122. Unveiling The Societal Impact of Gender-affirming Surgery and the Role of Surgery in Detransitioning

PURPOSE: Gender-affirming surgery (GAS) has been associated with substantial mental health benefits, including reduced psychological distress, lower rates of smoking, and decreased suicidal ideation. However, comprehensive studies exploring the broader societal impacts of GAS and the reasons for detransition are lacking. This study aims to evaluate the societal benefits of GAS while analyzing factors contributing to detransitioning. METHODS: Data was utilized from the 2015 U.S. Transgender Survey (USTS), which included over 27,000 transgender and non-binary respondents across all 50 U.S. states. This cross-sectional survey included both qualitative and quantitative measures to capture demographic, social, and healthcare-related information. Logistic regression models were used to understand factors influencing detransition, controlling for variables such as age at transition, income, family and coworker support, minority status, and healthcare access. Additionally, the role of GAS in relation to detransitioning was analyzed to assess its influence on the likelihood of detransitioning. RESULTS: Approximately 90% of detransition cases were due to external pressures, including family rejection (20.80%) and job insecurity (31.36%). Lower income levels (OR = 1.684, p = 0.0386) and workplace discrimination (OR = 1.277, p = 0.0343) were significantly associated with an increased likelihood of detransitioning. Strong family support emerged as a protective factor, reducing the odds of detransition by 24% (OR = 0.765, p = 0.0454). Conversely, individuals who had undergone GAS were 27% less likely to detransition than those who had not (OR = 0.725, p = 0.0192). Importantly, no significant difference was found in the reasons for detransitioning between individuals who had undergone GAS and those who had not had these surgeries (p = 0.3005).GAS was found to provide significant societal benefits, such as reduced rates of harassment (OR = 0.693, p = 0.0078), decreased engagement in sex work (OR = 0.685, p = 0.0488), and increased civic participation, as indicated by higher voting rates (OR = 1.339, p = 0.0005). Additionally, GAS reduced the likelihood of heavy substance use (OR = 0.858, p = 0.0438) and bathroom denial (OR = 0.509, p < 0.001). CONCLUSION: This study highlights the significant societal benefits of GAS, including improved safety, reduced substance use, and increased civic engagement, demonstrating its positive impact beyond individual mental health. Detransition is largely driven by external pressures, including economic challenges and lack of familial support, rather than internal factors, such as regret. GAS itself acts as a protective factor against detransitioning, highlighting the need for broader access, particularly in underserved rural areas where barriers to care are prevalent.