Gender-affirming surgery, also called sex reassignment surgery, has a positive effect on the mental health of transgender people, according to a new study published in the American Journal of Psychiatry. In the decade after surgery — that involves altering the physical appearance and function of genitalia of trans people to match the gender they identify with — the likelihood of a transgender person needing to continue to receive mental health care dropped by 8% each year, researchers found.

Though being transgender is not a form of mental ill-health — a fact only belatedly recognized by the World Health Organization in May — transgender individuals have long been known to experience higher rates of mental health problems than the general population. For some transgender individuals, the experience of one’s sex assigned at birth not matching one’s gender can cause distress to a degree in which it becomes a diagnosable state of gender dysphoria.

This most recent study, by researchers at Yale University’s School of Public Health, who used population data from the Swedish Total Population Register, found the transgender individuals involved, compared to the general population, were six times more likely to have a mood or anxiety disorder, three times more likely to have a prescription for antidepressant or anti-anxiety medication, and six times more likely to have been hospitalized after a suicide attempt.

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Gender dysphoria has been linked to anxiety and depression. The community’s disproportionate experience of stigma and violence is also thought, by experts, to contribute to such mental health risk. Transgender individuals routinely face misgendering (the act of mistaking someone for a gender associated with the sex they were assigned at birth, rather than by their gender identity — i.e., calling a trans man ‘she’ instead of ‘he’) and discrimination.

Transgender people are also more likely than the general population to experience violence. In the U.S., a disproportionately high murder rate of transgender people, especially transgender women of color, has prompted discussion of an “epidemic.” (Precise data is scarce, due to misgendering in reporting.) In South Asia, where reliable data is even rarer, first-hand accounts from transgender individuals as well as analyses by advocates who work in the field are the only trustworthy sources. “Violence, harassment, extortion, rape and murder of transgender persons continue to be committed. Police frequently refuse to file complaints, and are often themselves complicit in violence against transgender persons,” Frederick Rawski, Asia-Pacific director for the International Commission of Jurists, said in a statement last year. This violence receives a kind of condoning from the law itself; the Transgender Persons [Protection of Rights] Bill, 2016, passed by the Lok Sabha in 2018, aims at increasing the civil rights and protections of transgender individuals, advocates say. However, critics point out its gaping weaknesses — like the fact that it sets only two years as a maximum sentence for sexual assault of a transgender person, a far lighter, almost petty sentence compared with the minimum two-year sentence for rape, under the Indian Penal Code.

It’s encouraging that treatment in the form of gender-affirming surgery has been proven to have such a positive effect on the mental health of transgender people. (Hormone-only treatment provided no boost to mental health, according to the study.) The study “lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them,” its authors say in a statement. Increasing access to gender-affirming treatments, including surgery, is an important part of building a more transgender-friendly health care system, and a handful of advocates in India are actively trying to extend this option to more people, though cost and stigma within the medical community remain heavy obstacles.

But given that the bias that can underlie transgender people’s mental health struggles is still very evident in everyday life and in law, addressing social oppression has to be part of the solution, too.