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According to this study:

METHODS: All persons undergoing feminizing (vaginoplasty) and masculinizing (metoidioplasty/ phalloplasty) genital gender affirming surgery were identified in California from 2012-2018 from the Office of Statewide Health Planning and Development datasets using appropriate ICD-9/10 codes. All emergency room and inpatient psychiatric encounters were identified (noting those involving suicide attempts). Rates of these encounters were calculated before and after gender affirming surgery (using date of first operation if staged). On average, patients had a balanced two years of observation before and after their surgery.

RESULTS: Overall, 869 and 357 patients were identified undergoing vaginoplasty and phalloplasty with 193 (22.2%) and 74 (20.7%) having at least one psychiatric encounter (Table 1). Although the overall proportion of those experiencing a psychiatric encounter was similar between the vaginoplasty and phalloplasty groups, suicide attempts were more common in the vaginoplasty group (4.4% vs. 1.7%, p=0.033). The rate of a psychiatric encounter occurring after surgery if an episode prior surgery occurred was 33.9% and 26.5% for the vaginoplasty and phalloplasty groups. The overall rates of suicide attempts doubled (3.3 vs 1.5%, p=0.017) after vaginoplasty (effect not observed after phalloplasty).

CONCLUSIONS: Rates of psychiatric emergencies are high both before and after gender affirming surgery. Although both the phalloplasty and vaginoplasty patients have similar overall rates of psychiatric encounters, suicide attempts are more common in the later. In fact, our observed rate of suicide attempts in the phalloplasty group is actually similar to the general population, while the vaginoplasty group's rate is more than double that of the general population. Patients undergoing GAS with a history of prior psychiatric emergences or feminizing transition are at higher risk and should be counseled appropriately.

This makes no sense to me. How come phalloplasty doesn't see the same results as vaginoplasty?

Is the study's conclusion that vaginoplasty patients have twice the suicide attempt rate as the general population?

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    Note the first sentence of the conclusion: rates are high both before and after surgery. There's no suggestion of a causal link between surgery and suicide.
    – IMSoP
    Commented May 18 at 18:12
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    You ask "How come phalloplasty doesn't see the same results as vaginoplasty?" but you give absolutely no reason why they should be the same. It doesn't seem at all surprising to me that two very different surgeries with very different societal repercussions should have different outcomes, so the 'why' question seems nonsensical.
    – Oddthinking
    Commented May 19 at 5:00
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    @IMSoP "The overall rates of suicide attempts doubled (3.3 vs 1.5%, p=0.017) after vaginoplasty (effect not observed after phalloplasty)." This doesn't suggest a causal link?
    – Kyralessa
    Commented May 19 at 14:00
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    People who take insulin are more likely to die of diabetes than people who don't. I wonder why insulin hasn't been banned? Commented May 22 at 3:21
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    Nothing in this study suggests that the surgery caused more suicide attempts. It just shows that people who undergo sexual transition and who already had "at least one psychiatric encounter" prior to gender affirming surgery are not magically OK after this surgery. Transitioning is a lengthy process that (for most people) takes several years and involves much more than just changes to the genitals. Hostile behavior by other people doesn't magically stop after gender affirming surgery, so the psychological pressure that drives people to suicide doesn't stop either.
    – Elmy
    Commented May 24 at 11:31

1 Answer 1

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Is the study's conclusion that vaginoplasty patients have twice the suicide attempt rate as the general population?

Yes. That's a correct interpretation of the study: in aggregate, people who undergo surgical vaginoplasty are much more likely to commit suicide. However, the study is analyzing the correlation between them, not the causality, so it does not necessarily imply that the surgery causes them to be more suicidal.

Are post-vaginoplasty recipients more suicidal?

Yes, this claim is true in general even as accessed by other studies outside of the one mentioned. [1] [2] Straub et al find that "gender-affirming surgery is significantly associated with elevated suicide attempt risks..."

This makes no sense to me. How come phalloplasty doesn't see the same results as vaginoplasty?

Although the purpose of phalloplasty and vaginoplasty is similar (i.e to "reassign" the sex of the patient), the actual surgeries are completely different. Therefore, it's not surprising that they have different outcomes as well.

Consider also that the sex of patients differs in those two surgeries. Men and women have a different overall suicide rate, and there's no reason to assume that society treats transgender men the same way as transgender women. In other words, there are potential causal factors and potential correlational factors which could change the suicide rate between vaginoplasty patients and phalloplasty patients.

The study you linked to doesn't attempt to say which of those are the reasons for the discrepancy, although there are other studies which do attempt to roughly categorize the most common "final causes".


[1]: Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden Dhejne C, Lichtenstein P, Boman M, Johansson ALV, Långström N, et al. (2011) Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLOS ONE 6(2): e16885. https://doi.org/10.1371/journal.pone.0016885

[2]: Straub JJ, Paul KK, Bothwell LG, Deshazo SJ, Golovko G, Miller MS, Jehle DV. Risk of Suicide and Self-Harm Following Gender-Affirmation Surgery. Cureus. 2024 Apr 2;16(4):e57472. doi: 10.7759/cureus.57472. PMID: 38699117; PMCID: PMC11063965.

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