Experiences of Transgender and Gender Diverse Patients in Accessing Gender-Affirming Chest Masculinization: A Systematic Review and Qualitative Thematic Synthesis of the Literature.

INTRODUCTION: The objective of this review was to synthesize existing qualitative research regarding the experiences of transgender and gender diverse (TGD) individuals undergoing gender-affirming chest masculinization surgery, in order to identify critical barriers and facilitators which may affect access to and quality of care. METHODS: We searched eight electronic databases in August 2025 for qualitative results analyzing the experiences of TGD individuals undergoing chest masculinization. We included primary qualitative or mixed-methods studies published in English/French that involved trans masculine or gender-diverse individuals ≥12 years undergoing chest masculinization. Exclusion criteria included cisgender or trans feminine populations, nonsurgical or nongender-affirming care, absence of qualitative data, and nonpeer-reviewed literature. The Critical Appraisal Skills Programme checklist was used to appraise the quality of included studies. A thematic synthesis was conducted following Thomas and Harden. RESULTS: Sixty studies met the inclusion criteria. Four analytical themes were identified: (1) charting a course, (2) interactions with providers, (3) surgical goal setting, and (4) adjusting to oneself. CONCLUSION: TGD individuals face persistent structural and interpersonal barriers when accessing chest masculinization surgery. The domains identified in the present review form a patient experience-driven framework that healthcare stakeholders and providers can use to improve access to care. Healthcare providers should be aware that nonbinary and binary transgender patients may have varying surgical goals for chest masculinization.