“Gender-affirming” surgery is associated with increased risk of depression, anxiety, suicidal ideation, and substance use disorders.
A 2025 U.S. national database study1 examined over 107,000 adults diagnosed with gender dysphoria to compare those who did and did not undergo “gender-affirming” surgery. Using matched cohorts controlling for age, race, and ethnicity, the study found significantly higher risks of depression, anxiety, suicidal ideation, and substance use disorders within two years after surgery.
For males who had surgery, depression was 25.4% vs. 11.5% without surgery (RR 2.20) and anxiety 12.8% vs. 2.6% (RR 4.88). Females also showed increased rates: depression 22.9% vs. 14.6% (RR 1.56) and anxiety 10.5% vs. 7.1% (RR 1.48). Those undergoing feminizing procedures had particularly elevated risk for depression (RR 1.78) and substance use disorders (RR 1.28).