Qualitative Analysis of the Impact of Top Surgery on Physical Activity in Transmasculine and Non-Binary Adolescents and Young Adults: A Pilot Study

Purpose Physical activity (PA) is crucial in adolescents and young adults (AYA) for 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 between chest dysphoria, top surgery, and relationship with PA. Methods Two focus groups, each consisting of five TGNB AFAB AYA 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. Results 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 post-op chest. Complicating factors included mental health, which impacted PA both before and after surgery, and post-op healing process, which impacted PA for up to six 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.