An exploratory study of preoperative psychological assessment for gender-affirming surgery: personality traits, defense mechanisms, and cultural factors in a chinese sample

Chinese transgender individuals seeking gender-affirming surgery (GAS) face legal, familial, and healthcare barriers, yet data on their psychological characteristics and surgical motivations remain limited. This exploratory study examined personality traits, defense styles, and self-reported motivations in a Chinese clinical sample. In this cross-sectional study, 37 transgender individuals (transmasculine participants, n = 25; transfeminine participants, n = 12) completed the Eysenck Personality Questionnaire (EPQ), Defense Style Questionnaire (DSQ), and a self-developed GAS-related questionnaire. EPQ scores were compared with Chinese national normative values in an exploratory manner using Wilcoxon signed-rank tests. Associations between EPQ and DSQ dimensions were examined using Spearman correlations with false discovery rate correction. Findings from the self-developed questionnaire were analyzed descriptively. In exploratory comparisons with Chinese national norms, participants showed lower Extraversion ( p < 0.001), higher Neuroticism ( p = 0.012), and higher Lie scores ( p < 0.001), while Psychoticism did not differ significantly ( p = 0.976). After FDR correction, Neuroticism remained positively associated with immature defenses (ρ = 0.646, FDR-adjusted p < 0.001), middle defenses (ρ = 0.468, FDR-adjusted p = 0.032), and hidden defenses (ρ = 0.428, FDR-adjusted p = 0.043). Descriptive questionnaire findings indicated that common motivations included enhancing self-confidence, changing the gender marker on official identification documents, and increasing social acceptance. Cronbach’s α was 0.82 for the Likert-type domains, with subscale values ranging from 0.78 to 0.85. This exploratory study provides preliminary insights into personality traits, defense styles, and self-reported motivations among Chinese transgender individuals seeking GAS. The findings contribute context-specific descriptive data to the existing literature and may inform future research using larger, multicenter samples, appropriately matched comparison groups, and validated assessment instruments.