For a study, the researchers sought to conduct the first systematic review of all available gender-affirming surgery (GAS) publications to evaluate the outcomes reported in the literature and the methodologies used to measure results. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify all products measures in GAS cohorts, including PCOs, complications, and functional outcomes. Outcome data were pooled to assess reported difficulty, satisfaction, and other result rates. In total, 15,186 references were found, investigators moved 4,162 papers to abstract review, and 1,826 papers were reviewed in full. There were 406 GAS cohort publications after the study. Mastectomy, 6 mammoplasties, 21 face feminization, and 31 voice/cartilage were among the non-genitoplasty titles. Although PCOs were mentioned in 59.1% of non-genitoplasty articles, only 4.3% employed instruments that had been partially validated in transgender patients. Overall, data was reported in various ways, with a bias toward high-volume centers. This was the complete survey of GAS literature to date. The study provides a platform for discussions concerning present methodologic limits and what characteristics must be included in assessing surgical success by combining all previously used assessment instruments. The study group compiled a thorough list of outcome instruments, which would serve as a great starting point for discussions between patients and physicians regarding the shortcomings that new, better devices and measures will need to solve. The lack of regular use of the same outcome measures and validated GAS-specific tools were 2 significant roadblocks to high-quality research that should be addressed.