Prevalence and Factors Associated With Gender-Affirming Surgery Among Transgender Women & Transgender Men in a Community-Based Clinic in Metro Manila, Philippines: A Retrospective Study
Authors: Eustaquio Patrick C. , Castelo Aisia V. , Araña Yanyan S. , Corciega John Oliver L. , Rosadiño John Danvic T. , Pagtakhan Ronivin G. , Regencia Zypher Jude G. , Baja Emmanuel S. 
Published: March 2022

Abstract

Background
More information is needed about gender-affirming surgery (GAS) in the Philippines because of many self- or peer-prescribed gender-affirming procedures among transgender people.

Aim
To assess the desire of transgender adults for GAS, determined the prevalence, and evaluated factors associated with the desire.

Methods
We did a retrospective study of medical charts of 339 transgender men (TGM) and 186 transgender women (TGW) who attended clinical services at Victoria by LoveYourself, a transgender-led community-based clinic in Metro Manila, from March 2017 to December 2019. The medical charts were reviewed to ascertain data on gender dysphoria (GD), clinical and sociodemographic characteristics, health-seeking behaviors, and gender-affirmation-related practices, including the use of gender-affirming hormone therapy (GAHT). We also estimated the prevalence and explored factors associated with the desire for GAS using generalized linear models with a Poisson distribution, log link function, and a robust variance.

Main Outcome Measures
Our primary outcome was the self-reported desire for GAS.

Results
Almost half were already on GAHT, of whom 93% were self-medicating. Our study's prevalence of GD is 95% and nearly 3 in 4 desire GAS. The prevalence of desiring GAS was related to the specific surgical procedure chosen. Transgender adults opting for breast surgery and genital surgeries have 8.06 [adjusted prevalence ratio, (aPR): 8.06; 95% Confidence Interval, (CI): 5.22–12.45; P value &lt; .001] and 1.19 (aPR: 1.19; 95% CI: 1.11–1.28; P value &lt; .001) times higher prevalence of GAS desire, respectively, compared with otherwise not opting for those procedures. Moreover, the prevalence of GAS desire was higher among patients with GD (aPR 1.09; 95% CI: 1.01–1.18; P value = .03) than individuals without GD.

Clinical Translation
Providers' awareness of patients’ desires, values, and health-seeking preferences could facilitate differentiated guidance on their gender affirmation.

Strengths and Limitations
This quantitative study is the first to explore gender-affirming practices among transgender adults in the Philippines and provide significant insights into their healthcare needs. Our study focused only on TGM and TGW and did not reflect the other issues of transgender people outside of Metro Manila, Philippines. Furthermore, our retrospective study design may have missed essential predictors or factors not captured in the medical charts; hence, our study could never dismiss confounding factor bias due to unmeasured or residual confounding factors.

Conclusions
There is a high prevalence of self- and peer-led attempts from TGM and TGW to facilitate the gender transition, with the desire for GAS being significantly associated with GD and by which specific surgical procedure is chosen.