Construct Validity of the GENDER-Q Face and Neck Scales in 4,890 Transgender and Gender Diverse Adults

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Abstract Background Gender-affirming facial interventions aim to align facial features of people who identify as transgender or gender diverse (TGD) with their gender identity. GENDER-Q is a comprehensive patient-reported outcome measure with 11 scales that measure satisfaction with the face overall, facial features, specific facial areas, and laryngeal prominence (Adam’s apple). Objectives To examine construct validity for the Face and Neck scales in an international sample of people who identify as TGD. Methods An international cross-sectional survey collected GENDER-Q data between February 2022 and March 2024. Participants were aged 18 years and older and had sought or received gender-affirming care within the past five years. Predefined hypotheses for expected group-level differences and correlations between GENDER-Q scales were tested using independent t-tests, ANOVA, and Pearson correlation coefficients. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was followed to establish construct validity (i.e., ≥75% hypotheses confirmed). Results 4,890 participants completed the GENDER-Q Face Overall scale and additional scales as relevant. The sample identified as man (33%), woman (37%), non-binary (24%) and other gender (6%). The percentage of hypotheses that met the COSMIN criteria of evidence of construct validity ranged from 81% to 100% for the 11 scales. As hypothesized, participants who had undergone gender-affirming facial procedures reported significantly higher satisfaction with appearance scores than those who wanted surgery or required revision surgery. Conclusions GENDER-Q scales met COSMIN criteria for hypothesis-based construct validity. GENDER-Q can be used to inform clinical care and to advance research regarding gender-affirming facial interventions.

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