It is estimated that approximately 1.4 million (0.6%) adults in the United States identify as transgender. Recent studies indicate that transgender and gender diverse (TGD) persons in the United States are vulnerable to adverse mental health outcomes, including higher rates of psychiatric illness and increased risk of suicide attempt. There is also evidence to indicate that access to gender-affirming care alleviates psychological distress and improves mental health outcomes.
Clinical guidelines established by professional medical organizations support the provision of gender-affirming care, and there is a growing number of medical programs dedicated to providing care to transgender individuals. In this climate, requests for gender-affirming surgeries have been on the rise among transgender and gender diverse people. However, we have little information on the impact of these surgeries on mental health outcomes. A recent study from Alex Keuroghlian, MD, MPH, Director of the MGH Gender Identity Program, examines the impact of gender-affirming surgeries on mental health outcomes in a large cohort of transgender and gender diverse people.
In this study, a secondary analysis was performed using data from the 2015 US Transgender Survey. This survey, conducted across 50 states, Washington, DC, US territories, and US military bases abroad, is the largest existing dataset providing comprehensive information on the surgical and mental health experiences of TGD people and includes a total of 27,715 TGD adults surveyed between August 19, 2015, to September 21, 2015.
The majority of the respondents in this study sample (16,182 or 81.1%) were between the ages of 18 and 44 years and identified as White (16,386 or 82.1%). In this cohort, 7751 (38.8%) identified as transgender women, 6489 (32.5%) identified as transgender men, and 5300 (26.6%) identified as nonbinary.
In this group, 3559 (12.8%) reported undergoing one or more types of gender-affirming surgery at least two years prior to completing the survey; 16,401 (59.2%) reported a desire to undergo — but had not received — some type of gender-affirming surgery. Those who had received gender-affirming surgery, compared to those who had not, were more likely to be older, employed, more educated, to endorse family rejection, and to have health insurance and higher household income.
After adjusting for potential confounding sociodemographic variables and exposure to other types of gender-affirming care, the researchers observed that undergoing one or more types of gender-affirming surgery was associated with better mental health outcomes, including lower psychological distress during the previous month (adjusted odds ratio [aOR], 0.58; 95% CI, 0.50-0.67), lower odds of smoking in the previous year (aOR, 0.65; 95% CI, 0.57-0.75), and lower odds of suicidal ideation in the previous year (aOR, 0.56; 95% CI, 0.50-0.64). There was no association between receiving surgery and past-month binge alcohol use or past-year suicide attempts.
The current study demonstrates the mental health benefits of gender-affirming surgeries in transgender and gender diverse adults and is consistent with other studies demonstrating the benefits of gender-affirming care in gneral. This study also highlights the importance of policies facilitating access to surgical gender affirmation. In the present study, the number of people who had undergone gender-affirming surgical procedures was substantially smaller than the number of people who desired them, suggesting significant barriers to accessing this type of gender-affirming intervention. While state-level prohibitions against insurance exclusions for gender-affirming care have led to more extensive coverage of gender-affirming surgical procedures, barriers to gender-affirming care persist and may contribute to worse mental health outcomes in this vulnerable population.
Read More
Almazan AN, Keuroghlian AS. Association Between Gender-Affirming Surgeries and Mental Health Outcomes. JAMA Surg. 2021 Apr 28: e210952.
Beckwith N, McDowell MJ, Reisner SL, Zaslow S, Weiss RD, Mayer KH, Keuroghlian AS. Psychiatric Epidemiology of Transgender and Nonbinary Adult Patients at an Urban Health Center. LGBT Health. 2019 Feb/Mar;6(2):51-61. Free article.
Alex Keuroghlian, MD, MPH
Alex Keuroghlian, MD, MPH is the Director of the MGH Gender Identity Program and an Associate Professor of Psychiatry at Harvard Medical School. Dr. Keuroghlian is the Director of Education and Training Programs at the Fenway Institute and also directs the National LGBTQIA+ Health Education Center, a HRSA-funded cooperative agreement to improve health care for LGBTQIA+ people.
