Gender-Affirming Surgery as a Treatment Option for Gender Dysphoria in Adults: A Systematic Review of Ethical Reasons

Background: Gender dysphoria denotes the psychological distress experienced by individuals due to the incongruence between their gender identity and their sex assigned at birth. Gender-affirming surgery (GAS) is one of the treatment options available for people with gender dysphoria. This study aims to identify and analyze all ethical reasons both supporting and opposing GAS as a treatment option for gender dysphoria in adults. Methodology: A systematic review of reasons was conducted in accordance with the methodology proposed by Strech and Sofaer (2012) and the PRISMA guidelines. The literature search was conducted in seven major online databases-PubMed, Scopus, Embase, Web of Science, Philosopher's Index, ATLA Religion, and Index Theologicus-and in the Google Scholar search engine. Results: Twenty-nine articles published between 2003 and 2024 met the inclusion criteria. The ethical reasons identified in the included literature were grouped into five thematic categories: (1) the origin and nature of gender dysphoria, (2) reasons related to GAS as a treatment for gender dysphoria, (3) anthropological reasons, (4) reasons related to the effects of GAS, and (5) reasons stemming from traditional ethical principles. Discussion: The wide range of ethical reasons both supporting and opposing GAS as a treatment option for gender dysphoria in adults highlights the complexity of ethical deliberation in this area. This review provides a structured overview of the ethical reasons discussed in the literature, identifies important gaps, and suggests directions for future research.