Trans people who undergo surgical transition are much less likely to need mental health services, study finds

A giant trans flag outside the US Supreme Court as a community response to the landmark Supreme Court hearings that could legalise workplace discrimination against LGBTQ+ people

Transgender people who undergo gender-affirming surgery are significantly less likely to seek mental health treatment than trans people who don’t access gender-affirming surgery, according to new research from Yale University.

The study, published in the American Journal of Psychiatry, is believed to be the first analysis of the long-term effect of hormone therapy and gender-affirming surgery on trans people’s mental health.

Researchers used 10 years of medical data for the entire population of Sweden, and compared this with medical outcomes between 2005 and 2015 for trans individuals in Sweden who had received a diagnosis of “gender incongruence”.

“We know that transgender individuals are at higher risk of psychological distress than the general population due to stigma-related stress and stress associated with a lack of affirmation of their gender identity,” said co-author John Pachankis, associate professor at the Yale School of Public Health, in a statement.

“No longer can we say that we lack high-quality evidence of the benefits of providing gender-affirming surgeries to transgender individuals who seek them,” Pachankis added.

Ninety-five percent of the trans people in the study who had surgery had also received hormone therapy – but the researchers found that hormone therapy alone didn’t significantly reduce the likelihood of trans individuals seeking mental-health treatment and psychiatric medications.

But the likelihood of trans people who underwent gender-affirming surgery needing mental-health treatment – for depression, anxiety disorders or suicide attempts – reduced eight percent in the year after the procedure, and kept consistently going down by eight percent a year in every following year for which the scientists had data.

The study also found that trans people seeking gender-affirming care were six times more likely to have an anxiety or mood disorder than the general population, three times more likely to be on antidepressants or anti-anxiety medication and more than six times as likely to make suicide attempts resulting in hospitalisation.

“Despite the reductions in mental health care following gender-affirming surgery, the prevalence of mental health treatment for transgender individuals continued to exceed that of the general population,” Richard Bränström, a visiting professor at Yale from the Karolinska Institutet in Sweden who co-authored the study, said.

“The data identifies a clear need for expanding mental health support and other treatment options for this increasingly visible segment of the global population.”