The Effect of Gender-Affirming Surgery on Mental Health in the Transgender Community : Plastic and Reconstructive Surgery

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The Effect of Gender-Affirming Surgery on Mental Health in the Transgender Community

Cátala-Rivera, Natalia A.; Ramírez, Andrea M.D.; Obando, Duneska D. M.D.; Piplani, Charoo M.B.B.S.; Torres-Guzman, Ricardo A. M.D.; Garcia, John P. M.D.

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Plastic and Reconstructive Surgery: September 2022 - Volume 150 - Issue 3 - p 715e-717e
doi: 10.1097/PRS.0000000000009421
  • Free

Gender-affirming procedures allow transgender individuals to alter their appearance and sexual characteristics to resemble those associated with the sex with which they identify. These are considered elective procedures rather than a prioritized course of action to treat a medical condition. As a result, they are not widely accessible, are unprecedently complicated, and have significant effects on the mental health of the transgender population. One way to help establish these procedures as priorities in the medical community is to highlight the positive effects of gender affirmation on the transgender community, in the hopes that it becomes emergent medical care in the future.

First, accessibility to gender-affirming procedures is skewed among the transgender population. A major barrier to accessing gender-affirming care is a patient’s financial situation. Individuals of lower socioeconomic status are less likely to have received gender-affirming surgery despite a demonstrated need.1 One way to improve accessibility of these interventions is coverage by health insurance plans. A 2016 study2 details how U.S. health insurance plans deny transgender enrollees coverage for medically necessary services and explains that covering such services is cost-effective for insurance providers, given that it addresses the root cause of other adverse outcomes of gender dysphoria, such as substance abuse, sexually transmitted infections, depression, and suicidality. The study concluded that health insurance coverage for the U.S. transgender population is affordable, is cost-effective, and has a low budgetary effect on U.S. society.2

In addition, individuals with access to these procedures are subjected to a tumultuous postoperative reality. A gender-affirming surgery, for example, is not a one-time thing, and with it comes a host of unclear complications. A 2021 study3 illustrates the reality behind one of these interventions. Mentioned complications include neovaginal stenosis and necrosis, prolapse, fistulas, delayed wound healing, and permanent scarring. The rate at which these complications occur is not specified, ranging from 7 percent to 46 percent. Furthermore, patients face years of follow-up and comorbidities after these procedures.3 This is a huge price to pay for life-saving surgery.

Most importantly, denial of gender affirmation to transgender individuals has negative implications for their mental health. In a 2021 study4 analyzing data from the 2015 U.S. Transgender Survey, researchers found increased psychological distress, substance use, and suicidality among 3559 transgender persons who had undergone gender-affirming surgeries compared with 16,401 transgender persons who desired but had no access to gender-affirming surgeries. The authors determined that psychological distress decreased by 42 percent in the month after gender-affirming surgery and suicidal ideation decreased by 44 percent in the year after gender-affirming surgery.4 These procedures decrease mental health comorbidities among the transgender community and significantly improve quality of life.

Gender-affirming interventions should be a priority in the care of transgender patients. With increased accessibility, improved techniques that minimize comorbidities and complications, and upholding the goal of optimizing mental health, this community’s quality of life can be improved significantly.

references

1. de la Cretaz B. Trans people with access to gender-affirming surgery have better mental health. Condé Nast. Published online April 29, 2021. Available at: https://www.them.us/story/trans-people-with-access-gender-affirming-surgery-better-mental-health-study. Accessed June 21, 2021.
2. Padula WV, Heru S, Campbell JD. Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: A cost-effectiveness analysis. J Gen Intern Med. 2016;31:394–401.
3. Salibian AA, Schechter LS, Kuzon WM, et al. Vaginal canal reconstruction in penile inversion vaginoplasty with flaps, peritoneum, or skin grafts: Where is the evidence? Plast Reconstr Surg. 2021;147:634e–643e.
4. Almazan AN, Keuroghlian AS. Association between gender-affirming surgeries and mental health outcomes. JAMA Surg. 2021;156:611–618.

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