In general, transgender people are at increased risk of stigmatization and discrimination which can lead to depression, suicidality, relationship difficulties, and economic consequences such as unemployment.[15]Bockting WO, Miner MH, Swinburne Romine RE, et al. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013 May;103(5):943-51.
https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2013.301241
http://www.ncbi.nlm.nih.gov/pubmed/23488522?tool=bestpractice.com
Mental health problems may persist after gender reassignment in some individuals, particularly if they struggle to adjust to their new identity.[2]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). Washington, DC: American Psychiatric Publishing; 2022.
Meta-analysis evidence demonstrates that, for the majority of transgender people, gender-affirming treatment (including hormonal therapy) results in significant improvements in quality of life and psychosocial functioning.[43]Murad MH, Elamin MB, Garcia MZ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf). 2010 Feb;72(2):214-31.
http://www.ncbi.nlm.nih.gov/pubmed/19473181?tool=bestpractice.com
[44]Baker KE, Wilson LM, Sharma R, et al. Hormone therapy, mental health, and quality of life among transgender people: a systematic review. J Endocr Soc. 2021 Apr 1;5(4):bvab011.
https://academic.oup.com/jes/article/5/4/bvab011/6126016
http://www.ncbi.nlm.nih.gov/pubmed/33644622?tool=bestpractice.com
[45]Fisher AD, Castellini G, Ristori J, et al. Cross-sex hormone treatment and psychobiological changes in transsexual persons: two-year follow-up data. J Clin Endocrinol Metab. 2016 Nov;101(11):4260-9.
https://academic.oup.com/jcem/article/101/11/4260/2765000
http://www.ncbi.nlm.nih.gov/pubmed/27700538?tool=bestpractice.com
The percentage of people who regret their gender-affirming surgical intervention is low (estimated to be between 0.3% and 3.8%).[4]Coleman E, Radix AE, Bouman WP, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022;23(suppl 1):S1-S259.
https://www.tandfonline.com/doi/full/10.1080/26895269.2022.2100644
http://www.ncbi.nlm.nih.gov/pubmed/36238954?tool=bestpractice.com
Regret may be temporary or permanent; in this scenario multidisciplinary input is recommended in order to explore this further, with possible outcomes being medical and/or surgical treatment to continue the transition, or revision surgery to return anatomy to the sex assigned at birth.[4]Coleman E, Radix AE, Bouman WP, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022;23(suppl 1):S1-S259.
https://www.tandfonline.com/doi/full/10.1080/26895269.2022.2100644
http://www.ncbi.nlm.nih.gov/pubmed/36238954?tool=bestpractice.com
A retrospective cohort study found that adult transgender people who received hormone treatment were at a 2-fold increased mortality risk compared to the general population. The increased risk was not attributable to hormone treatment, but rather emphasized the importance of holistic transgender healthcare, including appropriate treatment of cardiovascular disease.[59]de Blok CJ, Wiepjes CM, van Velzen DM, et al. Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria. Lancet Diabetes Endocrinol. 2021 Oct;9(10):663-70.
http://www.ncbi.nlm.nih.gov/pubmed/34481559?tool=bestpractice.com