The article titled “Does every transgender person want gender affirming surgery? A survey of transgender individuals in the Midwestern United States” provides valuable insights into the factors influencing access to gender-affirming surgery (GAS) among transgender and gender-diverse (TGD) individuals [1]. The study offers valuable insights into the obstacles and supports in accessing GAS; however, I believe certain methodological and analytical aspects would benefit from further exploration. I commend the authors for their significant contribution to the field and would like to present some additional perspectives on specific points, detailed below:

Firstly, this study utilized a convenience sample of TGD individuals from Ohio, with a majority of participants being Caucasian (64.4%) and within a relatively young age range (74.6% between 24 and 40 years). This raises questions regarding the generalizability of the results, as this sample may not fully represent the broader TGD population, especially individuals of different ethnicities, older age groups, or from regions with varying healthcare accessibility. Future research would benefit from a more diverse and representative sample, ideally including individuals from different geographic regions and minority backgrounds, to provide a more comprehensive understanding of GAS access.