What Evidence Exists Regarding the Effects of Gender-affirming Surgery on Mental Health, Patient Satisfaction, and Detransition?

What evidence exists regarding the effects of gender-affirming surgery on mental health, patient satisfaction, and detransition?

Extensive evidence shows that gender-affirming surgery significantly reduces gender dysphoria and improves mental health outcomes for transgender and gender-diverse individuals. While the surgery is specifically a treatment for gender dysphoria and not for general mental health conditions, improvements are often seen in anxiety, depression, suicide attempt rates, quality of life, life satisfaction, and overall happiness following the procedure. Higher patient satisfaction is frequently associated with supportive perioperative interactions and assessments, which help clarify patient goals and expectations. Conversely, dissatisfaction tends to correlate with surgical complications, poor aesthetic or functional outcomes, and the absence of desired physical sensations, particularly following complex procedures like vaginoplasty or phalloplasty.

Regarding detransition, studies have shown that regret following gender-affirming surgery is very rare. In a review involving 7,928 transgender individuals, the pooled prevalence of regret was found to be less than 1%, with only 77 individuals expressing regret. Another study encompassing 17,151 participants looked more broadly at gender affirmation, including surgeries, hormone therapies, and social transitions, and reported a 13% history of detransition. However, detransition often resulted from external pressures, such as family rejection, societal stigma, or personal safety concerns, rather than internal uncertainty. It is crucial to recognize that detransition does not necessarily equate to regret over having undergone surgery.

This Ask the Expert is an edited excerpt from the course, ‘Gender Affirming Surgery for Adults: Conducting Readiness Evaluations,’ presented by Giselle Levin, PsyD