Impact of Gender-Affirming Surgery on Psychiatric Outcomes and Quality of Life in Transgender Individuals: A Systematic Review of Longitudinal Cohort Studies

<b>Background/Objectives:</b> Gender-affirming surgery (GAS) has become more accessible in recent years. It aims to align the physical characteristics of transgender individuals with their gender identity to alleviate distress associated with gender dysphoria. This may involve procedures such as genital reconstruction, breast augmentation or removal, and voice modification surgeries. However, the associations of these treatments on long-term mental health outcomes remain debated. This paper aims to review and synthesize current research on the associations of GAS on psychiatric outcomes and quality of life in transgender individuals. <b>Methods:</b> In accordance with the PRISMA statement, a search on PubMed, PsychInfo, and Embase yielded 867 articles, of which 14 studies of 3023 participants met the full inclusion criteria. <b>Results:</b> There is an initial improvement in psychological well-being and quality of life within the first year post-GAS, followed by subsequent plateau or decline thereafter. Factors such as younger age, higher levels of education, noticeable improvement in secondary sexual characteristics, and a supportive social environment have been identified as predictors of positive outcomes. Conversely, non-homosexual orientation and higher levels of pre-GAS psychopathology have been associated with poorer outcomes, highlighting the importance of tailored support and pre-operative mental health care to optimize long-term success. <b>Conclusions:</b> This study underscores the need for further research into long-term outcomes and tailored support strategies to optimize the mental health and well-being of transgender individuals undergoing GAS.