REVIEW A Review of Psychosocial Risk Factors Among Transgender Patients Seeking Bariatric Surgery Leah Hecht 1 & Chazlyn Miller 2 & Lisa R. Miller-Matero 3 & Aaron Hamann 1 & Arthur M. Carlin 1 & Kellie Martens 1 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract As nearly one third of transgender individuals in the USA are obese, more transgender patients may pursue bariatric surgery as a means of sustaining weight loss. Transgender individuals, like bariatric surgery patients, have high rates of mood pathology, substance use, abuse, and self-harm behaviors. However, there is no research on transgender bariatric surgery candidates. The aim of this review is to elucidate potential psychosocial risk factors, including sex hormone management, which may impact surgical clearance, presurgical psychosocial assessment, and treatment recommendations. Keywords Bariatric surgery . Transgender . Psychosocial factors Introduction The term transgender refers to “individuals who transiently or persistently identify with a gender different from their natal gender” whereas “cisgender” refers to people whose gender identity aligns with their sex at birth [1, 2]. A survey of adults across the USA and Guam found 28.16% of transgender people have a body mass index (BMI) in the obese range (> 30 kg/m 2 ), similar to rates of obesity (30.43%) among cisgender people [3]. Although rates of obesity appear to be relatively similar among transgender and cisgender individuals, less than 1% of individ- uals seeking bariatric surgery identify as lesbian, gay, bisexual, or transgender (LGBT) [4]. Considering the dramatic rise in severe obesity in the USA [5], coupled with an increase in the number of people undergoing bariatric surgery [6], there will likely be an increased prevalence of transgender individuals seeking surgical weight loss. A presurgical psychological evaluation is a standard part of the recommended work-up for those seeking bariatric surgery [7]. At minimum, a psychological evaluation for bariatric surgery should include an assessment of psychological health and functioning including eating behaviors and weight histo- ry, substance use, social support, decision-making capacity, and ability to adhere to postsurgery lifestyle behaviors [7–9]. Presently, there is a dearth of research on transgender individ- uals seeking bariatric surgery, and a review of potential psy- chosocial risk factors may help to inform psychological as- sessment in this population. The aim of this review is to highlight presurgical psycho- social risk areas among transgender individuals and bariatric candidates in order to better inform assessment and treatment recommendations for providers caring for transgender indi- viduals seeking bariatric surgery. In service of this goal, we will discuss areas of potential psychosocial risk among trans- gender individuals seeking bariatric surgery including gender dysphoria, sexual abuse, depression and anxiety, suicidal ide- ation and self-harm, substance use, and hormonal manage- ment. Additionally, the review will highlight several ways in which the psychosocial needs of transgender bariatric surgery candidates are unique from cisgender individuals and recom- mended assessment strategies for providers. Gender Dysphoria Gender dysphoria refers to the degree of discrepancy between physical gender characteristics and gender self-identification as well as associated distress or functional impairment [1]. Behavioral health clinicians may want to consider using an assessment of gender dysphoria to evaluate distress regarding * Kellie Martens KMarten2@hfhs.org 1 Bariatric Surgery, Henry Ford Health System, 1 Ford Place, 1C-46, Detroit, MI 48202, USA 2 University of Michigan-Dearborn, Dearborn, MI, USA 3 Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA Obesity Surgery https://doi.org/10.1007/s11695-019-04076-z