Sav Zwickl

Background: Top surgery refers to various gender-affirming surgical procedures involving breast or chest tissue. Existing research suggests top surgery improves physical, psychological, and social well-being in transgender and gender-diverse individuals (herein “trans”) who desire it. However, most studies have been retrospective, have not used validated outcome measures, and have excluded nonbinary individuals, limiting the robustness of the existing research. Objective: This study aims to examine changes in mental health, gender dysphoria, risky behaviors, and quality of life of trans people (including nonbinary individuals) following top surgery. Methods: Trans individuals aged 16 years and older undergoing top surgery will be recruited from a single surgeon’s office in Perth, Western Australia, as part of a longitudinal, prospective cohort study. Questionnaires will be administered to participants at 3 time points: within 8 weeks prior to surgery, 6‐8 weeks post surgery, and 1 year post surgery. These questionnaires will collect data on patient demographics, planning and expectations for surgery, support received during surgery access, satisfaction with care received from their surgeon, use of gender-affirming hormones, mental health (ie, anxiety, depression, self-harm and suicide, and mental health diagnoses), gender euphoria and dysphoria, exercise and diet, disordered eating, quality of life, substance use, social acceptance and discrimination, and reflections on the experience and outcomes of their surgery. Patient-reported outcomes will be measured using validated instruments and bespoke items developed through community consultation. Validated instruments include the GENDER-Q (health professional subscale); the Generalized Anxiety Disorder 7-item; the Patient Health Questionnaire-9; the Gender Euphoria Scale; an adapted version of the Olson-Kennedy Chest Dysphoria Scale; the International Physical Activity Questionnaire - Short Form; the Eating Disorder Examination Questionnaire - Short; the Assessment of Quality of Life 8 Dimensions; and the Alcohol, Smoking, and Substance Involvement Screening Test - Short Form. Surgical satisfaction will be assessed using both patient- and surgeon-reported measures, enabling between-group comparisons. Quantitative data will be analyzed using linear regression models and repeated-measures ANOVA to compare outcomes across the 3 time points; qualitative data will undergo a general inductive approach to analysis to produce categories that contextualize and supplement the quantitative findings, as well as identify any novel or unexpected experiences. Results: This study received funding in February 2024. Data collection commenced in May 2025 and is expected to be completed by December 2027. As of February 2026, 26 people have consented to participate. Conclusions: This study will extend research on the mental health, gender dysphoria, and quality-of-life outcomes of top surgery for trans individuals in Australia. By addressing limitations of existing research, this study aims to improve our understanding of trans people’s experience accessing and receiving top surgery. The findings may guide improvements in perioperative and postoperative care and support for patients and inform policy related to gender-affirming surgeries in Australia.

Background: Anti-trans stigma has escalated globally, yet there is limited empirical evidence examining its mental health impacts on trans populations. Methods: In a May 2024 mixed-methods cross-sectional online survey, trans people aged ≥16 years living in Australia reported the frequency of seven anti-trans stigma experiences in the previous month, including exposure to anti-trans remarks in the news media or online; personal experience of online bullying, harassment or threats; having thought about, seen or heard about anti-trans rhetoric by Australian politicians and high-profile individuals; or anti-trans rallies; or police violence; or international anti-trans legislation and violence. Generalized linear models examined associations between multiple times weekly exposure to each stigma type and anxiety (GAD-7), depression (PHQ-9), self-harm, and suicidality. Inductive thematic analysis was applied to free-text responses. Results: Among 807 respondents, multiple times weekly exposure to all seven forms of anti-trans stigma was associated with a statistically higher prevalence of anxiety, depression, self-harm ideation, and suicide ideation (relative risk (RRs) ranging 1.14 to 2.10). Six stigma types were associated with increased risk of suicide planning (RRs 1.41 to 2.55), and five with increased risk of self-harm (RRs 1.32 to 2.07). Qualitative analysis identified three themes: (1) Navigating exposure to news and social media, (2) Experienced and anticipated anti-trans stigma, and (3) Escalating and inescapable anti-trans stigma. Conclusion: Australian trans communities are frequently exposed to anti-trans stigma, with more frequent exposure associated with a statistically higher prevalence of adverse mental health outcomes. Urgent collaborative responses are required from governments and media platforms to reduce stigma-related harm.

Eating disorders (EDs) have stereotypically been viewed as conditions primarily affecting young, white, cisgender women (Halbeisen et al., 2022). However, emerging evidence suggests that trans and ...

Background: Functional neurological disorder (FND) is a common and disabling neuropsychiatric condition in which women comprise approximately 75% of cases. This paper examines whether the gender imbalance seen in FND is unique among neurological and psychiatric conditions and explores the biological, psychological, and social contributors to this disparity. Methods: A narrative review was conducted using MEDLINE, PsycINFO, and Web of Science. Gender ratios were compared across depression, anxiety, post-traumatic stress disorder, schizophrenia, eating disorders, Parkinson’s disease, and multiple sclerosis. Evidence regarding sex hormones, early life trauma, gender-based social determinants, and diagnostic biases were synthesized thematically. Results: Amongst the psychiatric and neurological conditions reviewed, FND shows a pronounced female predominance (approximately 3:1), placing it amongst the most gender imbalanced disorders in our sample, with only eating disorders showing a larger female predominance. Biological factors (particularly the influence of estrogen and progesterone on stress reactivity, neuronal excitability, and agency), may heighten female vulnerability. Social determinants (increased exposure to trauma, socioeconomic inequality, and gender norms) further contribute to this risk. FND shares clinical and demographic similarities with other internalizing disorders and conditions linked to dissociation and trauma. The literature suggests FND emerges from a bidirectional interaction between gonadal hormones and psychosocial stressors. Conclusions: The marked gender imbalance in FND arises from the interplay of biological vulnerability and gendered social adversity. Understanding these intersecting influences is essential for reducing stigma and guiding future research, diagnosis, and treatment. The findings support the need for a gender-sensitive, biopsychosocial approach to FND care, and investigation.

BACKGROUND Top surgery refers to various gender-affirming surgical procedures involving breast or chest tissue. Existing research suggests top surgery improves physical, psychological, and social well-being in trans individuals who desire it. However, most studies have been retrospective, have not used validated outcome measures, and excluded non-binary individuals, limiting the robustness of the existing research. OBJECTIVE This study aims to longitudinally examine the impact of top surgery on mental health, gender dysphoria, and quality of life of trans people, including both binary and non-binary individuals. METHODS Trans individuals aged 16 and older undergoing top surgery will be recruited from a single surgeon’s office in Perth, Western Australia, as part of a longitudinal prospective cohort study. Questionnaires will be administered to participants at three timepoints: 6–8 weeks pre-surgery, 6–8 weeks post-surgery, and 1-year post-surgery. Patient-reported outcomes will be measured using validated instruments and bespoke items developed through community consultation. Surgical satisfaction will be assessed using both patient- and surgeon-reported measures, enabling between-group comparisons. RESULTS Quantitative data will be analyzed using linear regression models and repeated measures ANOVA; qualitative data will undergo reflexive thematic analysis. CONCLUSIONS This study will extend current research on the mental health, gender dysphoria, and quality of life outcomes of top surgery for trans individuals. By incorporating a longitudinal design, validated measures, and inclusion of non-binary participants, this research aims to improve the understanding of trans people’s experience of accessing and receiving top surgery.