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Page 8 of 10 Hart et al. Plast Aesthet Res. 2026;13:3

racial and ethnic distribution of the TGD population: although racial/ethnic minority individuals comprise
34% of U.S. adults and an estimated 45% of trans-identified adults . 81% of respondents in our study
[27]
identified as White. This disproportion limits the applicability of our findings to racially and ethnically
diverse TGD populations. Prior research indicates that stigma, discrimination, and barriers to healthcare
have more pervasive effects on mental and physical health among TGD individuals with intersectional
identities, including Black, Indigenous, and People of Color (BIPOC), people living with disabilities, and
those experiencing housing instability or houselessness . Future research on mental health, coping
[1]
self-efficacy, and perceived social support among TGD populations seeking GGAS should prioritize
inclusion of racially and ethnically diverse participants to ensure generalizability and appropriately assess
intersectional impacts of race and gender diversity.

Consistent with other survey-based research, response bias must be considered when interpreting these
results. Our response rate of 25% suggests that individuals with greater psychological well-being may have
been more likely to participate, potentially skewing the findings. Respondents with inherently higher levels of
social support and coping self-efficacy, coupled with lower rates of depression, may be overrepresented.
Consequently, the overall level of social support in the broader patient population may be lower than our
results suggest.

Because demographic data did not include specific information on gender identity, we were unable to
disaggregate responses. This lack of granularity may obscure meaningful differences in social support, coping
self-efficacy, and mental health outcomes among TGD individuals seeking feminizing procedures.
Additionally, the cross-sectional design precludes assessment of temporal changes in mental health, coping,
and perceived social support. To address confounding, we applied multivariable logistic regression, adjusting
odds ratios for relevant covariables.

Despite these limitations, our study demonstrates that higher coping self-efficacy is associated with a lower
likelihood of depression and anxiety among TGD individuals navigating the complex process of seeking
GGAS.

Conclusion
Ongoing social marginalization, isolation, and stigma experienced by TGD individuals are compounded by
the stress of preparing for and recovering from GGAS. Our findings highlight the interplay between mental
health, coping self-efficacy, and social support among TGD populations seeking GGAS. Interventions that
strengthen coping skills and enhance social support within peer networks may foster resilience, promote
positive surgical outcomes, and improve overall mental health and quality of life. These benefits extend not
only to TGD patients but also to gender care centers and healthcare systems more broadly.

DECLARATIONS
Authors’ contributions
Conceptualization: Penkin A, Downing J, Dugi DD III, Gornick F
Investigation: Gornick F, Downing J, Dy GW
Formal analysis: Gornick F, Downing J, Dy GW, Latour E, Bassale S
Writing - original draft: Hart ER, Gornick F
Supervision: Dy GW
Writing - review and editing: Hart ER, Gornick F, Downing J, Latour E, Bassale S, Dugi DD III, Penkin A,
Dy GW

Availability of data and materials
The data supporting the findings of this study are available within the article and its Supplementary
Materials. All original data are available from the corresponding author upon reasonable request.