<![CDATA[This study aims to investigate the structural barriers to accessing gender affirmation surgery (GAS) and evaluate the resulting impact on the mental health of transgender individuals in Pakistan. Conducted through a cross-sectional survey from January to March 2025, the study engaged 500 transgender individuals across five major Pakistani cities: Karachi, Lahore, Islamabad, Peshawar, and Quetta. Data were gathered via a structured questionnaire encompassing demographics, healthcare barriers, and mental health metrics. Mental health indicators, including depression (42%), anxiety (38%), and PTSD (21%), were documented based on participant self-report of formal clinical diagnoses received prior to the study. The results reveal a stark reality: only 9% (n=45) of respondents had successfully undergone full GAS, while a substantial majority (61%, n=305) expressed a strong desire for the procedure but faced insurmountable obstacles. The most prominent barriers identified were the prohibitive high cost (73%) and a critical lack of specialized surgeons (56%). A mental health crisis is evident, with 74% of participants reporting regular symptoms of distress. A statistically significant association was established between the desire for surgery and heightened mental distress (x2 = 17.94, df = 1, p < 0.001), with a Cramer’s V of 0.19, indicating a moderate effect size. This research highlights a systemic failure at the intersection of healthcare, socio-legal policy, and mental health support, calling for urgent reforms such as financial subsidies and the integration of transgender health into medical education.]]>
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