• Alyson J Littman, Amy Jeon, Carolyn L Fort, Krista Dashtestani, Anna Korpak, Michael R Kauth, Jillian C Shipherd, Guneet K Jasuja, Hill L Wolfe, Paula M Neira, Josie Caballero, Sady Garcia, Cassandra Williamson, Benjamin Collongues, and Tracy L Simpson.
• Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA. Alyson.littman@va.gov.
• J Gen Intern Med. 2024 Nov 1; 39 (15): 304230513042-3051.

BackgroundGender-affirming surgery (GAS) can be an important part of comprehensive care for transgender and gender diverse (TGD) individuals, but this care is not provided by the Department of Veterans Affairs (VA) because of an exclusion in the medical benefits package.ObjectiveTo describe the receipt of GAS by veterans and assess the associations between key sociodemographic characteristics and receipt of chest ("top") and genital ("bottom") surgeries.DesignCross-sectional national survey (the GendeR Affirming Care Evaluation (GRACE)), among TGD Veterans conducted between September 2022 and July 2023.ParticipantsA total of 6653 Veterans (54% response rate) completed the survey.Main MeasuresSelf-reported "top" and "bottom" GAS were key outcomes. Covariates included gender identity, sex assigned at birth, age, race, ethnicity, income, employment status, education, relationship status, sexual orientation, and geographic region.Key ResultsAmong all respondents, 39% had ≥ 1 GAS. Among the 4430 veterans interested in top surgery, 38% received it; 23% of 3911 veterans interested in bottom surgery had received it. In multivariable models, older age (50 + vs. 18-39) was associated with higher receipt of top and bottom surgery while nonbinary gender identity (vs. binary gender identity), lower household income (< $50,000 vs. > $75,000), less education (less than a college graduate vs. Master's degree or more), sexual orientations other than heterosexual, and residing in a region other than the Pacific were associated with lower receipt of top and bottom surgery. Individuals assigned male (vs. assigned female) at birth had lower receipt of top surgery and higher receipt of bottom surgery.ConclusionsGAS receipt was low and there were important disparities by gender, sex, income, education, sexual orientation, and region. By removing the exclusion to providing GAS, VA could reduce barriers to accessing GAS and decrease disparities among TGD veterans.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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