Qualitative analysis of the impact of top surgery on physical activity in transmasculine and non-binary adolescents and young adults: a pilot study

Physical activity (PA) is crucial in adolescents and young adults (AYA) for the promotion of long-term cardiovascular health. In transgender and non-binary (TGNB) AYA who were assigned female at birth (AFAB), chest dysphoria may lead to avoidance of sports and exercise. Thus, it is important to understand the impact of gender-affirming top surgery on PA in TGNB AFAB AYA. In this pilot study, we conducted a qualitative analysis of the associations among chest dysphoria, top surgery, and the relationship with PA. Two focus groups, each consisting of five TGNB AFAB patients who were 13-25 years old at the time of top surgery, were conducted to elicit perspectives on factors impacting PA, including top surgery. Focus group transcripts were analyzed using grounded theory coupled with situational analysis. Identified themes were grouped into barriers, facilitators, and complicating factors of PA. Most barriers, including structural accessibility, passing, binding/clothing restrictions, and physical safety, were prominent prior to top surgery. Several facilitators to PA arose after top surgery, including top surgery improving PA, social acceptance, and PA to augment the post-op chest. Complicating factors included mental health, which impacted PA both before and after surgery, and the post-op healing process, which impacted PA for up to 6 months post-surgery. CONCLUSION: In TGNB AFAB adolescents and young adults, chest dysphoria poses several barriers to PA, many of which are resolved by top surgery. These findings suggest that alleviation of chest dysphoria via gender-affirming care has implications for the long-term cardiovascular health of TGNB patients. WHAT IS KNOWN: • Chest dysphoria can be a barrier to physical activity in transgender and non-binary (TGNB) adolescents and young adults (AYA). • Physical activity in adolescence can shape longer term cardiovascular health. WHAT IS NEW: • Gender-affirming top surgery resolves many barriers to physical activity in TGNB AYA. • Our findings suggest top surgery can have implications for long-term cardiovascular health.