Page 52 - Read Online

Hart et al. Plast Aesthet Res. 2026;13:3 Page 3 of 10

Measures
The survey, designed by the study authors (GD, AP, and JD), covered demographics, healthcare utilization,
and a range of mental health aspects. Depression and anxiety were screened using the Patient Health
Questionnaire-2 (PHQ-2) and the Generalized Anxiety Disorder 7-Item (GAD-7) scales, respectively.
[13]
[12]
Coping self-efficacy, defined as an individual’s confidence in their ability to cope with life’s stressors, was
measured using the Coping Self-Efficacy Scale (CSES) [14] . Social support was assessed using the
Multidimensional Scale of Perceived Social Support (MSPSS) . These comprehensive measures were
[15]
employed to evaluate multiple facets of participants’ mental health and well-being.

Statistical analysis
Data were extracted from Qualtrics, and statistical analyses were conducted using R . Descriptive statistics
[16]
(counts and percentages) summarized participants’ demographic characteristics. Questionnaire scores were
recoded into categorical variables based on standard scoring thresholds: PHQ-2 (< 3 vs. ≥ 3), GAD-7 (< 8 vs.
≥ 8), and MSPSS [low/medium (1.0-5.0) vs. high (5.1-7.0)]. Mean coping self-efficacy (CSES) scores
(standard deviation, SD) were compared across these binary categories using two-sample t-tests. A
multivariable logistic regression model was fitted with PHQ-2 as the outcome and CSES as the primary
predictor. In a prior study of a coping-effectiveness training intervention among HIV-seropositive gay men,
a 0.4-SD increase in CSES was associated with clinically significant improvements in anxiety and other
mental health outcomes . To assess whether this association was present in our sample, CSES was
[14]
standardized by subtracting the mean and dividing by 0.4 times the SD. Age, housing status, disability status,
and insurance type were included in the model as covariates. Similar approaches were applied with GAD-7
and MSPSS as outcomes. Results were considered statistically significant at P < 0.05.

RESULTS
Descriptive statistics
Of the 472 individuals invited to participate in the survey, 118 completed it and were included in the analysis,
yielding a response rate of 25%. Table 1 presents the demographic characteristics of TGD participants
seeking GGAS at our institution (N = 118). Most respondents were aged 25-44 years (57%). Participants
could select multiple options for self-reported race and ethnicity, with the majority identifying as White
(81%) and 17% identifying as people of color. A notable proportion of respondents (35%) reported having a
disability, and 14% reported housing instability. Most participants had health insurance (84.7%), primarily
through private insurance (53.4%) or Medicaid (25.4%).

The reported duration since consultation for GGAS was divided into four categories: less than 6 months
(19.5%), 6 months to 1 year (33.1%), 1 to 2 years (32.2%), and over 2 years (15.3%). A large majority of
respondents had a consultation for vaginoplasty (n = 99) rather than vulvoplasty (n = 19), the latter being a
procedure focused on constructing external vulvar anatomy without creating an internal vaginal canal.

Higher coping self-efficacy was associated with a lower likelihood of depression and lower levels of anxiety,
as measured by PHQ-2 [Figure 1A] and GAD-7 [Figure 1B] scores, respectively. Overall, 24% of respondents
reported symptoms consistent with major depressive disorder (PHQ-2 ≥ 3), and 41% reported symptoms of
anxiety (GAD-7 ≥ 8). Mean (SD) CSES scores for those with and without likely depressive symptoms were
99.4 (40.1) and 158.9 (33.9), respectively. The difference in mean CSES scores for participants with and
without symptoms of anxiety was 49.8 [95% confidence interval (CI): 34.3-65.4].