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Amitai Miller, BA



Grad Student


Harvard Medical School



Amitai S. Miller, Shawheen J. Rezaei, Oren Ganor*

Principal Investigator

Dr. Oren Ganor


Gender-affirming chest surgery online resources exceed patient health literacy: A readability analysis


“Background: Reduced health literacy serves as a critical barrier for transgender and gender-diverse (TGD) patients seeking gender-affirming surgical (GAS) care. Reduced health literacy may complicate obtaining informed consent, understanding a surgery’s associated risks and benefits, and adhering to pre-operative and post-operative instructions. The American Medical Association recommends publishing patient information at a 6th grade reading level. Prior research indicates that online resources for GAS are too complex for many patients to understand. The aims of this study were to assess the readability of online resources used for gender-affirming chest surgery, which is the most common GAS procedure.

Methods: An online search of popular websites for patients interested in gender-affirming chest surgery was conducted. The term “top surgery” (the procedures’ most commonly used expression) was entered into Google and Bing. The 10 leading websites between the search engines pertaining to patient information for gender-affirming chest surgeries were selected. The text from each main landing page and any other hyperlinked webpages from the parent site were extracted. Readability Studio Professional Edition was used to compute scores for ten validated tests.

Results: The top 10 landing webpages and 59 webpages from hyperlinked webpages were analyzed. The average readability score of all documents was 11.71, meaning that an individual would require English reading level skills appropriate to 11th or 12th grade to understand the webpages’ informational content. The Fry readability formula found that only one webpage was appropriate to an 8th grade reading level and that other webpages would require high school reading levels or higher to understand.

Conclusion: This study shows that popular online patient resources for gender-affirming chest surgeries are written above recommended reading levels and surpass the reading ability for many patients. This may impede TGD patients’ understanding of the procedures and their ability to make informed decisions about their health.”

Research Context

Gender identity, gender presentation, and sex are at the crux of gender-affirming surgeries. This work critically assesses the readability of online patient resources for transgender and gender-diverse (TGD) patients seeking gender-affirming surgery. This project specifically focused on feminizing and masculinizing procedures, which play significant role in patients’ gender-identity journeys, alleviating dysphoria, and aligning internal sense of self with external appearance. The authors hope this study will herald creation of online patient education resources for gender minorities that are more inclusive and accessible to patients of varied reading levels.