The suicide rate for men identifying as transgender women in California doubled among those who receive vaginoplasty, a new study found.

More than twice as many men who identify as transgender women had attempted suicide after receiving the surgery when compared to those who had not undergone the procedure, according to AUA Journals.

Data analysts assessed 869 patients who received a vaginoplasty and 357 people who received a phalloplasty in California between 2012 and 2018, according to the study. The attempted-suicide rate among post-vaginoplasty patients was 3.3%, more than double the pre-surgery rate of 1.5%. The data on patients originated from the state’s Office of Statewide Health Planning and Development.

Vaginoplasty “involves the removal of a man’s penis, testicles and scrotum” to sculpt a “feminine-appearing” vaginal canal and vulva, according to John Hopkins Medicine. Phalloplasty is a surgery in which skin is taken and used to create a male-appearing penis on a woman, according to UCSF Transgender Care. Both surgeries are conducted on people identifying as transgender to give them the appearance of the opposite sex.