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 名紀錄中註明過去做過性別手術、並曾急診就醫的成人中，3.47% 在五年內有自殺未遂紀錄，而 1,560 萬名其他急診患者為 0.29%，高出約 12 倍。
• 與 1,489 名接受輸精管結紮或輸卵管結紮的配對患者相比，自殺未遂為 3.50% 對 0.74%，高出近 5 倍。
• 與同一組絕育患者相比，有紀錄的死亡（4.9% 對 1.1%）、自殺或自傷（4.5% 對 0.9%）和創傷後壓力（9.2% 對 2.8%）也較高。
• 各組只依年齡、性別、種族和族裔配對；過去的心理健康診斷、過去的自殺未遂、荷爾蒙使用和收入都沒有納入考慮。
• 研究對象是依據代表「有性別重置的個人史」的紀錄代碼找到的，因此手術的類型和日期不明，五年期間的起點也不清楚。
• 與喉嚨痛患者的比較得出大致相似的結果（配對前自殺未遂約多 8 倍），不過事件太少，無法報告配對後的數字。
• 2024 年 6 月，期刊編輯更正了摘要和結論，刪除了說手術本身與較高自殺未遂風險有關的措辭，改為說接受手術的患者風險較高。
• 作者承認，這項研究顯示的是關聯，而不是因果，並結論是性別手術後的數年間需要完整的心理健康照護。

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.