Good news! A new study finds that if there’s something about your body that causes you grave distress, fixing that thing can improve your mental health! This is only shocking news to anyone because of the great amount of bias we bring to this discussion. And I include myself in that bias!
So, we’re talking specifically about trans people who get gender-affirming surgery, but let’s start by backing up a bit and talking about plastic surgery in general. As a baby tomboy/feminist/girl who didn’t care about makeup, I thought plastic surgery was, by and large, garbage and only likely to make your mental health worse. Wish your nose was smaller? Well, maybe you should learn to love yourself as-is! Getting a smaller nose will just make you focus on something else that is “wrong.”
And I still think there’s something to be said for coming to terms with who you are and what you look like, and if you are dissatisfied because your physical form doesn’t match what society expects of us, then you should place less value in what other people think and more value in things like personal growth, friendships, and physical and psychological health.
But that was easy for me to think, because I’ve always been pretty “normal” looking. Like, people don’t point and laugh when I walk down the street. Usually. But if I could snap my fingers and not have fucked up teeth, would I? Hell yeah. I’ve never had any cosmetic procedures done but hey, I’m getting older! I don’t know that I would say “no” if at some point in the future a doctor offered to slap my face back a decade or so. Does that make me a bad or shallow person? Hell no. Realizing that made me reevaluate my feelings about cosmetic surgery, and in fact when I looked into it, there is a decent amount of research that suggests that most people are happier after getting cosmetic surgery: they experience decreased anxiety, social phobia, depression, body dysmorphia, goal attainment, quality of life, life satisfaction, attractiveness, mental and physical health, well-being, self-efficacy and self-esteem. A handful are never satisfied, and continually try to change their physical appearance without addressing much larger underlying mental health issues. So, cosmetic surgery is good for most people who want it, but not necessarily good for everyone.
I suspect that the public at large doesn’t necessarily align with the science, generally looking down on people who get cosmetic surgery and seeing them as shallow and stupid, like I used to see them. So I guess it’s not a big surprise that it remains socially controversial to say that trans people are happier after getting gender-affirming surgery such as breast augmentation, facial feminization, and hysterectomies/orchiectomies.
In fact, trans-exclusionary radical feminists (TERFs) and other bigots often cite a 2011 Swedish study to claim that trans people are more likely to commit suicide following surgery. That claim even made it into the Washington Post, but it’s not true — the study’s author has been extremely clear that she wasn’t comparing suicide rates between trans people who did or did not have surgery. In fact, her research found that there was only a slightly increased suicide rate in trans people compared to the national average, and then it was only for people who had operations prior to 1989. For those who had surgery later, when societal acceptance of trans people had increased and people had more access to mental healthcare, there was no difference between trans people who had surgeries and the general public.
In fact, a meta-analysis of 28 studies involving 1,833 patients published in 2010 found that “sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.” But, they found that the data was very low quality, so more research was needed.
And good news! Harvard researchers have just published the first large-scale controlled study examining the potential psychological benefits and drawbacks of gender-affirming surgery and yep, it backs up the previous research: in a survey of nearly 28,000 transgender people, getting surgery cut psychological distress and suicidal thoughts practically in half, and as a fun bonus there was also a 35% reduction in tobacco smoking.
Whenever there’s a “controversial” medical intervention like abortion, the moral scold’s fallback position always includes some form of “you’ll regret it!” And just like with abortion, that is probably not true of gender-affirming surgery. Will some people regret it? Sure! That’s life. And just like with cosmetic surgery in general, it’s not for everyone and there is no one operation that will “cure” a person of all their ills. It’s complicated, but the research is getting clearer and clearer: in general, we should trust people to know what’s going to make them happy and we should let them do it. Because no matter what you think of trans people, respecting them as humans with autonomy is the kinder option that will make the world a better place for everyone.