Global Gaps In Gender-affirming Surgery Education: Insights From 1,000+ Medical Students Across 11 Countries

Background: As the demand for gender-affirming surgery (GAS) continues to rise globally, the next generation of surgeons must be equipped with foundational competencies in transgender and gender-diverse (TGD) healthcare. However, the scope and quality of GAS education in undergraduate medical curricula remain poorly defined, particularly on an international scale. This study aimed to evaluate medical students’ exposure to and perceptions of GAS education, identify barriers and motivators to learning, and characterize preferred educational modalities. Methods: A cross-sectional, anonymous survey was distributed electronically between January and June 2025 to students in clinical years of training at 38 medical schools across 11 countries. The survey assessed five key domains: (1) presence and type of GAS education, (2) clinical exposure to TGD patients, (3) self-perceived competence and confidence, (4) perceived importance and motivators for GAS training, and (5) barriers and preferred learning formats. Quantitative data was analyzed using descriptive statistics and subgroup comparisons by region and intended specialty (plastic surgery vs. other). Open-ended responses were coded thematically to identify recurring educational barriers and recommendations. Results: A total of 1,084 students completed the survey. Only 17% reported any formal GAS instruction, and 9% had observed or assisted in a gender-affirming surgical case. Online modules were most common (58%), followed by case discussions (32%) and lecture-based teaching (10%). 19% of respondents felt confident providing peri-operative care for TGD patients, while 68% believed GAS education should be mandatory within the medical curriculum. Motivators for seeking GAS education included improving patient care for under-served populations (74%) and promoting inclusion and equity in healthcare (71%). Major barriers included lack of trained faculty (56%), insufficient curricular time (43%), and limited access to clinical exposure (41%). Students most preferred clinical experience (74%), simulation-based sessions (58%), and interdisciplinary workshops (45%) over lecture-based formats. Those intending careers in plastic surgery (31%) reported greater exposure (41% vs. 17%, p<0.01) and higher confidence (32% vs. 13%, p<0.01). Conclusion: Across 11 countries, medical students report limited exposure to and low confidence in gender-affirming surgical care despite recognizing its educational importance. The findings highlight the global need for a structured, competency-based GAS curriculum that prioritizes clinical immersion and interdisciplinary collaboration. Embedding longitudinal and experiential learning opportunities mirroring the methods by which current providers gain expertise may be essential to preparing an inclusive, globally competent surgical workforce.