Exploring upper limb musculoskeletal symptoms after gender-affirming top surgery: a cross-sectional survey

Transgender and gender diverse (TGD) people may undergo gender-affirming top surgery to align their physical appearance with their gender identity. While these procedures are known to improve psychosocial well-being, their musculoskeletal (MSK) consequences remain largely unexplored. This study aimed to define the scope of post-surgical MSK issues in TGD individuals and examine their access to MSK-related healthcare. A cross-sectional online survey was distributed to Canadian adults who had undergone gender-affirming top surgery. The survey collected demographic data, surgical history, MSK symptom prevalence and severity, and healthcare access experiences. Quantitative data were analyzed descriptively, and qualitative responses were thematically summarized. Seventy-eight participants completed the survey, nearly all having undergone assigned female at birth top surgery. The most common MSK symptom was altered chest sensation (82%), followed by chest tightness (71%) and shoulder stiffness (56%). Only 29% reported full symptom resolution. Despite high symptom prevalence, only 28% sought MSK treatment, primarily massage and physical therapy. Most participants relied on internet searches for information, and fewer than half were informed by healthcare providers about potential MSK symptoms. Qualitative responses emphasized the need for improved postoperative care, including physiotherapy, mental health support, and scar management. MSK symptoms are common and often unresolved following gender-affirming top surgery, yet access to appropriate care is limited. These findings highlight a critical gap in postoperative support for TGD individuals and underscore the need for inclusive, informed, and proactive MSK healthcare pathways to improve long-term outcomes and quality of life.