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Gender-affirming surgery can make a substantial beneficial impact on the mental health of transgender and gender diverse (TGD) individuals, researchers reported.

In a secondary analysis of data from the 2015 U.S. Transgender Survey, undergoing at least one type of gender-affirming surgery nearly halved the likelihood of TGD individuals experiencing severe psychological distress within the past month (adjusted OR [aOR] 0.58, 95% CI 0.50-0.67, P<0.001), according to Anthony Almazan, and Alex S. Keuroghlian, MD, MPH, both of Harvard Medical School in Boston.

And those who underwent at least one gender-affirming surgery also reported significantly less suicidal ideation within the past year (aOR 0.56, 95% CI 0.50-0.64, P<0.001), they wrote in .

The researchers explained that the "term gender-affirming surgery refers to any surgical procedures offered to affirm the gender identities of TGD people," and that the "process of surgical gender affirmation is individually tailored because not all TGD people desire or access these procedures."

Undergoing one or more gender-affirming surgeries was also tied to a significant drop off in smoking within the past year (aOR 0.65, 95% CI 0.57-0.75, P<0.001).

While this mental health benefit was seen among those who only received some of their desired surgeries, the benefit was even greater for those who said they received all of their desired surgeries, according to the authors.

TGD individuals who already underwent all of their desired surgeries saw a significantly lower odds of experienced psychological distress, substance abuse issues, and suicidality versus those who didn't receive any of their desired surgeries (P<0.001 for all):

• Severe psychological distress in past month: aOR 0.47 (95% CI 0.39-0.56)
• Binge alcohol use in past month: aOR 0.75 (95% CI 0.64-0.87)
• Smoking in past year: aOR 0.58 (95% CI 0.49-0.68)
• Suicidal ideation in past year: aOR 0.44 (95% CI 0.38-0.51)
• Suicide attempt in past year: aOR 0.44 (95% CI 0.28-0.70)

All in all, those who received all their desired surgeries had significantly lower odds of all mental health variables across the board.

All models were adjusted for potential confounders, including age, education, employment status, family rejection, gender identity, health insurance, household income, race and ethnicity, sex assigned at birth, sexual orientation, history of gender-affirming counseling, pubertal suppression, and history of gender-affirming hormone therapy.

"Our findings offer empirical evidence to support provision of gender affirming surgical care for TGD people who seek it," Almazan and Keuroghlian stated, adding "prior mental health factors do not appear to confound associations between gender-affirming surgery and subsequent mental health outcomes in our study."

The main survey had data on 27,715 TGD individuals and was conducted across all 50 states, Washington, U.S. territories, and U.S. military bases abroad. In 2015, 12.8% (n=3,559) said they had undergone at least one or more type of gender-affirming surgery, while nearly 60% said they desired to undergo gender-affirming surgery but had never done so.

About 81% of these survey respondents were between ages 18 to 44, and the vast majority were white (82%). Roughly a third identified as transgender men, 39% identified as transgender women, and 27% identified as nonbinary.

Severe psychological distress was defined as a score of 13 or higher on the Kessler Psychological Distress Scale. Binge alcohol use was defined as consuming at least five alcoholic drinks during the same occasion.

In an , Devin Coon, MD, MSE, of Johns Hopkins Center for Transgender Health in Baltimore, and colleagues called the analysis a "controlled, well-powered study." They emphasized the difficulty in obtaining valuable clinical information on TGD individuals because "nearly all governmental surveys continue to omit gender identity as a survey item."

However, they noted a study limitation: In order to be a candidate for gender-affirming surgery, individuals are typically required to undergo mental health screening, which "may convolute the specific connection between these 2 variables."

"We hope that as [gender-affirming surgery] becomes increasingly accessible, more robust data to support optimal, evidence-based guidelines for health of transgender and gender diverse individuals will continue to emerge," Coon and colleagues concluded.

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