Rates of psychiatric emergencies are high both before and after gender affirming surgery. Although both the phalloplasty and vaginoplasty patients have similar overall rates of psychiatric encounters, suicide attempts are more common in the later. In fact, our observed rate of suicide attempts in the phalloplasty group is actually similar to the general population, while the vaginoplasty group's rate is more than double that of the general population. Patients undergoing GAS with a history of prior psychiatric emergences or feminizing transition are at higher risk and should be counseled appropriately.
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