The mental health of transgender individuals post-gender-affirming surgery has been a subject of ongoing research and discussion within the medical and psychological communities. A new study, published in The Journal of Sexual Medicine on February 25, 2025, sheds light on gender-specific mental health risks associated with gender-affirming surgery. The study, conducted using the TriNetX database, analyzed over 107,000 transgender patients diagnosed with gender dysphoria and evaluated their mental health outcomes based on whether they had undergone surgery.
While gender-affirming surgery can be life-changing and affirming for many transgender individuals, this study highlights the complexities of post-surgical mental health, emphasizing the necessity for gender-sensitive support systems. However, it is crucial to interpret these findings with care and context, especially when comparing them to past research on the same topic.
Understanding the Study and Its Purpose
The research team, comprised of Joshua E. Lewis, BS; Amani R. Patterson, MBS; Maame A. Effirim, BS; Manav M. Patel, BSA; Shawn E. Lim, BS; Victoria A. Cuello, BS; Marc H. Phan, BS; and Wei-Chen Lee, PhD, sought to examine mental health trends among transgender individuals after gender-affirming surgery. Importantly, their study does not aim to dissuade individuals from seeking surgery but instead highlights areas where post-operative mental health support is needed.
By analyzing a large dataset from the TriNetX database—focusing on individuals aged 18 and older between June 2014 and June 2024—the study was able to identify patterns in depression, anxiety, suicidal ideation, substance use disorder, and body dysmorphic disorder among transgender patients. The use of clinician-verified ICD-10 codes helped ensure accurate reporting of these conditions, minimizing bias commonly seen in survey-based research.
Key Findings: Increased Mental Health Risks Post-Surgery
The study found that transgender individuals who underwent gender-affirming surgery were at a higher risk of experiencing mental health issues compared to those who did not undergo surgery. Specifically:
- Transgender men (assigned female at birth) who had surgery exhibited higher rates of depression (25.4% vs. 11.5%) and anxiety (12.8% vs. 2.6%).
- Transgender women (assigned male at birth) who had surgery also had elevated depression (22.9% vs. 14.6%) and anxiety (10.5% vs. 7.1%).
- Feminizing individuals were particularly at risk for depression (RR 1.783) and substance use disorder (RR 1.284).
These findings emphasize that while gender-affirming surgery helps many transgender individuals align their physical selves with their gender identity, there remain mental health challenges that must be addressed in post-surgical care.
How These Findings Compare to Past Research
The results of this study align with previous research on transgender mental health, though they add new insights into gender-specific risks. Past studies have consistently shown that transgender individuals experience higher rates of mental health challenges due to societal stigma, discrimination, and barriers to gender-affirming care.
However, research from the past decade has also demonstrated that gender-affirming surgery often leads to significant improvements in gender dysphoria, self-esteem, and overall life satisfaction. For example, a 2021 study published in JAMA Surgery found that individuals who underwent surgery reported lower rates of suicidal ideation and psychological distress over time. Another 2020 study in The American Journal of Psychiatry initially reported improvements in mental health post-surgery, though a correction later clarified that the long-term benefits were less conclusive.
What makes this new study unique is its focus on specific mental health risks stratified by gender, providing a more detailed look at how transgender men and women experience mental health post-surgery differently. It does not suggest that gender-affirming surgery is harmful but rather that mental health support must be an integral part of post-surgical care.
The Need for Gender-Sensitive Mental Health Support
Rather than discouraging transgender individuals from seeking gender-affirming surgery, this study underscores the importance of ensuring that adequate mental health resources are available before, during, and after surgery. Gender-affirming care is not just about surgery—it also includes comprehensive psychological support to help individuals navigate post-surgical adjustments.
Many transgender individuals experience mental health challenges due to external factors such as lack of family support, workplace discrimination, and financial instability. The psychological impact of surgery, combined with these external stressors, can contribute to increased rates of anxiety, depression, and substance use.
To address these concerns, medical professionals and mental health providers should:
- Develop long-term post-surgical mental health care plans tailored to transgender individuals.
- Ensure that pre-surgical counseling includes realistic discussions about post-operative expectations and potential emotional challenges.
- Expand access to mental health professionals who specialize in transgender health care.
- Foster community-based support systems where transgender individuals can share their experiences and find peer support.
Debunking Misinformation and Right-Wing Distortions
Following the publication of this study, several far-right social media accounts, including the AFPost, misrepresented its findings to suggest that gender-affirming surgery significantly worsens mental health. These claims are not supported by the study’s actual methods or conclusions.
The study does not compare transgender individuals before and after surgery; rather, it looks at differences between those who have had surgery and those who have not—without assessing whether they desired surgery. This means it cannot determine whether surgery itself contributes to increased rates of depression or anxiety.
A common fallacy in these misleading narratives is selection bias: those who undergo surgery often start with higher levels of gender dysphoria, a well-documented risk factor for mental health challenges. If surgery alleviates distress but does not fully eliminate it, post-surgical individuals may still report higher levels of depression than those who never sought surgery in the first place. However, this does not mean surgery caused these mental health struggles.
Furthermore, transgender people who seek gender-affirming surgery often have greater interaction with the medical system, increasing the likelihood of receiving mental health diagnoses. This could further explain the higher recorded rates of depression and anxiety, rather than proving that surgery worsens mental health.
The Bottom Line
The latest findings from The Journal of Sexual Medicine contribute to our understanding of the complexities surrounding mental health after gender-affirming surgery. While the study highlights increased risks for depression, anxiety, and substance use disorders post-surgery, it is essential to interpret these results as a call for enhanced mental health support rather than as a deterrent to seeking surgery.
Right-wing media distortions of the study ignore the extensive body of research demonstrating the benefits of gender-affirming surgery for those who seek it. These misleading claims serve a political agenda rather than an effort to genuinely improve transgender healthcare. The conversation around mental health and gender-affirming surgery should focus on providing better support rather than being used as a weapon against transgender rights.
For transgender individuals considering gender-affirming surgery, these findings reinforce the importance of working with knowledgeable healthcare providers who can offer comprehensive care before and after the procedure. For families and allies, supporting a transgender loved one through their journey includes not only celebrating their gender affirmation but also ensuring they have access to the mental health resources they may need.
Ultimately, gender-affirming surgery remains a deeply personal and often necessary step for many transgender individuals. As medical research continues to evolve, the focus should remain on improving care and ensuring that transgender people receive the affirming and supportive healthcare they deserve.
