The Impact of Gender-affirming Surgeries on Suicide-related Outcomes: A Systematic Review

Abstract

Being transgender has been linked to poor mental health indicators, especially those related to suicide. We aimed to review the impact of gender-affirming surgeries (GAS) on suicidal behavior in the transgender population. An advanced search was conducted on PubMed until February 28, 2022, and a total of 11 studies were considered eligible. Data were extracted on the size of sample population, control group, type of procedure, means of assessment, duration of time between surgery and assessment, and suicide-related outcomes. The considered outcomes were suicidal ideation, suicide attempts, and death by suicide. Five studies compared the same patients pre- and post-GAS, while six studies compared patients who underwent GAS with a group who did not. Overall, suicide-related outcomes were found to be less frequent in patients after GAS when compared to those same patients’ pre-GAS indicators. The two studies that used either the general population or matched age and sex controls found a much higher prevalence of suicide-related outcomes, specifically suicide attempts and death by suicide, in post-GAS patients than in control groups. However, the studies that compared the treatment groups with either patients in an earlier phase of the transition or those who desired but had not yet undergone surgery showed lower post-GAS suicide-related outcomes, including suicidal ideation and suicide attempts. Suicidal ideation was generally found to decrease post-GAS; results regarding suicide attempts were inconsistent, and there was insufficient data to draw any conclusion about the effects of GAS on death by suicide.