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Larshans et al. Plast Aesthet Res. 2025;12:7 https://dx.doi.org/10.20517/2347-9264.2024.154 Page 9 of 13

Figure 7. Responses of patients who underwent gender-affirming surgeries to the “I have thought about hurting myself or taking my
own life” (question 13) in the GCLS. GCLS: Gender Congruence and Life Satisfaction Scale.
self-harm. This distribution is depicted in Figure 7, pointing to a crucial minority struggling with severe
mental health issues, which emphasizes the need for continued mental health support.

DISCUSSION
Assessing thoughts of self-harm or suicidal ideation in transgender women after GAS is crucial, given the
high prevalence of these issues in the GD population. The psychological distress resulting from
incongruence between an individual’s gender identity and gender assigned at birth can severely impact QoL
and can lead to severe mental health issues, including ideation and attempt of self-harm or suicide [32-36] .

This retrospective study aimed to enhance the understanding of life satisfaction, thoughts of self-harm or
suicidal ideation among transgender women after genital GAS.

While we found that most participants (72%) had never experienced thoughts of self-harm or suicidal
ideation, 28% of respondents had considered self-harm or suicide to some degree after GAS, indicating a
substantial mental health challenge for this group. This aligns with other research on transgender
individuals in Sweden, which showed that 36% had experienced suicidal thoughts or attempts in the past
[11]
year .

Despite the presence of thoughts of self-harm or suicidal ideation, respondents reported overall satisfaction
with life and mental health. Thus, surgical treatment may have had a positive impact on life satisfaction and
gender congruence.

No patient in our case series, at the time the questionnaires were completed, had attempted self-harm or
suicide. Our protocol for preventing self-harm and suicide begins even before surgery. In fact, a
psychological assessment to determine readiness for surgery is required a few weeks before the procedure.
Postoperatively, patients in Sweden are followed up at gender clinics for as long as necessary, with support