Gender-Affirming Surgery: Who Benefits? Who De-Transitions?
Most who gender transition say it improves their lives, but some de-transition.
Updated October 7, 2025 | Reviewed by Lybi Ma
Changing genders is never easy. It’s one thing to know deep down in your soul that the gender you were assigned at birth is a horrible mistake, but quite another to present to the world as the other gender or nonbinary, and face the daunting—and potentially dangerous—challenges of explaining your new identity to family, friends, and your larger community, and then living life as your new self, not to mention obtaining medical care.
In the U.S., gender-affirming surgeries have tripled since 2016. This raises a question: How do those who have gender-affirming surgery feel afterward? Are they pleased or regretful?
These questions are deeply personal, but they also have a political dimension. Trans activists and their supporters insist that gender transitioning, while challenging, significantly improves lives. But social conservatives contend that transitioning causes deep regret, particularly when pre-adolescents have gender-altering surgery.
Several studies have investigated this. Most find that the large majority of gender-changers report significantly improved mental health. But some show that 1 to 10 percent of transitioners ultimately de-transition, that is, they return to the gender they were assigned at birth, rarely because of regret, but usually for other reasons.
Transitioning Improves Mental Health and Saves Lives
University of Colorado researchers used one of the world’s largest medical databases to identify 100,097 people who felt deep discomfort with the gender they were assigned at birth, but who did not have surgery, and compared them to 4,061 gender-transitioners who went under the knife. Their average age was 36. Most were white, but the sample included all races. Based on medical records that tracked all 105,000 for five years, the researchers found the surgery provided substantial psychological benefits: less depression (p < 0.0001), less anxiety (p < 0.0001), less substance abuse (p < 0.0001), and fewer suicidal thoughts (p < 0.0001).
The reduction in suicidal ideation is particularly important. As many as 40 percent of presurgery trans individuals report seriously considering suicide. Many attempt it, and some take their own lives. Consequently, it’s no exaggeration to state that gender-affirming surgery saves lives.
This study’s findings strongly suggest that gender-affirming surgery is much more of a blessing than a curse, and that it benefits public health by reducing self-harm .
Other studies agree that most of the time, most transitioners feel happier after transitioning than they did before.
Some Transitioners De-Transition for Many Reasons
But not everyone is happy with gender transitioning. University of Toronto investigators surveyed 1,000 people who began or completed gender transitions only to decide later to stop or reverse the process (de-transitioning). Why did they de-transition?
Other studies agree that some transitioners stop hormone treatments before surgery or regret having surgery and de-transition. A Swedish study pegged the proportion at 2 percent. An English study found that 20 percent of people who start hormone treatment stop it.
In the U.S. in 2016, surgeons performed 4,500 gender-affirming operations. Since 2019, the figure has almost tripled to more than 12,000.
The good news is that most gender-transitioners feel fine about their decisions. But the bad news is that some trans folks express regrets and stop hormone treatment or decide to de-transition. It appears that some people who change their minds about gender once may change their minds again.
The weight of the research argues against blanket statements about gender-transition outcomes. Never say always . Those who say that transitioning always improves people’s lives and mental health are mistaken. Some transitioners express regrets, and some de-transition.
However, those who say that gender transitioners always regret the change are also mistaken. The large majority of post-operative trans people report improved mental health, notably less potentially fatal depression.
I know several happily trans folks. I’m glad they feel gender-affirmed. However, I hope future research elucidates the question of children deciding to transition, and whether they’re too young to decide.
The Toronto study showed that the group most likely to express strong regret—and to de-transition—are those assigned female at birth who decide to transition to male during childhood or adolescence and quickly act on that realization.
Trans activists may crucify me for saying this, but I hope parents, psychologists, and physicians appreciate the complexity of transitioning decisions. I hope they counsel those assigned female at birth who decide they're trans as children or adolescents not to rush into transitioning to male, because of the real possibility of regret, and the time, expense, and emotional impact of de-transitioning.
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Michael Castleman, M.A. , is a San Francisco-based journalist. He has written about sexuality for 36 years.
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