The Impact of Gender-Affirming Care on Suicide Rates

Written by Giovanna D’Ambrosio. Medically reviewed by Dr. Scott Mosser on February 2, 2025.

Understanding Gender-Affirming Care and Its Significance

The US Dept of Health and Human Services defines gender-affirming care as medical and non-medical interventions for minors and adults such as social affirmation, hormonal therapy and puberty blockers, as well as gender-affirming surgery.

Gender-affirming medical care encompasses a variety of interventions: hormonal therapy, surgery, vocal therapy, psychotherapy and more. Through accepting, embracing and affirming the patient’s gender-identity, medical gender affirmation helps trans, non-binary and gender non-conforming people treat gender dysphoria and meet their gender embodiment goals.

Several peer reviewed studies have demonstrated how addressing gender incongruence in gender diverse patient can significantly improve their mental health and other quality of life indicators such as self-esteem, positive body image and lower instances of suicidality in some cases.

Statistical Overview of Suicide Rates Among LGBTQ+ Individuals

In the 2015 United States Trans Survey (USTS), transgender adults reported a suicide attempt rate nine times higher than that of the general population in the US. The reported rate of suicide attempts in a person’s lifetime was even higher for trans people with disabilities. Other peer-reviewed research has demonstrated how trans adults and youth have higher rates of suicide than their cisgender peers. Not to mention, trans veterans are 20 times more likely to attempt suicide than their cisgender counterparts.

Sadly, this is a problem that plagues not just gender diverse adults, but also minors. A study published by The Trevor Project researchers in 2022 found that LGBTQ+ youth were up to three times more likey to attempt suicide than their cisgender, heterosexual peers.

Within the LGBTQ+ community, transgender, non-binary and other gender diverse people tend to be some of the most vulnerable to suicide. A 2020 peer-reviewed study by The Trevor Project researchers found that trans and non-binary youth were over twice as likely as cisgender lesbian, gay and bisexual youth to attempt suicide, seriously consider it and experience major depressive symptoms. A 2023 national survey found that LGBTQ+ youth of color were more likely than their white peers to attempt suicide. Amongst this group, Native American and Indigenous trans, two-spirit and non-binary minors consistently report the highest suicide risk of any othe ethno-racial group.

More recent research has shown that trans youth are at a greater risk of suicide if they live in states where anti-trans legislation is passed. These statistics not only underscore the need for access to quality gender-affirming medical care, but also protections of gender diverse people’s rights more broadly and the creation of safe spaces for trans youth.

The Link Between Gender Dysphoria and Mental Health

The DSM IV describes dysphoria as psychological distress that arises from the incongruence between one’s gender identity and sex assigned at birth. Gender dysphoria can arise from feeling like parts of your body–such as breasts–are not aligned with your gender identity. It can also be triggered and exacerbated by environments that do not accept, validate and respect an individual’s identity, chosen name or pronouns.

Not all trans, non-binary or gender diverse people necessarily experience gender dysphoria. For those who do, they are more likely to experience depression, anxiety, emotional distress, substance abuse disorders and suicidality. These challanges not only arise from the distress of gender dysphoria, but also from experiences of discrimination and stigma that target trans, non-binary and gender non-conforming people.

Benefits of Gender-Affirming Care on Mental Health and Reduced Suicide Rates

The World Professional Association for Transgender Health’s (WPATH) Standards of Care (SOC) 8 reviews the medical research literature around the short and long-term effects of gender-affirming surgery on trans and non-binary patients. Gender-affirming procedures report greater satisfaction and lower regret rates compared to similar cosmetic and reconstructive procedures performed in cisgender patients.

  • Improved overall mental health
  • Increased life satisfaction
  • Improved body-image
  • Enhanced quality of life

A review of 53 peer-reviewed studies demonstrates that rates of anxiety, depression, self-harm gender dysphoria and suicide risk all tend to decrease notably following surgery for those who need it. This is precisely why gender-affirming surgery are considered medically necessary for many patients.

Generally speaking, accessing good quality gender-affirming surgery is associated with a lower risk of suicide attempts–not to mention, a lowered chance of suicidality, psychological distress and smoking. That said, gender-affirming surgery is not a silver bullet for all trans people’s negative mental health outcomes. Harsh realities like discrimination, harassment and other minority stressors may prevent all quality of life measurements from improving for every individual.

Not All Gender-Affirming Care is the Same

The positive impacts of gender-affirming care on mental wellbeing are not overwhelming in all cases for a number of reasons. The first of these reasons that we will explore has do to with the quality of care provided. When patients do not access care from board-certified surgeons with access to the proper facilities, there is a much greater likelihood that the patient will experience medical complications.

For example, a survey of vaginoplasty patients in the 1980s was one of the first to find that patients who experienced significant post-operative complications were likely to continue having suicidal thoughts after surgery. Another peer-reviewed study found that complications, which impacted the esthetics of surgical results or led to poor functional outcomes, were also unlikely to see positive impacts on suicidality and other negative mental health outcomes in the short-term.

One challenge in measuring the impacts of gender-affirming care on individuals is that medical interventions tend to be multi-disciplinary. It is hard to measure the quality of care from multiple providers, across different types of healthcare: for instance, hormonal therapy, vocal therapy and surgical care. Having negative experiences with some providers, but not with others, can make it hard to find conclusive results for general studies on the experiences of individuals who have recieved multiple types of care.

Challenges in Accessing Gender-Affirming Care

Many trans and non-binary individuals face significant difficulties in accessing gender-affirming care. Beyond everyday experiences of discrimination in healthcare, gender diverse people often experience financial difficulties and even legal barriers in accessing high-quality gender-affirming care.

Currently, 24 states require insurance companies to provide coverage for gender-affirming care. Meanwhile, 26 states have bans on best-practice medical and/or surgical care for trans youth. Even where trans youth, adults and their families have legal protections to accessing care, high costs and difficulties with insurance can also act as substantial barriers, which tend to contribute to heightened levels of stress in these populations. This can leave many individuals in prolongues distress, increasing their vulnerability to suicidal ideation and other related risks.

Additional Risk Factors for Suicide Amongst Trans People

Suicidality is a complex phenomenon that requires taking multiple factors into account to understand it. There are multiple determinants that can lead someone to have suicidal ideations–meaning intrusive thoughts or fantasies about suicide–or having a more concrete desire to take their life. Sadly, gender dysphoria is not the only common denominator in trans people’s lives that puts them at risk for suicide.

Different risk factors can act together synergistically; mood disorders, a history of vicitimization (sexual and physical abuse), substance abuse, distrubed family relationships or major life stressors can come together to make a person even more at risk. The following are associated with increase risk of suicidality and/or suicide attempts amongst trans and non-binary individuals:

It is important to keep in mind that trans and non-binary people exist in different contexts and experience different levels and types of adversity throughout their lives, and often along race, class, geographic and other lines. People are complex. Even when the above factors are present in a persons life, high quality medical gender care might not be enough to reduce all of their negative mental health outcomes in the long-term.

The Role of Support Systems in Enhancing Care Efficacy

Research shows that having a strong social support system––like accepting family, authority figures in school, friends, medical services or community programs––substantially improved mental health outcomes for trans people. To offer an example of mental healthcare as a support system, access to quality outpatient and inpatient psychiatric care is associated with lower risks of suicide in trans individuals.

Trans and gender variant youth are at greater risk of depression, anxiety and substance abuse when they experience rejection and hostility around their identity from immediate caregivers. When trans youth experience rejection and bullying either at home or in school, they are placed at a greater risk of suicide than their cisgender peers who face similar victimization. Studies have shown that even having the presence of just one supportive adult can significantly help a trans or non-binary young person reduce suicidality.

Social support networks for many individuals, especially multiply marginalized trans people (e.g., trans people of color), is beneficial when it addresses other parts of their experiences beyond gender. A study on mental health and suicide risk amongst Black trans and non-binary youth in the US demonstrated the importance of including Black trans and non-binary youth in race and ethnicity-specific support structures, whether that look like accepting and embracing gender varience within the family, community centers or extracurricular programs. This research underscored the importance of intergenerational, culturally specific support, especially for youth eho experience minority stressors from pertaining to more than just one marginalized group.

Policy Implications and Recommendations for Improvement

Research suggests that there are various interventions in policy and at the community level that can serve as deterrants for suicide in trans and non-binary populations. For youth, the ability to change their name and gender marker on official documents, protections around accessing bathrooms that align with their gender, and being able to access spaces with their pronouns and identity is affirmed are all associated with a decreased risk.

For youth and adults, investments in peer support programs and public policies like educational programs that challange social structures like systematic discrimination, prejudice and even gender stereoytpes have all shown to combat the high rates of minority stress amongst trans and other minoritized populations. Not to mention, as suggested by the research cited in the sections above, legislation that protects gender-affirming care and lowers trans people’s barriers to accessing it can help many individuals improve their quality of life.

Beyond public policy that offers support and protections around healthcare, the broader context of discrimination and violence that many trans people are situated in must also be addressed if we want to see suicide and suicide attempt rates lower in these populations. The social and economic determinants of poor health outcomes must be addressed by public policy if we want to see an improvement on this front. For example, experiences of discrimination and violence that led to loosing a job, experiencing eviction, homelessness or a physical attack is associated with a higher probability of attempting suicide in the same year.

Conclusion: Future Research Directions on Gender-Affirming Care and Suicide Prevention

First, suicide in trans and non-binary youth and adults is not a one-dimensional issue. Even in studies that find statistically significant reductions in suicide risk when there is access to quality, gender-affirming care, it is hard to establish causality. This is because contrasting trans people who have and have not undergone surgery is not always the most fair comparison. If we just think about surgery as a means to alieviate gender dysphoria, we must take into account that every individual experiences dysphoria at different levels of intensity, which can fluctuate throughout different points in their life. For example, two people can undergo feminizing bottom surgery, but the extent to which their bottom dysphoria affected their mental health and ability to perform daily functions could have been different pre-op.

Another flaw in some studies is the unfair comparison of individuals who have had some form of top and bottom surgery (e.g., breast implants and vaginoplasty) with those who have no history of gender-affirming treatment. Not all trans and non-binary people need surgery to alleviate their gender dysphoria. Just as important, not all medical transitions are the same; interventions are targeted to address an individual’s unique needs, meaning not all transmasculine people need testosterone therapy, for example.

There is no one-size-fits all transition strategy; there is not a universal process that trans people need to follow (e.g., hormones first, then top surgery, then bottom surgery, etc.) to be“fully transitioned” or “complete” as the gender they identify as. Likewise, there is not a universally applicable medical plan that can be proven to alleviate all or most trans people’s suicide risk, when that is based in gender dysphoria. However, the overwhelming evidence that demonstrated high satisfaction rates and improved quality of life outcomes for those who access quality gender-affirming care is enough to establish that it is a medical necessity for many gender diverse people.

As Daniel Jackson notes in their 2023 literature review, most peer-reviewed research on the topic suggests that gender-affirming surgery is associated with a reduction in the risk of suicide for trans and non-binary people. Most of these studies, however, while they controlled for demographic factors like age and education, psychiatric comorbidities, substance abuse and other factors are not taken into account in regressions. Future research needs to take these more complex understandings of trans experience–rather than continuing to simplify or, even worse, homoginize them–into account. More than anything, the inability to prove a direct, causal relationship between one intervention (like top surgery) and lowering suicide should remind us that trans people’s mental health outcomes are determined by a complex set of factors. Healthcare access is important, and it is not the only solution to suicide risk amongst this population.