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

Patrick C Eustaquio; Aisia V Castelo; Yanyan S Araña; John Oliver L Corciega; John Danvic T Rosadiño; Ronivin G Pagtakhan; Zypher Jude G Regencia; Emmanuel S Baja

doi:10.1016/j.esxm.2022.100497

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

Sex Med. 2022 Apr;10(2):100497. doi: 10.1016/j.esxm.2022.100497. Epub 2022 Mar 2.

Authors

Patrick C Eustaquio¹, Aisia V Castelo¹, Yanyan S Araña¹, John Oliver L Corciega¹, John Danvic T Rosadiño², Ronivin G Pagtakhan¹, Zypher Jude G Regencia³, Emmanuel S Baja⁴

Affiliations

¹ LoveYourself Inc., Mandaluyong City, Philippines.
² LoveYourself Inc., Mandaluyong City, Philippines; Faculty of Management and Development Studies, University of the Philippines - Open University, Los Baños, Laguna, Philippines.
³ Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.
⁴ Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines. Electronic address: esbaja@up.edu.ph.

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 < .001] and 1.19 (aPR: 1.19; 95% CI: 1.11-1.28; P value < .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. Eustaquio PC, Castelo AV, Araña YS et al. 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. Sex Med 2022;10:100497.

Keywords: Community-Based; Gender Dysphoria; Gender-Affirming Services; Gender-Affirming Surgery; Philippines; Transgender Men (TGM); Transgender Women (TGW).