Summary
- Gender-affirming surgery is a safe and effective procedure to resolve gender dysphoria, a mental health condition which can cause severe depression and anxiety
- Gender-affirming surgery saves the NHS money in the long-term by improving mental and physical health
- Gender-affirming surgery is not available to under-18s and can take over 100 years to receive on the NHS
Is gender-affirming surgery safe?
Evidence shows that gender-affirming surgery is a safe procedure with a low risk of complications (Akhavan et al., 2021). Multiple safeguards are put in place to ensure that no individual receives unnecessary gender-affirming surgery.
To be eligible for gender-affirming surgery in the UK, a patient must:
- Be over 18 and capable of informed consent
- Have been diagnosed by a doctor or clinical psychologist
- Have fully socially transitioned gender
- Have already begun medical intervention (hormone replacement therapy)
All patients must provide signed informed consent before any surgery is allowed to go ahead.
Is gender-affirming surgery clinically effective?
Gender-affirming surgery can be highly effective at reducing gender dysphoria and can have a huge impact on an individual’s mental health and wider life in the long term (Park et al., 2022). A large body of literature supports the offer of gender-affirming surgery (Chou et al., 2023).
Regret rates in gender-affirming surgery are significantly lower than in other surgeries (e.g. hip surgery): one systematic review showed regret rates of less than 1% for gender-affirming surgery, compared to an average regret rate of 14.4% across all surgeries (Bustos et al., 2021)
In many cases, gender-affirming surgery is essential to prevent self-harm or suicide.
Is gender-affirming surgery cost-effective?
Untreated mental health conditions cost the NHS more in the long-term (Țîbîrnă et al., 2026). This is because individuals with poor mental health are less likely to have good physical health, or engage with healthcare professionals when their health is at risk.
By offering gender-affirming surgery, the NHS saves money that would need to be spent treating the consequences of untreated gender dysphoria over the next 50 years (Go, 2018).
Can children get gender-affirming surgery?
No under-18s are eligible for gender-affirming surgery anywhere in the UK.
Due to waiting list lengths, the typical age for an NHS gender-affirming surgery patient is 26.
Can people be forced into gender-affirming surgery?
Getting gender-affirming surgery is a substantial process which can take from 5 – 200 years on the NHS. To have surgery, multiple meetings with surgeons, and eventually signed informed consent, are needed. Many trans people do not have gender-affirming surgery.
What about the evidence against gender-affirming surgery?
There is a small body of evidence that has been used to further political aims. In most cases, these studies have not shown what has been claimed. For instance, Straub et al. (2024) is frequently cited as showing that gender-affirming surgery makes mental health worse, not better. In fact, it acknowledges that it does not provide a long-term view, but instead makes the point that surgery can be traumatic in a population already at risk for PTSD; therefore, enhanced psychiatric support is still needed after surgery.
References
Akhavan, A. A., Sandhu, S., Ndem, I., & Ogunleye, A. A. (2021). A review of gender affirmation surgery: What we know, and what we need to know. Surgery, 170(1), 336–340. https://doi.org/10.1016/j.surg.2021.02.013
Bustos, V. P., Bustos, S. S., Mascaro, A., DelCorral, G., Forte, A. J., Ciudad, P., Kim, E. A., Langstein, H. N., & Manrique, O. J. (2021). Regret after gender-affirmation surgery: A systematic review and meta-analysis of prevalence. Plastic & Reconstructive Surgery Global Open, 9(3), e3477. https://doi.org/10.1097/GOX.0000000000003477
Chou, J., Kilmer, L. H., Campbell, C. A., DeGeorge, B. R., & Stranix, J. Y. (2023). Gender-affirming surgery improves mental health outcomes and decreases anti-depressant use in patients with gender dysphoria. Plastic & Reconstructive Surgery Global Open, 11(6), 1. https://doi.org/10.1097/01.GOX.0000944280.62632.8c
Go, J. J. (2018). Should gender reassignment surgery be publicly funded? Journal of Bioethical Inquiry, 15(4), 527–534. https://doi.org/10.1007/s11673-018-9881-6
Park, R. H., Liu, Y., Samuel, A., Gurganus, M., Gampper, T. J., Corbett, S. T., Shahane, A., & Stranix, J. T. (2022). Long-term outcomes after gender-affirming surgery. Annals of Plastic Surgery, 89(4), 431–436. https://doi.org/10.1097/SAP.0000000000003233
Straub, J. J., Paul, K. K., Bothwell, L. G., Deshazo, S. J., Golovko, G., Miller, M. S., & Jehle, D. V. (2024). Risk of suicide and self-harm following gender-affirmation surgery. Cureus : Journal of Medical Science, https://doi.org/10.7759/cureus.57472
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