Translation and cultural adaptation of the GENDER-Q with pilot implementation among patients undergoing masculinizing chest surgery.

Abstract

This study aimed to translate and culturally adapt the GENDER-Q into German and evaluate its feasibility and responsiveness when integrated into routine clinical care among patients undergoing masculinizing chest surgery. This mixed-methods translation and pilot implementation study was conducted between January 2025 and January 2026 at a tertiary academic transgender health program in Germany. Linguistic validation included forward translation and back-translation, developer review, and cognitive debriefing interviews with 14 transgender and gender-diverse adults. For the pilot implementation, 14 consecutive patients undergoing masculinizing chest surgery completed scales assessing chest appearance, nipples and areolas, body image, gender dysphoria, psychological well-being, psychological distress, and experience of care. Linguistic validation identified minor semantic and conceptual issues resolved through iterative revisions, resulting in a linguistically accurate and conceptually equivalent German version. In the pilot implementation with a final sample of 13 patients, postoperative scores improved significantly across all assessed outcome scales (all p < 0.013), with the largest changes observed for chest appearance (mean change = 64.23; standardized response mean [SRM] = 3.59) and body image (mean change = 36.85; SRM = 1.59). Significant improvements were also observed for gender dysphoria (mean change = 23.08; SRM = 1.64) and psychological distress (mean change = 26.84; SRM = 2.04). Experience of care scores were high at baseline (mean range, 87.6-94.3) and remained stable. The German GENDER-Q demonstrated linguistic and conceptual equivalence and showed feasibility and preliminary responsiveness in a small single-center pilot implementation.