Transgender and gender diverse (TGD) people are at increased risk of adverse mental health outcomes, including increased suicidality and binge drinking. Social stigma, pathologization, discrimination, marginalization and violence undoubtedly impact these risks. The World Professional Association for Transgender Health considers gender-affirming surgeries to be medically necessary treatments. Demand for gender-affirming surgery is increasing, but there is a lack of high-quality evidence supporting the impact of surgery on the mental health of TGD people.
To begin to solve this problem, a secondary analysis of the 2015 US Transgender Survey, the largest available dataset about the surgical and mental health of TGD people, was recently conducted. The survey asked 27,715 TGD adults more than 300 questions, and for the purposes of this secondary analysis, those who did not wish to have gender-affirming surgery and those with recent procedures were excluded. This study included 19,960 respondents: 3,559 (17.8%) who had ≥ 1 type of gender-affirming surgery at least 2 years before completing the survey and 16,401 (82.2%) who expressed a wish to receive ≥ 1 type of gender-affirming surgery but had not yet done so when completing the survey.
Respondents who reported receiving gender-affirming surgery were older with a higher socioeconomic status. They reported higher rates of prior gender-affirming medical therapy but also family rejection. In adjusted analyses, gender-affirming surgery was associated with decreased past-month psychological distress (adjusted odds ratio [OR] 0.58, 95% CI 0.5-0.67), past-year smoking (adjusted OR 0.65, 95% CI 0.57-0.75), and past-year suicidal ideation (adjusted OR 0.56, 95% CI 0.5-0.64). Of note, associations between gender-affirming surgery and better mental health outcomes were stronger for people who had received all desired surgeries than for those who had only received some.
The nature of cross-sectional studies makes judging temporal relationships challenging. The authors attempted to overcome this inbuilt obstacle by asking about interventions that happened at least two years prior to the survey and outcomes that happened within one year of the survey. There is also a risk of residual confounding even after adjustment, as is true with most observational studies. For example, the association of gender-affirming surgery with higher socioeconomic status suggests that other factors may not have been part of the original questionnaire. However, this is the largest available study about gender-affirming surgery and mental health among TGD people, includes adjustment for many confounders, and is consistent with studies from the psychiatric and surgical literature. In the absence of randomized trials or longitudinal cohort studies, this study represents the best available evidence to date and provides support for the provision of gender-affirming surgery.
For more information, see the topic Management of the Female Transgender Patient and Management of the Male Transgender Patient in DynaMed®.
