Mental health issues may persist after gender-affirming surgery

Gender-affirming surgery is associated with an increase in the risk of mental health issues among transgender people, reveals a study.

A total of 107,583 patients were included in this retrospective study. Matched cohorts showed a significantly higher risk of depression, anxiety, suicidal ideation, and substance use disorders among patients undergoing surgery than those without surgery.

In particular, males with vs without surgery exhibited a higher prevalence of depression (25.4 percent vs 11.5 percent; risk ratio [RR], 2.203; p<0.0001) and anxiety (12.8 percent vs 2.6 percent; RR, 4.882; p<0.0001). Females also showed a similar trend, with increased depression (22.9 percent vs 14.6 percent; p<0.0001) and anxiety (10.5 percent vs 7.1 percent; RR, 1.478; p<0.0001).

Notably, feminizing individuals were at particularly high risk for depression (RR, 1.783; p=0.0298) and substance use disorders (RR, 1.284; p<0.0001).

“[These] findings suggest the necessity for gender-sensitive mental health support following gender-affirming surgery to address postsurgical psychological risks,” the investigators said. 

In this study, the investigators used the TriNetX database and identified US patients aged ≥18 years with gender dysphoria (International Classification of Diseases, Tenth Revision [ICD-10] F64) between June 2014 and June 2024. Six cohorts were created based on gender and surgery status: cohorts A–D (patients with or without surgery) and cohorts E–F (gender comparison among patients with surgery).

The investigators carried out propensity score matching to control for age, race, and ethnicity. They assessed mental health outcomes, including depression, anxiety, suicidal ideation, substance use disorder, and body dysmorphic disorder, over 2 years postsurgery using clinician-verified ICD-10 codes.

Body dysmorphic disorder was analysed separately to ensure distinction from gender dysphoria.