Abstract
Background
Gender-affirming surgery (GAS) can be an important part of comprehensive care for transgender and gender diverse (TGD) individuals, but this care is not provided by the Department of Veterans Affairs (VA) because of an exclusion in the medical benefits package.
Objective
To describe the receipt of GAS by veterans and assess the associations between key sociodemographic characteristics and receipt of chest (“top”) and genital (“bottom”) surgeries.
Design
Cross-sectional national survey (the GendeR Affirming Care Evaluation (GRACE)), among TGD Veterans conducted between September 2022 and July 2023.
Participants
A total of 6653 Veterans (54% response rate) completed the survey.
Main Measures
Self-reported “top” and “bottom” GAS were key outcomes. Covariates included gender identity, sex assigned at birth, age, race, ethnicity, income, employment status, education, relationship status, sexual orientation, and geographic region.
Key Results
Among all respondents, 39% had ≥ 1 GAS. Among the 4430 veterans interested in top surgery, 38% received it; 23% of 3911 veterans interested in bottom surgery had received it. In multivariable models, older age (50 + vs. 18–39) was associated with higher receipt of top and bottom surgery while nonbinary gender identity (vs. binary gender identity), lower household income (< $50,000 vs. > $75,000), less education (less than a college graduate vs. Master’s degree or more), sexual orientations other than heterosexual, and residing in a region other than the Pacific were associated with lower receipt of top and bottom surgery. Individuals assigned male (vs. assigned female) at birth had lower receipt of top surgery and higher receipt of bottom surgery.
Conclusions
GAS receipt was low and there were important disparities by gender, sex, income, education, sexual orientation, and region. By removing the exclusion to providing GAS, VA could reduce barriers to accessing GAS and decrease disparities among TGD veterans.
Topic
JGIM
Author Descriptions
Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
Alyson J. Littman PhD, Amy Jeon MS & Anna Korpak PhD
Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
Alyson J. Littman PhD, Carolyn L. Fort BS & Krista Dashtestani BA
Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
Alyson J. Littman PhD
Office of Patient Care Services, Department of Veterans Affairs, LGBTQ+ Health Program, Washington, DC, USA
Michael R. Kauth PhD & Jillian C. Shipherd PhD
Department of Psychiatry, TH Chan School of Medicine, UMass Chan Medical School, Worcester, MA, USA
Michael R. Kauth PhD
National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
Jillian C. Shipherd PhD
Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Jillian C. Shipherd PhD
Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
Guneet K. Jasuja PhD
Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Guneet K. Jasuja PhD
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
Guneet K. Jasuja PhD
VA Pain Research, Informatics, Multi-Morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
Hill L. Wolfe PhD, MPA
Department of Biomedical Informatics & Data Science, Yale School of Medicine, New Haven, CT, USA
Hill L. Wolfe PhD, MPA
Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, USA
Paula M. Neira JD, RN
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
Paula M. Neira JD, RN
National Center for Transgender Equality, Washington, DC, USA
Josie Caballero BA
Transgender American Veterans Association, Washington, DC, USA
Josie Caballero BA & Sady Garcia MBA
VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education, Seattle, WA, USA
Tracy L. Simpson PhD
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
Tracy L. Simpson PhD
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