Comparison Of Chest Femininity Of Transgender Women With Hormone Treatment Vs. Surgically Augmented With Breast Implants
Agnes Zhu, BS1, Steven Callori, MPH1, Nathan Hebel, BS1, Jorys Martinez-Jorge, MD2, Thanapoom Boonipat, MD2.
1Mayo Clinic Alix School of Medicine, Rochester, MN, USA, 2Mayo Clinic, Rochester, MN, USA.
PURPOSE: This study aims to assess whether lay individuals found surgically augmented breasts to be more feminine than breast development from hormone therapy in transgender patients.
METHODS: We obtained pre-operative (maximal breast growth on hormone therapy) and post-operative (after primary augmentation) chest images of 22 transgender patients. Images were age and BMI matched with male (n=17) and female controls (n=21).
Survey participants (n=271; 179 male, 91 female, 1 non-binary; 74 transgender, 193 not transgender, 4 prefer not to answer) each evaluated 20 randomly selected images. The average femininity of each chest image (1=very feminine; 5=very masculine) determined by participants was analyzed using ANOVA and Tukey's method.
RESULTS: Table 1: transgender survey respondents rated every image group more masculine than non-transgender respondents, except for male controls. The mean scores of each image group were significantly different between transgender and non-transgender respondents, except for preoperative transgender patients.
There was a significant difference in mean femininity score between all image types. Mean score for transgender patients fell by 0.478 points after surgery (p<0.0001); subgroup analysis looking at only transgender participant revealed the same significance trend postoperatively. Transgender respondents also found no difference in femininity between female controls and postoperative transgender patients (p = 0.132).
CONCLUSION: Breast augmentation significantly increased the perception of femininity. Transgender participants rated the images as more masculine compared to their non-transgender counterparts. 
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