prospective cohort recruiting trans individuals aged 16 and older from a single surgeon's office in Perth, Western Australia.

• Participants are recruited from a single surgeon's practice.
• Eligibility includes trans and gender-diverse individuals aged 16 years and older undergoing top surgery.
• The study explicitly includes nonbinary individuals, addressing a gap in prior research.
• As of February 2026, 26 people had consented to participate.

Questionnaires are administered at three time points to capture pre- and post-surgical changes.

• Time point 1: within 8 weeks prior to surgery.
• Time point 2: 6-8 weeks post surgery.
• Time point 3: 1 year post surgery.
• Domains assessed include anxiety, depression, self-harm and suicide, gender euphoria and dysphoria, disordered eating, quality of life, substance use, social acceptance and discrimination, and surgical satisfaction.

The study employs multiple validated instruments alongside bespoke items developed through community consultation.

• Validated instruments include the GENDER-Q (health professional subscale), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Gender Euphoria Scale, an adapted Olson-Kennedy Chest Dysphoria Scale, International Physical Activity Questionnaire – Short Form, Eating Disorder Examination Questionnaire – Short, Assessment of Quality of Life 8 Dimensions, and Alcohol, Smoking, and Substance Involvement Screening Test – Short Form.
• Bespoke items were developed through community consultation to capture experiences not covered by existing validated tools.
• Surgical satisfaction is assessed using both patient- and surgeon-reported measures to enable between-group comparisons.

Quantitative and qualitative analytical approaches are both planned to analyze study data.

• Quantitative data will be analyzed using linear regression models and repeated-measures ANOVA to compare outcomes across the three time points.
• Qualitative data will undergo a general inductive approach to produce categories that contextualize and supplement quantitative findings.
• Qualitative analysis is also designed to 'identify any novel or unexpected experiences.'

Data collection commenced in May 2025 and is expected to be completed by December 2027.

• The study received funding in February 2024.
• Data collection started in May 2025.
• Expected completion is December 2027.
• As of February 2026, 26 participants had consented.

The study aims to inform perioperative and postoperative care practices and policy related to gender-affirming surgeries in Australia.

• Findings are intended to 'guide improvements in perioperative and postoperative care and support for patients.'
• Results are expected to 'inform policy related to gender-affirming surgeries in Australia.'
• The study is described as extending research on top surgery outcomes specifically within an Australian context.