Background <p>Gender-diverse patients often have unique preferences for top surgery that differ from those of binary transgender men. Yet, discussions around tailored surgical options remain limited. Social media platforms provide insights into the preferences of gender-diverse individuals who frequently turn to digital spaces for information and support. This study sought to explore the diverse needs of gender-diverse respondents and gather their feedback on a pictorial algorithm designed to assist with preoperative surgical decision-making.<?oxy_comment_start comment="Please verify if the provided city and country are correct and amend if necessary."?><?oxy_comment_end??><?oxy_comment_start comment="This is correct"?><?oxy_comment_end??></p> Methods <p>A cross-sectional survey was distributed on Reddit to individuals considering or having undergone masculinizing top surgery. The survey collected data on aesthetic preferences, comfort with surgical options, surgeon communication, and the need for non-standard surgical choices. A pictorial algorithm was used to evaluate its utility in enhancing preoperative discussions. Data were analyzed for demographic differences and preferences across transgender male, non-binary, and other gender-diverse (OGD) groups.<?oxy_comment_start comment="Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 4 Given name: [Tricia Mae] Last name [Raquepo]. Also, kindly confirm the details in the metadata are correct."?><?oxy_comment_end??><?oxy_comment_start comment="Yes these are correct. Raquepo is the correct last name for Tricia Mae."?><?oxy_comment_end??></p> Results <p>Of 799 respondents, 639 met the inclusion criteria. Non-binary and OGD respondents were older (<i>p</i>&lt;0.0001) and had higher education levels (<i>p</i>&lt;0.0001). These groups showed a higher preference for “non-standard” chest reconstruction (<i>p</i>=0.02), were less likely to want nipple–areola complex (NAC) reconstruction, and reported more frequent interactions where they educated their surgeons on options (<i>p</i>&lt;0.0001) and greater comfort in these discussions (<i>p</i>=0.0002).</p> Conclusion <p>This study highlights the diverse preferences and needs of gender-diverse individuals seeking masculinizing top surgery. It underscores the importance of personalized care, with a structured communication tool and algorithm aiding better patient–provider alignment for more tailored surgical outcomes.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of&#xa0;Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>