Construct Validity of the GENDER-Q Face and Neck Scales in 4890 Transgender and Gender Diverse Adults.

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: The aim of the study was 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 5 years. Predefined hypotheses for expected group-level differences and correlations between GENDER-Q scales were tested using independent t-tests, analysis of variance, and Pearson correlation coefficients. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was followed to establish construct validity (ie, ≥75% hypotheses confirmed). RESULTS: A total of 4890 participants completed the GENDER-Q Face Overall scale and additional scales as relevant. The sample identified as man (33%), woman (37%), nonbinary (24%), and other gender (6%). The percentage of hypotheses that met the COSMIN criteria of evidence of construct validity ranged from 78% 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.