Summary

Researchers searched a large US health-record database for adults whose records noted a past sex-change surgery and who had an emergency visit. They compared five years of records with those of other emergency patients. Recorded suicide attempts, deaths, self-harm and post-traumatic stress were all several times more common in the surgery group. Suicide attempts were 12 times more common than among all emergency patients, and nearly 5 times more common than among people who had a vasectomy or had their tubes tied. The study shows this group carries a heavy mental health burden. But it cannot say whether surgery raised, lowered or did not change it. It did not compare trans people with and without surgery, and did not account for past mental health. In June 2024 the journal's editors corrected the conclusions to remove wording linking the risk to the surgery itself.

Key findings

• 在1,501名记录注明过去做过性别手术且有过急诊就诊的成年人中，3.47%在五年内有自杀未遂记录，而1,560万名其他急诊患者为0.29%，高出约12倍。
• 与1,489名做过输精管结扎或输卵管结扎的配对患者相比，自杀未遂为3.50%对0.74%，高出近5倍。
• 与同一绝育组相比，记录在案的死亡（4.9%对1.1%）、自杀或自伤（4.5%对0.9%）以及创伤后应激（9.2%对2.8%）也更高。
• 各组仅按年龄、性别、种族和族裔配对；过去的心理健康诊断、过去的自杀未遂、激素使用和收入均未考虑在内。
• 人们是通过表示“性别重置的个人史”的记录代码找到的，因此手术的类型和日期不明，五年窗口的起点也不清楚。
• 与咽喉痛患者的比较给出了大致相似的结果（配对前自杀未遂约多8倍），不过发生的事件太少，无法报告配对后的数字。
• 2024年6月，期刊编辑更正了摘要和结论，删除了说手术本身与较高的自杀未遂风险有关的措辞，改为说接受手术的患者风险更高。
• 作者承认，该研究显示的是关联而非原因，并得出结论认为，在性别手术之后的几年里需要全面的心理健康护理。

Abstract

Introduction With the growing acceptance of transgender individuals, the number of gender affirmation surgeries has increased. Transgender individuals face elevated depression rates, leading to an increase in suicide ideation and attempts. This study evaluates the risk of suicide or self-harm associated with gender affirmation procedures.

Methods This retrospective study utilized de-identified patient data from the TriNetX (TriNetX, LLC, Cambridge, MA) database, involving 56 United States healthcare organizations and over 90 million patients. The study involved four cohorts: cohort A, adults aged 18-60 who had gender-affirming surgery and an emergency visit (N = 1,501); cohort B, control group of adults with emergency visits but no gender-affirming surgery (N = 15,608,363); and cohort C, control group of adults with emergency visits, tubal ligation or vasectomy, but no gender-affirming surgery (N = 142,093). Propensity matching was applied to cohorts A and C. Data from February 4, 2003, to February 4, 2023, were analyzed to examine suicide attempts, death, self-harm, and post-traumatic stress disorder (PTSD) within five years of the index event. A secondary analysis involving a control group with pharyngitis, referred to as cohort D, was conducted to validate the results from cohort C.

Results Individuals who underwent gender-affirming surgery had a 12.12-fold higher suicide attempt risk than those who did not (3.47% vs. 0.29%, RR 95% CI 9.20-15.96, p < 0.0001). Compared to the tubal ligation/vasectomy controls, the risk was 5.03-fold higher before propensity matching and remained significant at 4.71-fold after matching (3.50% vs. 0.74%, RR 95% CI 2.46-9.024, p < 0.0001) for the gender affirmation patients with similar results with the pharyngitis controls.

Conclusion Patients who have undergone gender-affirming surgery are associated with a significantly elevated risk of suicide, highlighting the necessity for comprehensive post-procedure psychiatric support.

Conclusion

The results of this study indicate that patients who have undergone gender affirmation surgery are associated with significantly higher risks of suicide, self-harm, and PTSD compared to general population control groups in this real-world database. With suicide being one of the most common causes of death for adolescent and middle-aged individuals, it is clear that we must work to prevent these unfortunate outcomes. This further reinforces the need for comprehensive psychiatric care in the years that follow gender-affirmation surgery.