Mental health improves following gender-affirming surgery
Transgender adults were more likely to report better mental health outcomes after having gender-affirming surgery compared with those who wish to have surgery, but have yet to undergo a procedure, according to study data.
“Due to the paucity of strong data describing the benefits of gender-affirming surgeries, the provision of these procedures has historically been driven by clinical consensus rather than robust evidence,” Anthony N. Almazan, BA, a MD and MPH candidate at Harvard Medical School, told Healio. “This study offers stronger data to suggest that gender-affirming surgery offers evidence-based mental health benefits. It therefore supports the provision of these procedures for transgender and gender-diverse people, and it reaffirms the importance of policies that expand and protect access to gender-affirming surgical care.”
Almazan and Alex S. Keuroghlian, MD, MPH, associate professor of psychiatry at Harvard Medical School, director of the National LGBTQIA+ Health Education Center at The Fenway Institute, and director of the psychiatry gender identity program at Massachusetts General Hospital, analyzed data from the 2015 U.S. Transgender Survey, which contained 324 questions from 32 domains addressing health and health care access. Five mental health outcomes were examined: psychological distress, past-month binge alcohol use, past-year tobacco smoking, past-year suicidal ideation and past-year suicide attempts. The exposure group included 3,559 participants who had one or more gender-affirming surgeries at least 2 years before the survey. The control group included 16,401 respondents who desired gender-affirming surgery but had not yet received it. The study’s findings were published in JAMA Surgery.
After adjusting for sociodemographic factors and exposure to other types of gender-affirming care, participants in the exposure group were less likely to report psychological distress (adjusted OR = 0.58; 95% CI, 0.5-0.67; P < .001), smoking in the past year (aOR = 0.65; 95% CI, 0.57-0.75; P < .001) and having suicidal ideation in the past year (aOR = 0.56; 95% CI, 0.5-0.64; P < .001). In the primary analysis, no associations were found between having gender-affirming surgeries and binge alcohol use or suicide attempts. There were also no associations found between lifetime mental health and undergoing gender-affirming surgery.
In post hoc analysis, people who received all of the gender-affirming surgeries they desired had reductions in the odds of every adverse mental health outcome examined, including past-year suicide attempts and past-month binge alcohol use. Furthermore, compared with people who received only some of the gender-affirming surgeries they desired, those who received all of their desired surgeries experienced more profound mental health benefits across every outcome, according to Almazan.
“This is, to our knowledge, the first study to demonstrate preliminary evidence for a dose-response relationship between surgical gender affirmation and mental health, including suicide attempts,” Almazan said.
In a related commentary, Devin Coon, MD, MSE, chief medical director of the Johns Hopkins Center for Transgender Health, and colleagues wrote that the study contributes more evidence to support the efficacy of gender-affirming surgery on mental health, but added there are several limitations to the data, such as the use of survey questions to quantify psychosocial distress and the possibility that the mental health screening necessary for gender-affirming surgery may confound findings. The researchers wrote that prospective cohort studies with well-validated outcome instruments are needed in the future.
“We hope that as gender-affirming surgery becomes increasingly accessible, more robust data to support optimal, evidence-based guidelines for health of transgender and gender-diverse individuals will continue to emerge,” Coon and colleagues wrote.
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Anthony N. Almazan, BA, can be reached at firstname.lastname@example.org.