{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:01:17Z","timestamp":1787238077900,"version":"build-2736575974"},"reference-count":55,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to assess the effects of facial feminization surgery (FFS) on mental health resource utilization among patients with gender dysphoria within an integrated multicenter health care system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>A retrospective database review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>An equal\u2010access, integrated health care system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed the medical records of Kaiser Permanente Northern California patients who underwent FFS from 2016 to 2021 on utilization of mental health services in a large integrated health care system. Full FFS was defined as all 3 facial thirds. We compared average quarterly utilization for 12 to 24 months before FFS with quarterly utilization during 12 to 24 months of follow\u2010up. Patients who did not have continuous coverage for at least 12 months before and 12 months after FFS were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 699 FFS cases were performed between 2016 and 2021, of which 478 cases were included (35.6\u2009\u00b1\u200912.3 years old, 207 [43.3%] had full FFS). Wilcoxon matched\u2010pairs signed\u2010rank tests comparing pre\u2010FFS and post\u2010FFS utilization counts showed statistically significant reductions in the number of mental health\u2010associated visits. Age and comorbid mental health diagnoses were significant predictors of mental health resource utilization in the pre\u2010FFS period. A comorbid mood or anxiety disorder was a predictor of changes in resource utilization following FFS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>To our knowledge, this endeavor is the first utilization study of FFS conducted in the United States. FFS was associated with significantly lower utilization of mental health services in the 12\u2010month post\u2010FFS period compared to the 12\u2010month pre\u2010FFS period.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1172","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T23:41:40Z","timestamp":1740526900000},"page":"1585-1593","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Facial Feminization Surgery and Mental Health Resource Utilization: A Retrospective Institutional Review"],"prefix":"10.1002","volume":"172","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5878-1442","authenticated-orcid":false,"given":"Pauline P.","family":"Huynh","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery Kaiser Permanente Oakland Medical Center Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Kleinberger","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Kaiser Permanente Walnut Creek Medical Center Walnut Creek California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleyn","family":"Brandstetter","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Kaiser Permanente San Leandro Medical Center San Leandro California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice R.","family":"Pressman","sequence":"additional","affiliation":[{"name":"Department of Health Systems Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Shih","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Kaiser Permanente Oakland Medical Center Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.0952"},{"key":"e_1_2_8_3_1","unstructured":"GrantJ MotterL TanisJ. Injustice at every turn: a report of the National Transgender Discrimination Survey. 2011. Accessed December 25 2022.https:\/\/www.transequality.org\/sites\/default\/files\/docs\/resources\/NTDS_Report.pdf"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2017.04.014"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare9050530"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2018.01.016"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1179173X19849419"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820924635"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2016.10.007"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00684-X"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2015.11.010"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2016.07.003"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000475754.71333.f6"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2019.02.005"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/15532739.2011.700873"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000011325"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2019.19010080"},{"key":"e_1_2_8_18_1","first-page":"715e","volume-title":"Plast Reconstr Surg","author":"C\u00e1tala\u2010Rivera NA","year":"2022"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000003233"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1716440"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1215\/9780822372707"},{"key":"e_1_2_8_22_1","unstructured":"WPATH. Position statement on medical necessity of treatment Sex Reassignment and Insurance Coverage in the U.S.A.2016.https:\/\/wpath.org\/wp-content\/uploads\/2024\/11\/WPATH-Position-on-Medical-Necessity-12-21-2016.pdf"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004521"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.9.5.318"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2012.04.024"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000545"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004123"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.6231"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000006220"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002171"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000003450"},{"key":"e_1_2_8_32_1","unstructured":"Centers for Medicare & Medicaid Services website. Decision memo for gender dysphoria and gender reassignment surgery (CAG\u201000446N). Published August 30 2016. Accessed December 25 2022.www.cms.gov\/medicare-coverage-database\/details\/nca-decision-memo.aspx-?NCAId=282"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2018.1531159"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-015-3529-6"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2006.09.014"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-020-01754-3"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-010-9668-7"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2020.07.019"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1089\/fpsam.2021.0373"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2019.0606"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1735648"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/21.038"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.19686"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.113419"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1177\/0020764020960770"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.07.012"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-019-1069-1"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12262-024-04020-1"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1283621"},{"issue":"2","key":"e_1_2_8_50_1","first-page":"159","article-title":"The twenty years Kaiser\u2010Permanente experience with psychotherapy and medical utilization: implications for national health policy and national health insurance","volume":"1","author":"Cummings NA","year":"1981","journal-title":"Health Policy Q"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1257\/aeri.20210515"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1177\/1362361320931268"},{"issue":"1","key":"e_1_2_8_53_1","first-page":"18","article-title":"Health care service utilization and cost among adults with autism spectrum disorders in a U.S. integrated health care system","volume":"1","author":"Zerbo O","year":"2018","journal-title":"Autism Adulthood"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2012.01.001"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-4300K"},{"key":"e_1_2_8_56_1","unstructured":"GordonN. Similarity of the adult Kaiser Permanente membership in Northern California to the insured and general population in Northern California: Statistics from the 2011\u201012 California Health Interview Survey.2015.https:\/\/divisionofresearch.kaiserpermanente.org\/projects\/memberhealthsurvey\/SiteCollectionDocuments\/chis_non_kp_2011.pdf"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.1172","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:31:23Z","timestamp":1760956283000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.1172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,25]]},"references-count":55,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/ohn.1172"],"URL":"https:\/\/doi.org\/10.1002\/ohn.1172","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,25]]},"assertion":[{"value":"2024-09-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}