Grant: Op. Gr. Adv. 2S_LGBTQI+ Heal. Thr. Res. - Gend Aff Care, Ment/Brain Health

Transgender and non-binary people often experience high levels of chronic stress due to discrimination, stigma, and the distress that can come from their body not matching their gender identity. This ongoing stress can take a physical toll on the body over time, measured through something called "allostatic load"-essentially, the wear and tear that chronic stress causes on different body systems. This study will investigate whether gender-affirming chest surgery (commonly called "top surgery") helps reduce this physical stress burden in transgender men and non-binary individuals. While we know that top surgery improves mental health and how people feel about their bodies, we don't yet know if these psychological benefits translate into measurable improvements in physical health markers. The research will measure stress markers in the body using blood tests and other biomarkers, and track how people feel about their bodies before and after surgery. The researchers will use smartphone-based surveys to capture real-time experiences over time. They expect that top surgery will reduce the body's stress burden, and that improved body satisfaction is the key reason why this happens. This research is important because it could provide the first scientific evidence that gender-affirming surgery doesn't just improve mental health-it may also protect physical health by reducing the damaging effects of chronic stress. With approximately 100,800 transgender and non-binary people living in Canada, this evidence could strengthen support for access to gender-affirming care.