Gender-affirming Surgery Improves Quality of Life Despite External Societal Factors Influencing Detransition

Background:. Gender-affirming surgery (GAS) has been shown to reduce psychological distress and suicidal ideation among transgender individuals. However, few studies have examined its broader societal benefits or the factors contributing to detransition. This study assessed these outcomes using data from the 2015 US Transgender Survey. Methods:. A cross-sectional analysis was conducted using responses from 27,000 transgender and nonbinary individuals across all 50 US states. Primary exposures included demographics, healthcare access, family and workplace support, and GAS status. Outcomes included detransition likelihood and societal benefits of GAS such as reduced harassment and substance use and increased civic participation. Logistic regression models were used. Results:. More than 90% of detransition cases were attributed to external pressures, including family rejection and job insecurity. Lower income (odds ratio [OR] = 1.684; P = 0.0386) and workplace discrimination (OR = 1.277; P = 0.0343) increased detransition risk, whereas family support reduced it by 24% (OR = 0.765; P = 0.0454). Individuals who underwent GAS were 27% less likely to detransition (OR = 0.725; P = 0.0192). GAS was also associated with reduced harassment (OR = 0.693; P = 0.0078), decreased sex work involvement (OR = 0.685; P = 0.0488), and increased civic participation (OR = 1.339; P = 0.0005). Conclusions:. GAS offers significant societal benefits beyond mental health. Detransition is rare and primarily driven by external pressures rather than regret. Expanding access to GAS, legal protections, and family support may reduce involuntary detransition.

Abstract licence: CC BY-NC-ND

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