Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 1;156(7):611-618.
doi: 10.1001/jamasurg.2021.0952.

Association Between Gender-Affirming Surgeries and Mental Health Outcomes

Anthony N Almazan  1   2 , Alex S Keuroghlian  1   3   4
Affiliations

Association Between Gender-Affirming Surgeries and Mental Health Outcomes

Anthony N Almazan et al. JAMA Surg. .

Abstract

Importance: Requests for gender-affirming surgeries are rapidly increasing among transgender and gender diverse (TGD) people. However, there is limited evidence regarding the mental health benefits of these surgeries.

Objective: To evaluate associations between gender-affirming surgeries and mental health outcomes, including psychological distress, substance use, and suicide risk.

Design, setting, and participants: In this study, we performed a secondary analysis of data from the 2015 US Transgender Survey, the largest existing data set containing comprehensive information on the surgical and mental health experiences of TGD people. The survey was conducted across 50 states, Washington, DC, US territories, and US military bases abroad. A total of 27 715 TGD adults took the US Transgender Survey, which was disseminated by community-based outreach from August 19, 2015, to September 21, 2015. Data were analyzed between November 1, 2020, and January 3, 2021.

Exposures: The exposure group included respondents who endorsed undergoing 1 or more types of gender-affirming surgery at least 2 years prior to submitting survey responses. The comparison group included respondents who endorsed a desire for 1 or more types of gender-affirming surgery but denied undergoing any gender-affirming surgeries.

Main outcomes and measures: Endorsement of past-month severe psychological distress (score of ≥13 on Kessler Psychological Distress Scale), past-month binge alcohol use, past-year tobacco smoking, and past-year suicidal ideation or suicide attempt.

Results: Of the 27 715 respondents, 3559 (12.8%) endorsed undergoing 1 or more types of gender-affirming surgery at least 2 years prior to submitting survey responses, while 16 401 (59.2%) endorsed a desire to undergo 1 or more types of gender-affirming surgery but denied undergoing any of these. Of the respondents in this study sample, 16 182 (81.1%) were between the ages of 18 and 44 years, 16 386 (82.1%) identified as White, 7751 (38.8%) identified as transgender women, 6489 (32.5%) identified as transgender men, and 5300 (26.6%) identified as nonbinary. After adjustment for sociodemographic factors and exposure to other types of gender-affirming care, undergoing 1 or more types of gender-affirming surgery was associated with lower past-month psychological distress (adjusted odds ratio [aOR], 0.58; 95% CI, 0.50-0.67; P < .001), past-year smoking (aOR, 0.65; 95% CI, 0.57-0.75; P < .001), and past-year suicidal ideation (aOR, 0.56; 95% CI, 0.50-0.64; P < .001).

Conclusions and relevance: This study demonstrates an association between gender-affirming surgery and improved mental health outcomes. These results contribute new evidence to support the provision of gender-affirming surgical care for TGD people.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Keuroghlian reported grants from Patient-Centered Outcomes Research Institute Contract AD-2017C1-6569 (PI: Sari L. Reisner) during the conduct of the study; in addition, Dr Keuroghlian stands to receive future royalties as editor of a forthcoming McGraw-Hill Education textbook on transgender and gender diverse care. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Desire for and History of Gender-Affirming Surgical Procedures in Study Sample
Includes 2015 US Transgender Survey respondents who indicated they desired and either had or had not undergone at least 1 type of gender-affirming surgery. Respondents were presented with 1 of 2 lists of gender-affirming surgeries based on their self-reported sex assigned at birth.
Figure 2.
Figure 2.. Comparison of Mental Health Outcomes Among Respondents Who Did and Did Not Undergo Gender-Affirming Surgery
See this image and copyright information in PMC

Comment in

References

    1. Dhejne C, Van Vlerken R, Heylens G, Arcelus J. Mental health and gender dysphoria: a review of the literature. Int Rev Psychiatry. 2016;28(1):44-57. doi:10.3109/09540261.2015.1115753 - DOI - PubMed
    1. Grant J, Motter L, Tanis J. Injustice at every turn: a report of the National Transgender Discrimination Survey. 2011. Accessed October 11, 2020. https://www.transequality.org/sites/default/files/docs/resources/NTDS_Re...
    1. Gilbert PA, Pass LE, Keuroghlian AS, Greenfield TK, Reisner SL. Alcohol research with transgender populations: a systematic review and recommendations to strengthen future studies. Drug Alcohol Depend. 2018;186:138-146. doi:10.1016/j.drugalcdep.2018.01.016 - DOI - PMC - PubMed
    1. Wheldon CW, Wiseman KP. Tobacco use among transgender and gender non-conforming adults in the United States. Tob Use Insights. 2019;12:X19849419. doi:10.1177/1179173X19849419 - DOI - PMC - PubMed
    1. Reisner SL, Poteat T, Keatley J, et al. . Global health burden and needs of transgender populations: a review. Lancet. 2016;388(10042):412-436. doi:10.1016/S0140-6736(16)00684-X - DOI - PMC - PubMed

Publication types