"Mastectomy for individuals with gender dysphoria below 26 years of age: A systematic review and meta-analysis".
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BACKGROUND: Gender dysphoria (GD) refers to psychological distress associated with the incongruence between one's sex and one's gender. In response to GD, birth-registered females may choose to undergo mastectomy. In this systematic review, we summarize and assess the certainty of the evidence on the effects of mastectomy. METHODS: We searched MEDLINE, Embase, PsycINFO, Social Sciences Abstracts, LGBTQ+ Source, and Sociological Abstracts through June 20, 2023. We included studies comparing mastectomy to no mastectomy in birth-registered females under 26 years of age with GD. Outcomes of interest included psychological and psychiatric outcomes, and physical complications. Pairs of reviewers independently screened articles, abstracted data, and assessed risk of bias of the included studies. We performed meta-analysis and assessed the certainty of the evidence using the GRADE approach. RESULTS: We included 39 studies. Observational studies (n=2) comparing mastectomy to chest binding provided very low certainty evidence for the outcome of GD. One observational study comparing mastectomy to no mastectomy provided very low certainty evidence for the outcomes global functioning and suicide attempts, and low certainty evidence for the outcome non-suicidal self-injury (aOR 0.47 [95% CI 0.22 to 0.97]). Before-after (n=2) studies provided very low certainty evidence for all outcomes. Evidence from case series (n=34) studies ranged from high to very low certainty. CONCLUSION: Case series studies demonstrated high certainty evidence for the outcomes of death, necrosis, and excessive scarring; however, these are limited in methodological quality. In comparative and before-after studies the evidence ranged from low to very low certainty.
