The regret rate for gender-affirming surgery is approximately 1%, based on a large meta-analysis pooling 7,928 transgender patients across 27 studies. That figure holds across different procedure types, with regret after surgeries for transgender men coming in below 1% and regret after surgeries for transgender women at roughly 1 to 2%.
What the Largest Reviews Found
The most comprehensive look at this question comes from a 2021 systematic review and meta-analysis published in Plastic and Reconstructive Surgery. Across nearly 8,000 patients, the pooled regret prevalence was 1%, with a 95% confidence interval ranging from less than 1% to 2%. In total, 77 patients out of the entire pool expressed regret. Of those, 28 experienced what researchers classified as minor regret and 34 as major regret.
Breaking it down by procedure type, chest surgery (mastectomy) had a regret rate below 1%, while vaginoplasty had a slightly higher rate of about 2%. These differences are small in absolute terms, but they reflect the greater surgical complexity and longer recovery associated with some procedures compared to others.
How This Compares to Other Surgeries
A 2024 systematic review in the American Journal of Surgery put gender-affirming surgery regret into broader context by comparing it to regret rates across other surgical specialties. The numbers are striking. Regret after breast reconstruction ranges from 0 to 47%. Breast augmentation carries a regret rate between 5 and 9%. Body contouring procedures see regret in 11 to 33% of patients. Around 30% of patients report regret after prostate removal, and up to 20% regret bariatric (weight loss) surgery.
By this measure, gender-affirming surgery has one of the lowest regret rates of any elective procedure studied.
Why People Experience Regret
The small number of people who do regret surgery don’t all regret it for the same reason, and understanding the distinction matters. Research published in Annals of Translational Medicine divided post-surgical regret into three categories, based on what drove patients to request reversal procedures.
- True gender-related regret accounts for about 42% of reversal requests. This involves someone who, after transitioning, wants to return to their sex assigned at birth. Causes include misdiagnosis, insufficient exploration of gender identity before surgery, or limited options for non-binary transition.
- Social regret makes up about 37% of reversal requests. These patients don’t necessarily feel their gender identity was wrong, but they struggle with the social consequences of transitioning: feeling unsafe in public, losing a partner or community, religious conflict, or facing professional barriers.
- Medical regret is the least common, cited in only 8% of reversal requests. This covers dissatisfaction with surgical outcomes, complications, or feeling that pre-operative counseling was inadequate.
One important detail: 24% of patients in that study experienced some kind of post-operative complication, but only 8% cited medical issues as a reason for regret. Complications alone don’t typically lead to regret if the patient’s underlying gender identity was accurately assessed and the social environment is supportive.
The Role of Social Support
Social factors play a real part in how satisfied someone feels after surgery. Research on social support and surgical outcomes found that parental acceptance of the surgery ranged from 66 to 77%, depending on the study group. Roughly 9 to 20% of parents did not accept their child’s decision. Acceptance from the patient’s own children followed a similar pattern, with about 65 to 71% supportive and 7 to 11% unsupportive.
This context helps explain why social regret makes up such a large share of the small group who seek reversal. When someone’s family, community, or workplace rejects them after surgery, that external pressure can generate regret even when the person’s sense of their own gender hasn’t changed. The surgery itself isn’t the source of distress; the social fallout is.
Mental Health Outcomes After Surgery
Large-scale outcome data paints a broadly positive picture. A study comparing over 3,100 patients who had gender-affirming surgery to a matched group who didn’t found significant improvements across multiple mental health measures. Depression rates dropped by 7.7 percentage points after surgery. Suicidal ideation decreased by 5.2 points, and suicide attempts fell by 2.3 points. Anxiety improved by 1.6 points. Antidepressant prescriptions dropped by 8.8 percentage points. Rates of alcohol and drug misuse also declined.
These improvements don’t mean surgery eliminates mental health challenges. But they do indicate that, for appropriately assessed patients, the procedure tends to move mental health indicators in a positive direction rather than a negative one.
How Patients Are Assessed Beforehand
The low regret rate isn’t accidental. Current clinical standards, outlined in the World Professional Association for Transgender Health’s Standards of Care (version 8), require a structured assessment process before anyone undergoes surgery. For adults, the experience of gender incongruence must be marked and sustained over time. Any mental health conditions that could affect outcomes need to be evaluated, and the patient’s ability to give informed consent must be confirmed.
For adolescents, the criteria are stricter. The experience of gender incongruence must be both marked and sustained. The adolescent must demonstrate the emotional and cognitive maturity to consent. And for most surgical procedures, at least 12 months of hormone therapy is required beforehand, unless hormones are not desired or are medically inappropriate. These layered requirements function as a screening process designed to reduce the chance of regret before surgery ever takes place.
Limitations of the Data
The 1% figure is the best estimate available, but it comes with caveats worth knowing. There is no standardized questionnaire for measuring surgical regret in this population, which means different studies define and capture regret differently. Some studies rely on whether a patient formally requested reversal surgery, which likely undercounts people who feel regret but never pursue additional procedures. Follow-up periods vary across studies, and patients who drop out of follow-up may differ systematically from those who stay in touch with their surgical teams.
The statistical heterogeneity in the meta-analysis was also notable, particularly for transfeminine procedures, meaning the studies included didn’t all point to exactly the same number. The overall conclusion of very low regret is consistent across the literature, but the precise percentage could shift somewhat as longer-term data and more standardized measurement tools become available.