People who identified as transgender in California who underwent vaginoplasty surgery were twice as likely to commit suicide following surgery, according to a study published by the American Urological Association’s peer-reviewed The Journal of Urology.

Researchers examined the data on 869 biological men who received the sex alteration surgery known as vaginoplasty and 357 biological women who received phalloplasty in the state of California between the years 2012 and 2018.

“Rates of psychiatric emergencies are high both before and after gender-affirming surgery. Although both the phalloplasty and vaginoplasty patients have similar overall rates of psychiatric encounters, suicide attempts are more common in the latter. In fact, our observed rate of suicide attempts in the phalloplasty group is actually similar to the general population, while the vaginoplasty group’s rate is more than double that of the general population,” the study concluded.

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The study noted that 22.2% of male vaginoplasty recipients and 20.7% of female phalloplasty recipients had at least one ER or in-patient psychiatric encounter. It also went on to say that if the patient had undergone a psychiatric encounter before they had a sex alteration surgery, for biological men undergoing vaginoplasty, the rate of it occurring again was 33.9%. In contrast, for biological women undergoing phalloplasty, it was 26.5%.

“Although the overall proportion of those experiencing a psychiatric encounter was similar between the vaginoplasty and phalloplasty groups, suicide attempts were more common in the vaginoplasty group,” the study said.

The authors of the study noted that patients with a history of psychiatric emergencies “should be counseled appropriately” before undergoing a “feminizing transition.”

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