Gender-Changing Surgery and Well-Being, By Mrs Vera West
The American Thinker blog post titled "So-called 'Gender Affirming' Surgery is Bad for People's Happiness," published on March 7, 2025,
argues that gender-affirming surgery does not deliver the happiness or psychological relief it promises. It cites a large study from The Journal of Sexual Medicine, analysing over 107,583 patients with gender dysphoria, which found that those who underwent surgery experienced significantly higher rates of depression, anxiety, suicidal ideation, and substance use disorders compared to those who did not. The post uses this data to challenge the prevailing narrative that such surgeries are a panacea for gender dysphoria, suggesting instead that they may exacerbate underlying psychological distress.
The core of the critique lies in the psychological aftermath of gender-changing surgeries. The study highlighted in the blog post indicates that, rather than resolving gender dysphoria, surgery often correlates with worsened mental health. For example, males who underwent surgery showed depression rates of 25.4 percent versus 11.5 percent for those who did not, and anxiety rates of 12.8 percent versus 2.6 percent. Females exhibited similar trends, with depression at 22.9 percent post-surgery versus 14.6 percent without, and anxiety at 10.5 percent versus 7.1 percent. These statistics suggest that surgery might not address the root causes of dysphoria, which could be more psychological than physical.
Critically, this raises the question: if gender dysphoria is a condition of the mind—discomfort with one's biological sex—why is the solution a permanent alteration of the body? The blog post invokes the adage, "wherever you go, there you are," implying that surgery cannot outrun a troubled psyche. This perspective aligns with a broader scepticism about treating mental health conditions with physical interventions alone. Unlike fixing a broken bone or removing a tumour, where the problem is distinctly physical, gender dysphoria involves complex identity and perception issues that surgery might not resolve. The data suggests that post-surgical patients remain deeply depressed after the initial euphoria fades, pointing to a potential mismatch between expectation and reality.
From a medical standpoint, gender-changing surgeries are invasive, irreversible, and carry significant risks. Procedures such as mastectomies, phalloplasties, or vaginoplasties, involve removing healthy tissue and reconstructing anatomy, often requiring multiple follow-up surgeries due to complications. The blog post does not delve into these specifics, but the broader discourse notes high rates of postoperative issues—chronic pain, infections, or loss of sexual function—which can compound psychological distress rather than alleviate it. The permanence of these changes is particularly concerning when mental health outcomes remain poor, as patients cannot undo the decision if regret or dissatisfaction sets in.
Moreover, the push for these surgeries often downplays the need for exhaustive preoperative psychological evaluation. Critics argue that the medical establishment sometimes rushes patients toward surgery without fully exploring less invasive alternatives, such as therapy or hormonal treatments, which themselves carry risks but are less final. The American Thinker piece hints at this by criticising the study's suggestion of "ongoing, gender-sensitive mental health support" as inadequate, implying that such support should precede, not merely follow, surgery.
The blog post attributes some post-surgical distress to "stigma and lack of gender affirmation," a point the study itself raises. However, it counters that this explanation is flawed since stigma exists both before and after surgery—thus, surgery does not eliminate it. This critique suggests a societal failure: if acceptance is the goal, altering the body might not address the external pressures driving dysphoria. Instead, it could reinforce a cultural narrative that one must conform physically to be valid, rather than fostering acceptance of "diverse identities" without surgical intervention.
This leads to a broader societal critique: the promotion of gender-changing surgeries may be ideologically driven rather than evidence-based. The rapid normalisation of these procedures, especially for minors, has outpaced rigorous long-term research. The American Thinker post reflects a conservative scepticism of progressive ideology, accusing it of prioritising narrative over science. This raises a valid point: the enthusiasm for "affirmation" might overlook data showing poor outcomes, as seen in the Houston study, in favour of a feel-good story of transformation.
If surgery doesn't guarantee happiness—and may worsen it—what then? Critics, including the blog's author, argue for prioritising mental health treatment over physical alteration. Gender dysphoria could be approached as a condition akin to body dysmorphia or depression, where therapy aims to reconcile the individual with their body rather than reshape it. The high rates of mental health issues post-surgery suggest that many patients have coexisting psychological struggles that surgery doesn't address. Exhausting non-surgical options first—cognitive behavioural therapy (CBT), support groups, or even time to mature, especially for adolescents—could reduce the rush to irreversible decisions.
Gender-changing surgeries, as critiqued through the lens of the American Thinker post and broader analysis, appear to fall short of their promise. The evidence of increased depression, anxiety, and suicidal ideation post-surgery challenges the narrative of "life-saving care." Medically, the procedures are risky and irreversible, potentially locking patients into a choice that doesn't resolve their distress. Societally, they may reflect ideological pressures more than scientific consensus. A critical examination suggests that treating the mind, not reshaping the body, should be the priority—a stance supported by the troubling outcomes of large-scale studies. While individual stories of success exist, the data urges caution, not celebration, in the rush to affirm through surgery.
"When my kids were growing up, I knew a young man who was charming, funny, sociable, and quite obviously going to be gay. Exactly no one was surprised when, at 13, he came out of the closet. All would have been well if COVID hadn't hit when he was in college. Isolated and depressed, he signed up for therapy, ending with a therapist who informed him that he was actually a woman. (I'm sure social media algorithms, such as Chinese-run TikTok's, helped steer him in that direction.)
This young man has now had hormones and two surgeries. He's stacked up top and empty down below. The big question is whether he will find happiness.
Sadly for my young friend, the odds are against him, at least according to a massive study done in Houston and published in The Journal of Sexual Medicine, an outlet of Oxford Academic, which is, in turn, part of Oxford University Press. In other words, a big study published on a reputable forum. According to that study, once the surgery is over, and once the euphoria associated with realizing a dream has passed, the post-surgical patients are deeply depressed.
The study examined information from 107,583 patients, using the TriNetX database. (Electronic medical records are very helpful for looking at large population segments.) The study examined people over age 18 with gender dysphoria, and broke them into six useful categories for data analysis.
WPATH, the largest organization pushing "transgender" ideology on doctors and hospitals, along with the usual collection of activists, would undoubtedly predict that the study showed increased levels of happiness among post-surgical people. They surely would argue that so-called "transgender" people who had surgery would magically be less depressed, less inclined to substance abuse, and less likely to commit suicide.
In fact, the opposite was true, and not just a little true, but very true. Those who had surgery were markedly less happy than their so-called "transgender" peers who stopped short of slicing and dicing their bodies:
From 107 583 patients, matched cohorts demonstrated that those undergoing surgery were at significantly higher risk for depression, anxiety, suicidal ideation, and substance use disorders than those without surgery. Males with surgery showed a higher prevalence of depression (25.4% vs. 11.5%, RR 2.203, P < 0.0001) and anxiety (12.8% vs. 2.6%, RR 4.882, P < 0.0001). Females exhibited similar trends, with elevated depression (22.9% vs. 14.6%, RR 1.563, P < 0.0001) and anxiety (10.5% vs. 7.1%, RR 1.478, P < 0.0001). Feminizing individuals demonstrated particularly high risk for depression (RR 1.783, P = 0.0298) and substance use disorders (RR 1.284, P < 0.0001).
Sadly, the study pulls back from stating the obvious conclusion, which is that so-called transgenderism is a mental condition, not a physical one. Mutilating one's body, even if that mutilation is deeply desired and ostensibly conforms to a perceived "better body," does not address the underlying problems of gender dysphoria.
Or as the old saying goes, "wherever you go, there you are." You cannot outrun yourself with surgery. Surgeries are good for fixing distinct medical conditions (e.g., a broken hip or clogged heart), or even making little cosmetic tweaks (e.g., a nose job), but they will not fix a broken psyche.
But again, the study will not or cannot acknowledge that. Instead, it believes the post-surgical problems arise, in part, from "stigma and lack of gender affirmation." That cannot be right, because the stigma and lack of gender affirmation logically exist before the mutilating surgery as well as after. Ignoring logic, the study recommends "ongoing, gender-sensitive mental health support for transgender individuals' post-surgery." The same logic says this won't help either.
Again, wherever you go, there you are. Cutting off your breasts or castrating yourself will not change that, no matter how much you sign up for "mental health support" from ideologues who, like the therapist my young friend saw, are effectively hammers who believe everything is a transgender nail.
Transgender madness will pass, as all societal delusions must. However, it will leave so many broken lives in its wake.
Currently, my young friend is living a narcissist's dream, taking endless photos of his feminized self to affirm that, yes, he really is a girl. Eventually, though, those photos won't help. I fear that this once brilliant, funny, sociable young man will fall into an abyss as he looks down at his eunuch's body and realizes there is no going back."
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