Mental Health Treatment following Gender-Affirming Surgeries: Evidence from administrative data in Australia
Melbourne Institute Working Paper No. 09/25
Date: August 2025
Author(s):
Abstract
Importance: Gender-affirming surgery is associated with improved mental health outcomes among transgender and gender-diverse (TGD) individuals. However, limited evidence examines how mental health treatment, and associated government costs, change following gender-affirming surgery. Objective: To estimate how gender-affirming surgery influences utilization of mental health services and mental health prescriptions, and associated government expenditure. Design, Setting, and Participants: Secondary analysis of Australian administrative data (2013–2024) on 3,698 TGD adults who underwent gender-affirming surgery. Exposures: Gender-affirming chest surgery among TGD individuals treated with testosterone-based hormone therapy or gender-affirming genital surgery among TGD individuals treated with estradiol-based hormone therapy. The comparison group included TGD individuals who went on to receive the same type of surgery later in the study period. Main Outcomes and Measures: Within-individual change in annual use of mental health services, use of psychotropic prescriptions (antidepressants, anxiolytics), and associated government expenditures, in the five years before and after surgery. Associations were estimated separately for each surgery type using a dynamic difference-in-differences event-study model, with all effects referenced to two years before surgery. Results: 2,872 individuals underwent gender-affirming chest surgery and 826 underwent genital surgery between 2013 and 2024 (mean follow-up 3.9 and 4.6 years, respectively). Compared with the reference period, gender-affirming surgeries were associated with a reduction in mental health service use. Five years post-surgery, gender-affirming chest and genital surgery recipients respectively used 1.87 (95% CI 0.88;2.80) and 5.03 (95% CI 3.62;6.44) fewer mental health services per annum. Mental health prescription utilization also decreased for chest surgery recipients [1.26 (95% CI 0.42;2.10) fewer prescriptions at five years], but were not significantly different to the reference period for genital surgery recipients [0.01 (95% CI -1.03;1.06) at five years]. Annual government spending on mental healthcare per person decreased by $430 (95% CI 270;591) for chest surgery recipients and $884 (95% CI 545;1,222) for genital surgery recipients at five years. Conclusions and Relevance: Expanding gender-affirming surgery access for TGD individuals may help improve mental health and reduce associated government spending on mental health treatment. These results contribute new evidence to support the provision of gender-affirming surgeries for TGD people who seek it.
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