Patient-Reported Outcomes in Masculinizing Gender-Affirming Chest Surgery: Validation of the GENDER-Q Chest Scales

Abstract Introduction Masculinizing gender-affirming chest surgery is the most frequently accessed gender-affirming procedure. The GENDER-Q Chest scales were developed to better assess patient-reported outcomes in masculinizing gender-affirming chest surgery, yet previous psychometric assessment of these scales is limited. The objective of this study was to assess the construct validity of the GENDER-Q Chest scales (Chest, Nipples & Areolas, and Scars). Methods An international, cross-sectional study was performed to develop the GENDER-Q between February 2022 and March 2024. Individuals were included in this analysis if they had sought or received masculinizing gender-affirming chest surgery and completed the GENDER-Q Chest scale. Construct validity was assessed for each scale by testing a priori hypotheses. According to Consensus-based Standards for the Selection of Health Measurement Instruments guidelines, greater than 75% acceptance of hypotheses indicates sufficient evidence of construct validity. Results A total of 2,846 participants completed the GENDER-Q Chest scale. For the GENDER-Q Chest, Nipples & Areolas, and Scars scales, 95% (21/22), 79% (15/19), and 100% (12/12) of hypotheses were accepted for each scale, respectively. Patients who underwent surgery and do not currently need revisions reported the highest satisfaction, while patients who had not yet undergone surgery reported the lowest satisfaction. Conclusion The GENDER-Q Chest scales evidenced construct validity to measure appearance of chest, nipples, and scars for individuals seeking or undergoing masculinizing gender-affirming chest surgery. The GENDER-Q Chest scales provide a robust, validated approach for assessing outcomes in this context and are well-suited for generating high-quality evidence on patient-reported outcomes.