In recent years, gender-affirming surgeries have been promoted as a vital solution for transgender individuals struggling with gender dysphoria—the distress of feeling a mismatch between one’s body and gender identity. Advocates argue that these procedures, which alter physical characteristics to align with a person’s identified gender, can ease mental anguish and improve quality of life. However, a growing body of evidence and expert opinion is casting doubt on this narrative, suggesting that these surgeries may not only fail to deliver the promised relief but could even worsen mental health struggles. As the debate heats up, it’s worth asking: Are we rushing into irreversible decisions without fully understanding the consequences?
A Troubling Connection to Mental Health Decline
A new study from The Journal of Sexual Medicine has raised serious red flags. Researchers at the University of Texas analyzed medical records of over 107,000 adults diagnosed with gender dysphoria, comparing those who underwent gender-affirming surgeries to those who didn’t. The results were startling. Men who had surgery faced a depression rate of 25.4%, compared to just 11.5% for those who didn’t. Anxiety rates were similarly alarming—12.8% for surgical patients versus 2.6% for non-surgical ones. Women showed a similar pattern, with depression hitting 22.9% post-surgery compared to 14.6% without it. Substance abuse and suicidal thoughts also spiked among those who went under the knife.
What’s more, surgeries aimed at feminizing the body—like turning male anatomy into female—were linked to especially high levels of distress afterward. Far from being a cure, these procedures seem to amplify the very problems they’re meant to solve. The researchers used a massive database called TriNetX, pulling data from 56 healthcare organizations across the U.S., and tracked patients for two years after surgery. Even after accounting for factors like age and race, the pattern held: surgery often led to worse mental health outcomes.
Experts Sound the Alarm
This isn’t just numbers on a page—experts are taking notice. Psychotherapist Jonathan Alpert, based in Manhattan, warns that while surgery might help someone’s body match their identity, it’s not a magic fix for deeper psychological pain. “They are not a cure-all,” he says bluntly. Florida neurosurgeon Dr. Brett Osborn goes further, questioning whether the surgery itself might be causing harm. “Is the distress coming from the procedure, or were these struggles already there?” he asks. No one’s sure yet, but the uncertainty is unsettling.
The reality is, transgender individuals face unique challenges—stigma, rejection, and isolation—that can weigh heavily on mental health. Some argue that these external pressures, not the surgeries, are to blame for the distress. But if that’s true, why do rates of depression and anxiety jump so much after surgery? It’s a question that demands more than wishful thinking.
The Youth Factor: A Dutch Debate
The risks don’t stop with adults. In the Netherlands—where the “Dutch Protocol” for youth gender transitions was born—experts are starting to push back. This protocol, updated in 2018, guides doctors worldwide on using puberty blockers and hormones for kids with gender dysphoria. But a 2023 debate, sparked by medical articles, legal critiques, and a documentary, has exposed cracks in the system. Critics point out that puberty blockers—drugs that halt natural development—might lock kids into a medical path they can’t escape, even if their feelings change later. Studies show that 94-98% of kids on blockers move on to hormones, raising fears of a “conveyor belt” effect.
Worse, the long-term impact of these drugs on brain development is a giant question mark. One study found IQ drops in kids given blockers for other conditions, hinting at potential cognitive risks. Dutch critics are now calling for a major overhaul—limiting medical interventions to rare cases and focusing on counseling instead. Countries like Sweden and Finland are already moving in this direction, prioritizing mental health support over scalpels and syringes.
Rushing Into the Unknown
Back in the U.S., the push for surgery is hitting roadblocks too. Federal judges recently blocked Trump-era rules that would’ve cut funding for gender-affirming care, showing how heated this issue has become. Meanwhile, states like Texas and Iowa are tightening restrictions, with Texas eyeing a ban on these procedures for adults and Iowa stripping “gender identity” from its civil rights protections. Even California’s Governor Gavin Newsom, a longtime progressive, admitted on a podcast that letting trans-identified males compete in women’s sports—a related debate—is “deeply unfair.”
The science isn’t settled either. A 2023 review in Cureus found shaky evidence that surgery reduces suicidality, with sloppy research muddying the waters. Another 2022 study by Daniel Jackson echoed this, pointing to biases and weak methods in studies claiming benefits. The Cass Review in England went even further, slamming the “remarkably weak” evidence for puberty blockers in kids—a stance backed by The Times, which called trials of these drugs “macabre” given the known harms like infertility and stunted growth.
A Call for Caution
So where does this leave us? Gender dysphoria is real, and those who experience it deserve compassion and care. But rushing into surgery—especially for young people whose identities are still forming—might be doing more harm than good. The data suggests it’s not the fix we’ve been sold. Depression, anxiety, and regret don’t vanish post-op; they often grow. Experts like Alpert and Osborn urge a slower approach—therapy, lifestyle changes, and thorough evaluations before anything permanent happens. “You don’t amputate a limb for temporary pain,” Alpert warns. Why should this be different?
As the debate rages on, one thing’s clear: we need better answers. Surgery might feel like a quick solution, but the risks—mental, physical, and emotional—are too big to ignore. For now, maybe it’s time to step back, ask hard questions, and put well-being first—not ideology or haste.
