Gender-affirming surgery refers to any surgical procedures offered to affirm the gender identities of transgender and gender diverse (TGD) people. Evidence supporting a positive effect of gender-affirming surgeries on mental health is largely derived from low-quality studies. A secondary analysis of the 2015 US Transgender Survey evaluating the associations between gender-affirming surgery and self-reported mental health outcomes among TGD adults was recently published. Of 27,715 respondents, 3,559 (12.8%) endorsed undergoing 1 or more types of gender-affirming surgeries at least 2 years prior to completing the survey (exposure group), while 16,401 (59.2%) endorsed a desire to undergo 1 or more types of surgery but denied undergoing any of these (control group). After adjusting for sociodemographic factors and exposure to other gender affirming care (e.g., hormone therapy), undergoing 1 or more types of gender-affirming surgery was associated with lower past-month psychological distress (aOR, 0.58; 95% CI, 0.50-0.67; p<0.001), past-year smoking (aOR, 0.65; 95% CI, 0.57-0.75; p<0.001), and past-year suicidal ideation (aOR, 0.56; 95% CI, 0.50-0.64; p<0.001), compared to control. After Bonferroni correction, undergoing 1 or more gender-affirming surgery was not significantly associated with past-month binge alcohol use or past-year suicide attempt, compared to control. This first large-scale, controlled study demonstrates an association between gender-affirming surgery and improved mental health outcomes in TGD adults that is consistent with previous small-sample studies. These findings offer evidence to support the clinical practice of gender affirming surgery and highlight the importance of policies that facilitate access to surgical gender affirmation.
Almazan AN, Keuroghlian AS. JAMA Surg 2021; epub ahead of print. Abstract
Marano AA et al. JAMA Surg 2021; epub ahead of print. Abstract