Gender-affirming surgery linked to better mental health in transgender people

"When I looked down at my body, I couldn't stop crying. I finally felt like myself." Zack's reaction after undergoing gender-affirming surgery—in his case, a phalloplasty—was similar to that of many transgender people. Now, results of a new study show what a number of researchers, clinicians, and trans patients already suspected: Gender-affirming surgery is associated with better mental health.

To learn more about the relationship between gender-affirming surgery and psychological well-being, Anthony Almazan, a fourth-year medical student at Harvard Medical School, and Dr. Alex Keuroghlian of The Fenway Institute reviewed data from 27,715 trans and gender-diverse adults who were part of the 2015 U.S. Transgender Survey, the largest set of information on this population.

Gender surgery: a protective effect?

They found that people who had undergone at least one gender-affirming surgery had significantly lower odds of psychological distress within the previous month than their peers who wanted such procedures but had not yet had them. They were also less likely to have used tobacco or experienced suicidal thoughts within the previous year.

Specifically, trans and gender-diverse people who hadn't received any of the affirming surgeries they wanted were almost twice as likely to report severe psychological distress and suicidal thoughts as those who had been able to access surgery. The results were published in the April 28, 2021, issue of JAMA Surgery.

Looking to the future

"This paper is particularly important right now, as some groups are attempting to limit transgender individuals' ability to access gender-affirming care and gender-affirming surgery," says Elizabeth Boskey, a social worker in the Center for Gender Surgery at Boston Children's Hospital. "Hopefully, this research will raise awareness of the need to continue to reduce barriers to accessing gender-affirming surgery."

Future research is needed to look more directly at the effects of surgery on mental health, says Boskey. "What changes are seen in people's mental health as they go through surgery and then continue to live their lives? That's something we're in the process of studying in the Center and hope to see more research on overall."