How age influences outcomes in MtF gender-affirming surgery

Gender-affirming surgery (GAS) is a life-changing step for many transgender individuals seeking alignment between their physical appearance and gender identity.

A study¹ in Sexual Medicine sheds light on how age at the onset of gender dysphoria influences outcomes for patients undergoing male-to-female (MtF) gender-affirming surgery, including vulvoplasty and vaginoplasty.

By analysing two distinct age-related subgroups, the study provides valuable insights into the psychological, sexual, and medical profiles of transgender women and how these factors impact their surgical and emotional journeys.

Younger vs. older onset: understanding two subgroups

The study categorised participants into two groups based on the age at which they first experienced gender dysphoria: those 17 years or younger and those 18 years or older. This division revealed significant differences in their paths to surgery and postoperative outcomes.

The “younger group,” with an average first surgery age of 32.7 years, tended to experience gender dysphoria earlier in life, often during childhood or adolescence.

In contrast, the “older group,” with an average surgery age of 43.8 years, typically reported their gender dysphoria beginning in adulthood. This age difference may reflect broader generational and societal changes in the visibility and acceptance of transgender identities, which can influence when individuals feel empowered to seek affirming care.

Interestingly, the younger group reported higher rates of depressive symptoms before surgery compared to the older group. These symptoms, often tied to prolonged distress over gender incongruence, were largely resolved after surgery, underscoring the mental health benefits of affirming interventions.

Sexual attraction and activity: notable differences

The study also highlighted differences in sexual attraction between the two groups. At baseline, the younger group showed a higher prevalence of attraction to men (53%) compared to the older group (19%).

After surgery, sexual orientation remained consistent for most participants in the younger group. However, in the older group, 86% reported attraction to women, both men and women, or no attraction at all.

Sexual activity was another area of divergence. The younger group was more likely to be sexually active both before and after surgery. This may reflect differences in confidence, comfort with their bodies, or opportunities for sexual exploration.

Implications for care

The findings suggest that age at the onset of gender dysphoria is a critical factor in understanding the unique needs of MtF patients.

For individuals with early-onset dysphoria, mental health support may be especially crucial before surgery to address depressive symptoms and improve overall well-being. In contrast, those with late-onset dysphoria may require tailored discussions around sexual identity and expectations for surgical outcomes.

The study also emphasizes the importance of personalised care plans that integrate psychotherapeutic, endocrinological, and surgical strategies. These plans should account for differences in age, mental health, and sexual orientation to ensure the best possible outcomes for each patient.

A path toward better understanding

This research marks an important step in refining care for transgender women. By exploring how age-related differences shape the journey toward gender affirmation, it opens the door to more informed, empathetic, and effective approaches in medicine and mental health.

Whether patients seek surgery in their 20s, 40s, or beyond, the study underscores that every individual’s story is unique—and that understanding these nuances is key to supporting their authentic selves.

References

1.
Zavlin D, Wassersug RJ, Chegireddy V, Schaff J, Papadopulos NA. Age-Related Differences for Male-to-Female Transgender Patients Undergoing Gender-Affirming Surgery. Sexual Medicine. Published online January 9, 2019:86-93. doi:10.1016/j.esxm.2018.11.005