Transgender individuals who undergo gender-affirming surgery are significantly less likely to seek mental health treatment for depression and anxiety disorders or attempt uicide in the years following the procedure, new research led by the Yale School of Public Health finds.
Published in the American Journal of Psychiatry, the study reviewed 10 years of medical data for the entire population of Sweden and is believed to be the first analysis of the long-term effect of hormone therapy and gender-affirming surgery on transgender individualsâ€™ mental health based on a countryâ€™s population.
While more than 95 percent of the transgender individuals who had surgery also received hormone therapy, the researchers found that hormone therapy alone did not significantly reduce the likelihood of mental health therapy visits and psychiatric medications for individuals diagnosed with gender incongruence.
For those who underwent surgery, however, the likelihood that they would receive mental health treatment for depression and anxiety disorders was reduced by 8 percent for each year after the procedure, the study found.
â€œWe 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,â€� said co-author John Pachankis, the Susan Dwight Bliss Associate Professor of Public Health at the Yale School of Public Health. â€œNo longer can we say that we lack high-quality evidence of the benefits of providing gender-affirming surgeries to transgender individuals who seek them.â€�
Richard BrÃ¤nstrÃ¶m, an associate professor at the Karolinska Institutet in Sweden and visiting professor at the Yale School of Public Health, co-authored the study.
An estimated 1 million to 1.5 million individuals in the United States alone are believed to identify as transgender. Although gender-affirming surgeries are medically recommended for individuals experiencing gender incongruence who desire such treatments, such care remains unavailable or unaffordable in some U.S. states and in many countries around the world.
Denial of surgery increases the likelihood that transgender individuals will seek alternate treatments such as unsupervised use of hormone medication or risky surgeries that exacerbate health risks. Lack of access to appropriate care can also heighten mental health distress, including elevating the risk of suicide for transgender individuals, the study said.
The studyâ€™s findingsâ€”linking gender-affirming surgeries with significant reductions in mental health careâ€”â€œshould help inform policymakers of the cost effectiveness of gender-affirming treatments given the very high cost of mental health problems to society,â€� Pachankis said.
The study analyzed medical outcomes between 2005 and 2015 for 2,679 individuals in Sweden who had received a diagnosis of gender incongruence.
The study also found that transgender individuals seeking gender-affirming care:
â€œDespite 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,â€� BrÃ¤nstrÃ¶m said. â€œThe data identify a clear need for expanding mental health support and other treatment options for this increasingly visible segment of the global population.â€�
The full study can be found on the American Journal of Psychiatry website at https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010080.