Determinants of Public Opinion Toward Gender-Affirming Surgery in the United States

Purpose: National polling data indicate that Americans support the right of transgender persons to undergo gender-affirming surgery (GAS). It remains unknown whether public perceptions of GAS differ depending on patient subpopulations, anatomical site, or insurance coverage and whether the public widely believes that transgender people will regret GAS. Methods: We built a Qualtrics™ survey derived from an online validated 2017 Ipsos survey and distributed it to American adults through Amazon Mechanical Turk. Associations of demographic characteristics with perception of GAS were determined using multinomial logistic regression. Results: Respondents (n=312) were predominantly non-Hispanic White (69.2%), held a bachelor's degree (64.7%), and reported an annual income of $25,000 to $74,999 (64.4%). Approximately half of respondents identified as socially liberal (50.3%); 34.0% as socially conservative; and 15.7% as neither. Respondents supported a right to GAS independent of anatomy and insurance. Support for transgender children (62%) was less than for adult transgender men (84%) and women (83%). Despite supporting a right to GAS, respondents agreed that transgender adults (67%) and children (74%) would regret GAS. Education was the strongest predictor of support for GAS rights. Socially conservative respondents were significantly more likely than nonideological or liberal respondents to believe that transgender people would regret GAS. Conclusion: This large online sample of American adults with diverse ideologies demonstrated support for GAS independent of anatomical site and insurance. Support of GAS for transgender children is robust, although lower than support for adults. Despite broad support, most laypersons believe that transgender people would regret GAS.