Introduction

Gender incongruence (GI) occurs when a person’s gender identity doesn’t match the gender they were assigned at birth, sometimes leading to significant mental health challenges like anxiety, depression, and suicidal thoughts. These issues often stem from both the internal conflict of gender misalignment and external pressures such as stigma and hiding one’s true identity.

To help address these challenges, some people with GI seek gender-affirming therapies, which can include hormone treatments, counseling, and surgeries. One type of surgery, called genital gender-affirming surgery (GGAS) or “bottom surgery,” reconstructs genitalia to better align with a person’s gender identity.

Recent studies have shown that gender-affirming surgeries, including GGAS, can improve mental health outcomes. However, many past studies have not thoroughly examined the impact of GGAS on psychiatric conditions. Therefore, a new study aimed to fill that gap by comparing rates of depression, anxiety, PTSD, substance abuse, and suicidality in people with GI who had GGAS versus those who did not. The goal was to better understand how GGAS affects these psychiatric conditions and to support improved mental health for individuals with GI.

Methods

To investigate how GGAS affects mental health, researchers used a large health database called TriNetX, which contains anonymized data from over 250 million patients worldwide. They looked for patients aged 18 and older with gender incongruence and divided them into two groups: those who had GGAS and those who had not.

The researchers matched individuals from both groups based on several factors such as age, sex assigned at birth, race, health history, and body mass index to ensure the groups were comparable. This matching process helps control for variables that might affect the results, making the comparison more reliable.

They then examined the rates of psychiatric issues, like depression, anxiety, PTSD, substance abuse, and suicidality, in both groups one year and five years after GGAS. To do this, they used specific medical codes to identify these conditions and applied statistical analysis to compare the outcomes. This approach allowed them to assess whether GGAS is associated with changes in psychiatric conditions over time.

Results

In the end, the researchers analyzed data from over 100,000 patients. They found that one year after GGAS, patients had significantly lower rates of depression, anxiety, substance use disorder, and suicidality compared to their matched peers who had not undergone the surgery.

After five years, the positive effects of GGAS on mental health were even more pronounced. GGAS patients continued to show lower rates of depression, anxiety, PTSD, substance abuse, and suicidality compared to the control group. This suggests that GGAS has a lasting positive impact on mental health for those with GI.

Discussion & Conclusion

The results of this study show that GGAS leads to significant reductions in depression, anxiety, PTSD, and suicidality in individuals with GI compared to those with GI who didn’t have the surgery. This supports earlier findings that gender-affirming surgeries can improve mental health for transgender individuals.

GGAS may reduce misgendering and ease the process of coming out, contributing to better mental health. However, GGAS isn’t necessary for everyone, and personalized care plans are important. For those who don’t have surgery, other forms of gender-affirming care like hormone therapy and mental health support are crucial.

The study has limitations, such as the inability to determine causality and the potential impact of coding errors. More research is needed to explore long-term mental health outcomes and different types of gender-affirming surgeries. Overall, the findings underscore the importance of making GGAS accessible to improve mental health outcomes for those with GI.

References:

• Garoosi, K., Yoon, Y., Hale, E., Kahan, R., Kalia, N., Higuchi, T., Mathes, D., Hudish, T., & Kaoutzanis, C. (2024). Association between genital gender-affirming surgery and psychiatric comorbidities in individuals with gender incongruence. The Journal of Sexual Medicine, 21(8), 729–733. https://doi.org/10.1093/jsxmed/qdae077