M. Levine1, Z. Freedman1, O. Waldron1, L. Levine2 1Penn State University College Of Medicine, Hershey, PA, USA 2North Shore University And Long Island Jewish Medical Center, Manhasset, NY, USA
Introduction: The decision to undergo gender affirming surgery is difficult for individuals with gender dysphoria disorder due to cost, recovery time, and possible complications. It is well–established that transgender individuals have higher rates of mental health disorders and substance use than the general population, but the effects of gender affirming surgery on mitigating these factors are less understood. Our aim is to characterize how undergoing or not undergoing gender-affirming surgery impacts the development of substance abuse and psychological disorders in this population.
Methods: A retrospective analysis was conducted using TriNetX, a multi-institutional de-identified database that operates through Current Procedure Terminology (CPT) and International Classification of Diseases (ICD) codes. Assigned females at birth (AFAB) over 18 years of age with a diagnosis of gender dysphoria disorder within TriNetX from inception to August 2023 were included in the study. The cohort was then separated based on undergoing gender affirming surgery. If a patient had a previous substance use disorder or psychological disorder, they were removed from that specific analysis. Risks of developing Opioid Use Disorder (OUD), Cannabis Use Disorder (CUD), Alcohol Use Disorder (AUD), cocaine dependence, nicotine dependence, depression, anxiety, and attempted suicide were determined any time following diagnosis in the non-surgical group, and starting 1 day after surgery in the surgical group. Propensity score matching was used to balance cohorts based on age, race, and ethnicity. A p-value <0.05 was used to determine statistical significance.
Results: After selection criteria were met, 35,299 AFAB were in the non-surgical cohort while 5,189 AFAB were in the surgical cohort. Following propensity score matching 5,189 AFAB remained in both groups. AFAB who did not receive gender affirming surgery had a higher risk of developing OUD (p=0.014), CUD (p=0.005), AUD (p=0.001), cocaine dependence (p=0.002), nicotine dependence (p<0.001), depression (p<0.001), anxiety (p<0.001), OCD (p=0.039), and attempted suicide (p=0.006) than individuals who did receive surgery.
Conclusion: Based on our study, AFAB with gender dysphoria who did not receive gender affirming surgery had a higher risk of developing OUD, CUD, AUD, nicotine dependence, depression, anxiety, and attempted suicide than those who did receive surgery. This data suggests that gender affirming surgery may play a positive role in improving quality of life in AFAB with gender dysphoria disorder. Additional research is required to characterize this effect further, as well as evaluate the impact of surgery on assigned males at birth (AMAB) and children.
