BOSTON, April 28, 2021—A new study published today in JAMA Surgery found that gender-affirming surgery is associated with improved mental health outcomes among transgender people. The study was authored by researchers at Harvard Medical School, Harvard T.H. Chan School of Public Health, The Fenway Institute at Fenway Health, and the Department of Psychiatry, Massachusetts General Hospital. It is the first large-scale, controlled study to demonstrate an association between gender-affirming surgery and improved mental health outcomes and adds important new knowledge to the field as there is little high-quality evidence regarding the mental health effects of gender-affirming surgery.
“There is great demand among transgender and gender diverse people for gender-affirming surgery, and thanks to recommendations by professional associations and clinical support for gender-affirming surgical care, these treatments are much more common today than they were even just 10 years ago,” said study lead author Anthony N. Almazan, a fourth-year medical student at Harvard Medical School. “But until now there has been limited evidence that these surgeries result in better mental health outcomes.”
The study, titled “Association Between Gender-Affirming Surgeries and Mental Health Outcomes,” compared the psychological distress, substance use, and suicide risk of 3,559 transgender people who had undergone gender-affirming surgery with those of 16,401 transgender people who desired gender-affirming surgery but had not yet undergone any. It found that transgender people who had received one or more gender-affirming surgical procedures had a 42% reduction in the odds of experiencing past-month psychological distress, a 35% reduction in the odds of past-year tobacco smoking, and a 44% reduction in the odds of past-year suicidal ideation.
This study also found that people who received all of the gender-affirming surgeries they desired had significant reductions in the odds of every adverse mental health outcome examined, including past-year suicide attempts and past-month binge alcohol use. Furthermore, compared to people who only received some of the gender-affirming surgeries they desired, people who received all of their desired surgeries experienced even more profound mental health benefits across every outcome.
Recent attempts to test the theory that gender-affirming surgeries are associated with better mental health outcomes among transgender and gender diverse people have yielded mixed results. A 2010 meta-analysis of 1,833 transgender and gender diverse people across 28 studies concluded that there was “low-quality evidence” that gender-affirming surgery would result in positive mental health outcomes. Although a 2019 study of 2,679 transgender people demonstrated an association between gender-affirming surgery and reduced utilization of mental health treatment, a correction to the study issued in 2020 reported no mental health benefits after comparison with a control group of transgender people who had not yet undergone surgery.
“These results are incredibly important for the evolving field of transgender health care. Although clinicians have long supported the provision of gender-affirming medical and surgical care, the practice has been challenged by health insurers asking for more evidence showing its efficacy,” said study senior author Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. “In light of this study’s results, gender-affirming surgeries should be made available for transgender and gender diverse people who seek them, and we should work to remove barriers to gender-affirming surgery such as insurance exclusions for such care.”
The study uses data from the 2015 U.S. Transgender Survey (USTS) conducted by the National Center for Transgender Equality, which is the largest dataset containing comprehensive information on the surgical and mental health experiences of transgender and gender diverse people. The USTS survey includes responses from over 27,000 transgender people living in all 50 U.S. states, the District of Columbia, U.S. territories, and U.S. military bases abroad. Adjustments were made for exposure to other types of gender-affirming care such as counseling, pubertal suppression, and hormone therapy. Adjustments were also made for sociodemographic factors including age, education level, employment status, household income, and race.
“Association Between Gender-Affirming Surgeries and Mental Health Outcomes” is available here.