Many transgender and nonbinary individuals choose to undergo phalloplasty and/or metoidioplasty during their medical transition. In different surgical specialties, a wide range of supportive resources is commonly provided to help patients prepare for procedures. These typically include educational materials, workshops, peer support networks, and recommended lifestyle modifications. For gender-affirming surgeries in particular, patients are required to complete assessments that evaluate their readiness for the operation and offer guidance to help them become fully prepared when necessary. However, relatively few studies have explored which specific resources actually help patients feel ready for phalloplasty or metoidioplasty, or how the assessment process and available supports can better promote patient autonomy. Although respect for patient autonomy remains a fundamental principle of ethical medical care, earlier research on pre-surgical evaluations for gender-affirming procedures has largely focused on selecting the most suitable surgical candidates rather than on individual patient needs and on supporting autonomous decision-making. The present study aimed to address this research gap by examining data from the PROGRESS (Patient-Reported Outcomes of Genital Reconstruction and Experiences of Surgical Satisfaction) study. This was a cross-sectional, community-based survey conducted among trans and nonbinary adults residing in the United States and Canada who had received one or more of these genital reconstruction surgeries. The findings indicated that the large majority of participants (86%, n = 186) reported feeling prepared for their surgery. Nevertheless, over half of the sample (53%, n = 105) indicated that referral letter assessments were not helpful to them. In contrast, peer support—particularly online resources and blogs—was rated as highly valuable, along with direct surgical consultations. Multivariable logistic regression analysis revealed that higher levels of perceived preparedness were associated with identifying as queer (including gay, bisexual, and pansexual orientations, in comparison with identifying as straight) and with perceiving the overall assessment process as useful rather than unhelpful. The specific assessment type used showed no significant relationship with preparedness levels. This suggests that the most effective preparation strategies are likely to vary considerably between individuals. Healthcare providers who work with patients preparing for these surgeries should either develop new resources or adapt existing ones to help individuals better recognize their personal preparation needs and successfully achieve readiness. The data from this study support the use of assessments that prioritize surgical care planning over evaluations focused on measuring the degree of gender dysphoria. Additional longitudinal research would be valuable for determining which assessment approaches are most effective for supporting patients before these procedures. Ultimately, assessments should confirm that patients are properly equipped to undergo and recover from surgery through a comprehensive informed consent process.
