Facial Feminization Surgery and Mental Health Resource Utilization: A Retrospective Chart Review

Introduction: The health burden and psychosocial sequelae that transgender and gender diverse (TGD) individuals experience have been well described. Gender-affirming surgeries (GAS), including facial feminization surgery (FFS), are procedures aiming to harmonize visual gender congruence, reduce dysphoria, and relieve psychological distress. The goal of the proposed research project is to perform an economic evaluation of FFS on a healthcare system and TGD patients mental health resource utilization, focusing on the number of mental health associated clinical encounters.

Methods: We retrospectively analyzed the effects of facial feminization surgery (FFS) performed in 2016-2017 on utilization of mental health services, including individual and group sessions, in a large integrated healthcare system. We compared average quarterly rates for 12-24 months before FFS with quarterly rates during 24 months of follow-up. Patients who did not have continuous coverage for at least 12 months before and 12 months after FFS were excluded.

Results: A total of 64 FFS cases performed between 2016-2017, of which 47 cases (mean age 37.5 + 13.2 years, 68.1% White, 60.9% “full FFS” spanning all three facial thirds) were included. Wilcoxon matched-pairs signed-ranks tests comparing pre-FFS with post-FFS utilization rates showed statistically significant reductions in numbers of mental health associated visits, including individual and group sessions (p < 0.05). This reduction was first noted starting at the month of FFS, and deemed statistically significant starting the third quarter after FFS (p < 0.05 for subsequent quarters). A single patient had a documented mental health crisis prior to FFS requiring hospital admission, and none following FFS.

Conclusions: To our knowledge, this endeavor is the first utilization study of specifically FFS conducted in the United States. FFS had a positive effect on both the utilization of mental health care services, with a reduction in the number of mental health associated visits within an integrated healthcare system.