THE EFFECTS OF SEX REASSIGNMENT SURGERY ON MALES
Although the psychological pain that boys feel from gender dysphoria is undoubtedly real, studies demonstrate no psychological relief from cross-sex hormone treatment or surgery.
Elevated Mortality Rates
Surgery increases mortality rates even more than cross-sex hormones do.
Obtaining their mortality information from the Swedish national registers, a long-term study (from 1973–2003) revealed that transgender-identified males (TIMs) who underwent sex reassignment surgery (SRS) experienced higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population (Dhejne et al., 2011). These mortality data were then compared to population controls matched for age and gender. Comparing the mortality risk for this cohort after SRS to those who underwent surgeries for other reasons, the analysis revealed a significant mortality risk increase: ten years after SRS, the TIM has the same risk of dying as a non-SRS person after 30 years on cross-sex hormone treatment (CSHT).
Dhejne, C., Lichtenstein, P., Boman, M., V. Johansson, A. L., Långström, N., & Landén, M. (2011). Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLOS ONE, 6(2), e16885. https://doi.org/10.1371/journal.pone.0016885
Postoperative Complications
Sex reassignment surgery has a high frequency of serious postoperative complications.
In 2004, the Guardian (US edition) asked Birmingham University's Aggressive Research Intelligence Facility (ARIF) to assess the findings of more than 100 follow-up studies of postoperative transgender-identified males (TIMs). It concluded that none of the studies provided conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, and the findings of the few studies that have tracked significant numbers of patients over several years were flawed because the researchers lost track of at least half of the participants, and the complications were not investigated. The experiences of the actual patients make for harrowing reading.
The past twenty years have not improved the situation. In 2023, researchers published data from Canada’s first vaginoplasty postoperative care clinic (Potter et al., 2023), indicating that nearly a quarter of the TIMs who were operated on accessed care for surgical complications or pain within the first three years after surgery, and more than half of them sought care within the first year. More than three-fifths (61.3%) were seen for more than one visit and presented with more than two symptoms or concerns.
Common patient-reported symptoms during clinical visits included pain (53.8%), dilation concerns (the body identifies the neovagina as a gaping wound, and so it has to be dilated for life, including multiple times daily during the first year; see here for the eight-page aftercare regimen) (46.3%), and surgical site/vaginal bleeding (42.5%). Sexual function concerns were also common (33.8%), with anorgasmia (inability to orgasm) (11.3%) and dyspareunia (painful intercourse) (11.3%) being the most frequent complications. The most common adverse outcomes identified by healthcare providers included hypergranulation (an excess of granulation tissue that rises above the surface of the wound bed) (38.8%), urinary dysfunction (18.8%), and wound healing issues (12.5%). An older review of the literature on complications of the neovagina in postoperative TIMs shows an overall complication rate of 32.5% (i.e., about one in three cases) and a reoperation rate of 21.7% (more than one in five cases) for “non-aesthetic reasons” (Dreher et al., 2017).
Another paper discusses various neovaginal complications in TIMs (Mundluru & Larson, 2018): fifteen percent suffered from a neo-urethra stricture (an abnormal narrowing of the urethra), leading to urinary tract infections and pain. Ten percent of the cases developed scar tissues in the neovagina, causing it to become narrower and shorter. One in 10 patients experienced stenosis of the neovagina, which negatively impacts sexual functioning. Another significant concern was “intravaginal hairballs.” Other complications include vaginal prolapse (when the top of the vagina weakens and collapses into the vaginal canal) and recto-vaginal fistulas (a tunnel between the vagina and rectum, leading to rectal discharge through the vagina, including during sexual intercourse).
Potter, E., Sivagurunathan, M., Armstrong, K., Barker, L. C., Mont, J. D., Lorello, G. R., Millman, A., Urbach, D. R., & Krakowsky, Y. (2023). Patient reported symptoms and adverse outcomes seen in Canada's first vaginoplasty postoperative care clinic. Neurourology and Urodynamics, 42(2), 523-529. https://doi.org/10.1002/nau.25132
Dreher, P. C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S., & Rumer, K. L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clinical Anatomy, 31(2), 191-199. https://doi.org/10.1002/ca.23001
Mundluru, S., & Larson, A. (2018). Medical dermatologic conditions in transgender women. International Journal of Women's Dermatology, 4(4), 212-215. https://doi.org/10.1016/j.ijwd.2018.08.008
Psychological Outlook
Psychological outlook is not improved by surgeries.
A 2019 study initially claimed there was a psychological improvement after sex reassignment surgery (SRS) (Bränström & Pachankis, 2020a); however, the authors issued a retraction after their statistical methodology was questioned (Bränström & Pachankis, 2020b). In this retraction, they acknowledged that “the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison.” Not only did those who refrained from surgery fare no worse, but they also had half as many serious suicidal attempts; however, this difference did not reach the threshold of statistical significance.
Bränström, R., & Pachankis, J. E. (2020a). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. American Journal of Psychiatry, 177(8), 727–734. https://doi.org/10.1176/appi.ajp.2019.19010080
Bränström, R., & Pachankis, J. E. (2020b). Correction to Bränström and Pachankis. American Journal of Psychiatry, 177(8), 734–734. https://doi.org/10.1176/appi.ajp.2020.1778correction
Personal Story
Read a firsthand account of living with surgical complications
"Aside from keeping myself hygienic, I dilate about 4 times a year for 20 mins each and it never closes and most of the time never bother outside managing the trickle of urine from my constricted urethra after going to the toilet, the occasional shooting pain and the despair of my own stupidity.
"My pelvis is behaving as if it’s been impaled, constantly trying to heal, constantly confused with what to do with the nerves. My urethra goes through cycles of constriction, meaning every 2 years I need surgery to open it again.
"Dismiss me if you like, and put it down to ‘poor surgical outcomes’, but it’s not - I got lucky if you can believe it, I can climax, but there is nothing but numbness in the outer groin, I have tried prodding with clean knives and needles to see if I feel anything, but it’s just not there, there are isolated patches of nerve connectivity too where i can, but its mostly numb. This is not rare.
"Most of my friends who had SRS have no sensation. Nothing."