40 Years After Surgery – What Does Long-Term Research Say?

Current scientific studies show: gender-affirming procedures permanently improve the quality of life of trans* individuals – across decades. An overview of the state of research

Medical Editorial Team transgenderklinik.de | Created by Dr. med. Timo A. Spanholtz, Specialist in Plastic and Aesthetic Surgery, Last updated: March 2026 | Reading time: approx. 10 minutes

In times of political debate surrounding gender-affirming medicine, a look at the scientific evidence is more important than ever. What does someone experience who underwent gender-affirming surgery (GAS) 20, 30, or even 40 years ago? Does this person regret the decision? Did they benefit from it – in the long term?

A growing number of high-quality scientific studies now answer these questions. This article summarizes the most important findings – evidence-based, transparent, and with source references that you can look up yourself.

The Key Study: 40-Year Follow-up at the University of Virginia

One of the most important and most frequently cited long-term studies was published in 2022 in the renowned journal Annals of Plastic Surgery. Authors led by Dr. Rachel H. Park et al. from the University of Virginia studied patients who had already received gender-affirming surgeries in the years 1970 to 1990 – that is, up to 50 years ago.

Methodology

The research team identified 97 patients with comprehensive preoperative evaluations from an archive period of 20 years. Based on these data, a standardized follow-up survey was developed that captured mental health, surgical outcomes, body acceptance, and patient satisfaction. 15 individuals participated in telephone interviews and the survey.

Results at a Glance

The authors' conclusion is clear: „Gender-affirming surgery is a permanent treatment that improves the overall well-being of patients.“ (Park RH et al., Annals of Plastic Surgery, 2022, PMID: 36149983)

Mental Health: What Do the Large Surveys Say?

In addition to the 40-year study, there are further important findings on mental health after GAS:

JAMA Surgery Study (2021, n = 27,715 individuals)

In the largest analysis of its kind to date – a secondary analysis of the US Transgender Survey with 27,715 participants – trans* individuals with and without GAS were compared. The result:

• Individuals after GAS had significantly lower psychological distress (aOR 0.58)

• Suicidal ideation in the past year: significantly reduced (aOR 0.56)

• Tobacco use: also significantly lower (aOR 0.65)

Source: Almazan AN & Keuroghlian AS, JAMA Surgery, 2021, PMID: 33909023

Antidepressant Use as an Objective Indicator

A further study examined not only subjective self-reports but also the objective use of antidepressants (SSRIs/SNRIs) as a measure. The result: After GAS, the need for antidepressant medication decreased significantly – evidence that goes beyond mere patient reports.

Source: PubMed PMID: 38315125 (Plastic and Reconstructive Surgery, 2024)

How High Is the Regret Rate Really?

In political debates, so-called "detransition" and the question of regret after GAS are often instrumentalized. What does science say?

Important for understanding: According to research, the most common reason for regret is not the decision to have surgery itself, but negative psychosocial reactions from the social environment (family, work, society). This means: Good psychosocial aftercare and a supportive environment are decisive factors for long-term satisfaction.

What Improves After Gender-Affirming Surgeries? A Detailed Look

Body Acceptance and Gender Dysphoria

Studies consistently show that gender dysphoria is permanently reduced by GAS. The body is perceived as "one's own" – a feeling that, in the 40-year study, was still stable even decades later.

Quality of Life

A systematic review (Johnson et al., 2022, PMC 9255096) of 79 studies showed: Trans* individuals typically report positive psychological and sexual outcomes after GAS. Their quality of life is comparable to that of trans* individuals without surgery – or better.

Sexual Health

Current reviews (2025) demonstrate: After vaginoplasty, 91% of trans* women report an improved quality of life. After phalloplasty, approximately 85% of trans* men are satisfied with the result.

Important Context: What Research (Still) Cannot Answer Conclusively

Serious medical information also includes the limits of the evidence:

• Many studies have small sample sizes or lack control groups – this makes clear statements about causality difficult

• Selection bias: Individuals who participate in follow-up studies may be more satisfied – and do not represent all operated individuals

• The quality of the measurement instruments used varies greatly – standardized patient-reported outcome measures (PROMs) validated for trans* individuals have largely been lacking so far

• Long-term data over 10+ years are still limited; most studies measure outcomes over 1–2 years

These limitations do not mean that GAS is not an effective therapy – on the contrary. They show that the field has a growing and improving research foundation that points in a clear direction.

Frequently Asked Questions (FAQ)

Is regret after gender-affirming surgery common?

No. Meta-analyses show a pooled regret rate of about 1%. For comparison: With other elective procedures such as breast augmentation, comparable figures are considerably higher. Decisive for low "regret rates" are a careful selection process, psychological support, and a supportive social environment.

How long do the positive effects of a GAS last?

According to the 40-year study (Park et al., 2022), the positive effects on mental health, body acceptance, and life satisfaction are still stably measurable even after four decades. In medicine, this is an exceptionally good long-term result.

Does mental health improve through GAS?

Yes – several studies consistently show a reduction in depression, suicidal ideation, and psychological stress. The large JAMA Surgery study (n = 27,715) in particular provides strong evidence here. Important: Good psychological support before and after the surgery is a decisive factor.

Who is gender-affirming surgery suitable for?

GAS is not the right thing for every trans* person – and it does not have to be. The best decision is always the one made individually with an experienced interdisciplinary team. Our team accompanies you through all steps – without pressure, without a time limit.

Sources & Literature

1. Park RH, Liu YT, Samuel A et al. (2022). Long-term Outcomes After Gender-Affirming Surgery: 40-Year Follow-up Study. Annals of Plastic Surgery, 89(4), 431–436. PMID: 36149983

2. Almazan AN & Keuroghlian AS (2021). Association Between Gender-Affirming Surgeries and Mental Health Outcomes. JAMA Surgery, 156(7), 611–618. PMID: 33909023

3. Bustos VP, Bustos SS, Mascaro A et al. (2021). Regret after gender-affirmation surgery: a systematic review and meta-analysis of prevalence. Plastic and Reconstructive Surgery – Global Open, 9(3), e3477. PMC: 8099405

4. Johnson C et al. (2022). Surgical satisfaction and quality of life outcomes reported by transgender men and women at least one year post gender-affirming surgery: A systematic literature review. PMID: 35799954

5. PubMed PMID: 38315125 (2024). Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Antidepressant Use in Patients with Gender Dysphoria. Plastic and Reconstructive Surgery.