Needs Assessment of Gender‐Affirming Face, Neck, and Voice Procedures and the Role of Gender Dysphoria

Abstract

ObjectiveTo assess the needs of transgender and nonbinary (TNB) adults for gender‐affirming face, neck, and voice procedures.Study DesignCross‐sectional survey.SettingOnline, February to May 2022.MethodsPrimary outcomes included utilization of otolaryngologists and speech‐language pathologists; gender dysphoria felt from the face, neck, and voice self‐reported on a 0 to 10 numeric rating scale (0 = no dysphoria, 10 = unbearable); and desire for various gender‐affirming face, neck, and voice procedures. We used ordinal logistic and linear regression to assess relationships between site‐specific dysphoria and the desire for relevant procedures.ResultsTNB participants (N = 234) infrequently sought gender‐affirming care with speech‐language pathologists (23%), facial plastic surgeons (8%), or laryngologists (3%). Participants experienced the strongest dysphoria from the voice (median 7/10), jawline/chin (4/10), and neck (3.5/10). Transmasculine and nonbinary participants typically seeking masculinization (n = 83) frequently desired voice therapy (want = 35%, had = 8%). Transfeminine and nonbinary participants typically seeking feminization (n = 145) frequently desired voice therapy (want = 52%, had = 23%), chondrolaryngoplasty (want = 45%, had = 5%), and hair removal/electrolysis (want = 43%, had = 44%). Many desired at least 1 facial feminization surgery procedure (65%), especially mandible reduction (want = 42%, had = 3%), rhinoplasty (want = 41%, had = 1%), and forehead reduction (want = 37%, had = 4%). Dysphoria ratings were associated with desiring relevant procedures (p < .05 for all), notably voice therapy (odds ratio [OR] = 1.50), chondrolaryngoplasty (OR = 1.46), mandible reduction (OR = 1.38), rhinoplasty (OR = 1.59), and forehead reduction (OR = 1.82).ConclusionGender dysphoria from the face, neck, and voice can be severe for TNB people and is associated with the desire for gender‐affirming procedures. The high demand yet low reported access to these procedures highlights the need for providers of gender‐affirming face, neck, and voice care.

The Role of the Otolaryngologist in Sexual Health

“…For a variety of reasons, for both cisgender and transgender patients, these can be of concern. For example, gender dysphoria among transgender patients, specifically from the face, neck, and voice has been found to be significant, but access to gender‐affirming procedures is limited 5 …”

“…For example, gender dysphoria among transgender patients, specifically from the face, neck, and voice has been found to be significant, but access to genderaffirming procedures is limited. 5 Taken as a whole, the otolaryngologist is assuming an increasingly prominent role in the area of sexual health. Sexual health training, however, is often lacking.…”