Transgender Surgeries in US Nearly Tripled in 3 Years

"Gender-affirming" surgeries have become lucrative business, but that raises ethical questions as research reveals problems with complications and quality of life.UfaBizPhoto/Shutterstock

Transgender surgeries nearly tripled in the United States between 2016 and 2019, with breast and chest procedures accounting for 56.6 percent of all operations, results of a study published Wednesday in the JAMA Network Open show.

Close behind was genital reconstruction, making up 35.1 percent, followed by facial and cosmetic procedures at 13.9 percent. The greatest number of procedures overall were undergone by women, 19- to 30-year-olds, people with private insurance, and people with higher incomes. Most procedures occurred in the West and were performed in urban teaching hospitals.

When divided into subgroups, breast and chest procedures comprised more of the surgical interventions in younger patients. Genital procedures were higher in older patients.

About 15 percent of the over 48,000 respondents examined indicated mental health or addiction problems, including drug and alcohol abuse, depression, and psychosis.

“These findings suggest that there will be a greater need for clinicians knowledgeable in the care of transgender individuals with requisite expertise to perform gender-affirming procedures,” the study authors wrote.

What Are the Dangers of Transgender Surgery?

Transgender surgeries do not come without potential dangers. Evidence concerning regret rate, long-term medical complications, effects of hormonal therapy, and the link between surgeries and depression and suicide rates require further study.

Side Effects 

A 2021 study found reoperations due to long-term complications following breast augmentations do happen. Implant ruptures, capsular contractures (an immune response to breast implants resulting in scar tissue), and aesthetic problems can occur anywhere from 30 days to 5.5 years after surgery.

According to the American Society of Plastic Surgeons, side effects of reconstructing male genitalia to female genitalia, known as transfeminine bottom surgery, include the following:

• Bleeding.
• Infection.
• Poor incision healing.
• Hematoma.
• Nerve injury stenosis of the vagina.
• Inadequate vaginal depth.
• Urinary tract injury.
• Abnormal connections between the urethra and the skin.
• Painful intercourse.

Suicide Risk and Attempts

A study published in PLOS One highlighted the alarming rates of suicide and suicide attempts in people who underwent sex-reassignment surgery. Experiment results by researchers in Sweden found people who underwent sex reassignment were 4.9 times more likely to attempt suicide and 19.1 times more likely to die of suicide than the controls.

“Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population,” the authors wrote. “Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.”

Updated Recommendations

Hormone therapy is recommended and sometimes required for some patients before breast and chest surgery.

However, evidence supporting hormone therapy for transgender individuals is inconclusive.

The Tavistock Centre in London, characterized as a clinic for young people facing gender identity difficulties, is slated to close by the end of 2023 after an independent review (pdf) cited a lack of conclusive evidence supporting routine recommendations of hormone therapies such as puberty blockers, among other complications in running the clinic.

The clinic closure comes on the heels of Sweden’s National Board of Health and Welfare’s 2022 updated recommendations. Board officials concluded there was insufficient scientific evidence on “gender-affirmative” care, calling for caution and restraint in hormonal interventions for minors.

“The update to the Swedish treatment guidelines represents an impressive step toward safeguarding the growing numbers of gender dysphoric youth from medical harm arising from inappropriate gender transition,” health officials wrote in the recommendations.