Sex Reassignment Surgery Leads to Lower Rates of Nonsuicidal Self-Injury

Transgender sex equality concept. Female hand holding speech bubble with transgender flag and symbol
The researchers’ objectives included determining the prevalence of nonsuicidal self-injuries in transgender patients with gender dysphoria and to discover the effect of parental support on these patients.

The following article is a part of conference coverage from the American Psychiatric Association Annual Meeting 2021, held virtually from May 1 to 3, 2021. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the APA 2021.


Transgender adults who have low levels of parental support and high rates of parental alienation are more likely to experience suicidal ideation or participate in nonsuicidal self-injury compared with transgender adults who undergo sex reassignment surgery. This is according to study results presented at the American Psychiatric Association annual meeting, held virtually from May 1 to 3, 2021.

Researchers indicated that transgender individuals demonstrate 14.8 increased odds of engaging in nonsuicidal self-injury compared with gay and bisexual men. However, the literature on these behaviors, as well as the related variables, is limited.

To address this, researchers collected data via questionnaire from 105 transgender patients at the Gender Variation Clinic at Mahidol University in Thailand. All participants were 18 years and older and were diagnosed with gender dysphoria per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Data collected included demographic information and results of the Impulse, Self-Harm, and Suicide Ideation Questionnaire for Adolescents (ISSIQ-A) and the Inventory of Parent and Peer Attachment-Revised (IPPA-R).

Among the participants, 86.7% were assigned female at birth. Mean age was 29.23±0.7 years, 79% were undergoing sex reassignment hormone therapy, and 39% had undergone sex reassignment surgery.

Overall, 36.2% of participants reported engaging in nonsuicidal self-harm behaviors in their lifetimes. The 3 most common behaviors were hurting, hitting, and scratching themselves on purpose (24.9%, 21.9%, and 12.5%). Nearly 80% (78.1%) reported engaging in other self-harm behaviors, including driving recklessly, abusing alcohol, and participating in promiscuous sexual behavior.

The most commonly reported motives for these behaviors were to control anger, to calm themselves, and to stop feeling sad or depressed. Investigators found that 52.4% of participants reported experiencing suicidal ideation, 42.9% reported feeling hopeless and helpless, and 38.1% reported experiencing a passive death wish.

After conducting a logistic regression analysis, researchers indicated that participants who underwent sex reassignment surgery were less likely to experience nonsuicidal self-injury behaviors, and higher alienation from parents was associated with higher levels of suicidal ideation.

“There is a significant rate of [nonsuicidal self-injury] and suicidal ideation among transgender [people] with gender dysphoria,” the researchers concluded. “We encourage caretakers to be aware of [nonsuicidal self-injury and suicidal ideation] among transgender [individuals] and to seek help from professionals.”

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Thitiseranee L, Kiatrungrit K, Thongpan M, et al. Association between sex reassignment therapy and self-injurious or suicidal behaviors in patients with gender dysphoria. Presented at: APA annual meeting May 1-3, 2021. Abstract/Poster 5167.