Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study

Abstract

Abstract Background Despite professional recommendations to consider gender-affirming hormonal and surgical interventions for transgender individuals with gender dysphoria, the long-term effect of such interventions on mental health is largely unknown. This study aims to ascertain the prevalence of mood and anxiety disorder healthcare visits and antidepressant and anxiolytic prescriptions in 2015 as a function of gender dysphoria diagnosis and gender-affirming medical treatment in the entire Swedish population. Methods This study used the Swedish Total Population Register (n = 9,747,324), linked to the National Patient Register and Prescribed Drug Register. Among those who received a gender dysphoria diagnosis between 2005 and 2015 (n = 2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming medical treatment. The main outcome measure was mood and anxiety disorder healthcare visits and antidepressant and anxiolytic prescriptions. Results Compared to the general population, individuals diagnosed with gender dysphoria were about six times as likely to have had a mood and anxiety disorder healthcare visit and more than three times as likely to have been prescribed antidepressants and anxiolytics. Years since initiating hormones was not significantly related to likelihood of mental health treatment (AOR: 1.01; 95% CI: 0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (AOR: 0.92; 95% CI: 0.87, 0.98). Conclusions In this first total population study of transgender individuals diagnosed with gender dysphoria, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them. Main messages: This study lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.