Gender-Affirming Surgery Boosts Mental Health in Transgender Adults

Transgender or unisex icons
Transgender or unisex icons
The researchers studied links between gender-affirming surgeries and mental health outcomes, including psychological distress, substance use, and suicide risk.

Transgender adults who undergo gender-affirming surgery have better mental health than those who do not go through surgery, according to a recent study published in JAMA Surgery. Those who had surgery reported fewer suicidal thoughts and less psychological distress than those who did not.

The study analyzed data from the 2015 US Transgender Survey and used the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. The survey included more than 27,000 transgender adults from across the United States, including US territories and US military bases.

The researchers examined past-month severe psychological distress, binge alcohol use, tobacco smoking, suicidal thoughts, and suicide attempts. The exposure group reported having gender-affirming surgery at least 2 years before responding to the survey. The control group included respondents who wanted surgery but had not had surgery.

Of the adults who participated in the survey, 12.8% had 1 or more types of gender-affirming surgery at least 2 years before completing the survey.

Undergoing 1or 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). “There was no statistically significant association between gender-affirming surgeries and past-month binge alcohol use or past-year suicide attempts,” the researchers found.

The study also showed “transgender adults who underwent all desired surgeries had significantly lower odds of all adverse mental health outcomes, and these benefits were stronger than among transgender people who received only some desired surgeries,” the researchers said.

Sampling may limit generalizability. The survey was self-reported and possibly subject to response bias. The survey included only 10 types of gender-affirming surgery, not all types.

“Our findings offer empirical evidence to support provision of gender-affirming surgical care for transgender people who seek it,” the researchers concluded. “Furthermore, this study provides evidence to support policies that expand and protect access to gender-affirming surgical care for TGD [transgender and gender diverse] communities.”


Almazan AN, Keuroghlian AS. Association between gender-affirming surgeries and mental health outcomes. JAMA Surg. Published online April 28, 2021. doi:10.1001/jamasurg.2021.0952