Claim: Transgender Surgery Provides A Health Benefit

The study that claimed this was corrected; surgery actually does not provide a health benefit.

A very large transgender population study by Richard Bränström and John E Pachankis in October 2019 concluded that gender-affirming surgery helped mental health; this claim was shown to be completely wrong after a series of letters to the editor of the American Journal of Psychiatry challenged the conclusions of the study.

The study Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study was published in the American Journal of Psychiatry (AJP) and looked at the population of Sweden, which has a public health system that gathers a great deal of data. The authors of the study claimed that transgender people who had gender-affirming surgery were less likely to access mental health treatment after their gender surgery.

There were letters to the editor of the AJP from 12 authors challenging the conclusions of this study; they pointed out that the results of the study seemed to contradict the results of an earlier study, Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden, 2011 which found

substantially higher rates of overall mortality, death from cardiovascular disease and suicide, suicide attempts, and psychiatric hospitalisations in sex-reassigned transsexual individuals compared to a healthy control population.

The letter authors pointed out that there is a gap in knowledge: the comparison of rates of suicide/mental health difficulties between those transgender people who have had surgery and those who have not.

GENDER DYSPHORIC PEOPLE ALREADY HAVE MENTAL HEALTH PROBLEMS

The letter authors also asked, people who had gender-affirming surgery were less likely to access mental health treatment compared to whom? The logical group of comparison would be gender dysphoric people who had not had surgery.

The letter authors pointed out that as people with gender dysphoria get older, they might generally be less likely to access mental health treatment, due to increasing maturity; furthermore, as they had no data on suicides, any people who committed suicide after the surgery would obviously not be accessing mental health treatment, and the study did not look at hospitalisation after suicide attempts or suicides themselves.

The AJP for some reason took TEN MONTHS to publish these letters, using the excuse that they had to give the study authors time to look at their stats and respond.

This is an unacceptably long time when this study, if its conclusions were incorrect, could convince people to have transgender surgery, when the result of that could be worsened mental health outcomes and suicide.

These were the letter writers’ main concerns (from Bränström and Pachankis’ response):

• Concern 1: The analysis focused on mental health treatment utilization during one specific year (i.e., 2015) rather than during a longer follow-up period, such as before and after provision of gender-affirming treatment.

• Concern 2: The study did not employ an adequate comparison group.

• Concern 3: The study did not sufficiently highlight the elevated mental health care needs of transgender individuals seeking gender-affirming care during the perioperative period.

NO DIFFERENCE TO MENTAL HEALTH

The authors of the study Bränström and Pachankis gave a response dealing with the concerns, affirming that they had to agree with the letter writers. They re-analysed their data, comparing use of mental health service of patients with gender incongruence who had had surgery, with those who had gender incongruence who had not had surgery (rather than the general population) and found that having the operation makes no difference at all to mental health in the year following surgery.

MORE ANXIETY AFTER SURGERY

One of their most interesting conclusions after the re-analysis was that gender incongruent individuals who had received gender-affirming surgery were actually more likely to be treated for anxiety disorders than those gender incongruent individuals who had not received gender affirming surgery, a conclusion 180° away from the direction of the original conclusion – the complete opposite conclusion in fact!

However, individuals diagnosed with gender incongruence who had received gender-affirming surgery were more likely to be treated for anxiety disorders compared with individuals diagnosed with gender incongruence who had not received gender-affirming surgery.

WE STILL DON’T KNOW IF IT RESULTS IN MORE SUICIDES

Disappointingly, the study authors said they did not have enough data on suicide attempts or suicides to come to any conclusion.

MUCH TOO SLOW FACT CHECK HALL OF INFAMY

The American Journal of Psychiatry was far too slow to publish the dissenting letters.

REFERENCES

https://www.thepublicdiscourse.com/2020/09/71296/

Bränström, R, Pachankis, J E., Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study Am J Psychiatry 2020; 177:727-734 (ORIGINALLY PUBLISHED October 4 2019) Abstract

Bränström, R, Pachankis, J E., Toward Rigorous Methodologies for Strengthening Causal Inference in the Association Between Gender-Affirming Care and Transgender Individuals’ Mental Health: Response to Letters Am J Psychiatry 2020: 177:769-772 Abstract

Anckarsäter H, Gillberg C: Methodological shortcomings undercut statement in support of gender-affirming surgery. Am J Psychiatry 2020; 177:764–765 Abstract

Van Mol A, Laidlaw M, Grossman M, et al.: Gender affirmation surgery conclusion lacks evidence. Am J Psychiatry 2020; 177:765–766Abstract

Curtis D: Study of transgender patients: conclusions are not supported by findings. Am J Psychiatry 2020; 177:766 Abstract

Malone W, Roman S: Calling into question whether gender affirming surgery relieves psychological distress. Am J Psychiatry 2020; 177:766–767 Abstract

Landén M: The effect of gender-affirming treatment on psychiatric morbidity is still undecided. Am J Psychiatry 2020; 177:767–768 Abstract

Wold A: Gender corrective surgery promoting mental health in persons with gender dysphoria not supported by data presented in paper. Am J Psychiatry 2020; 177:768 Abstract

Ring A, Malone M: Confounding effects on mental health observations after sex reassignment surgery. Am J Psychiatry 2020; 177:768–769 Abstract

Bränström R, Pachankis JE: Toward rigorous methodologies for strengthening causal inference in the association between gender-affirming care and transgender individuals’ mental health. Am J Psychiatry 2020; 177:769–772 Abstract

CHANGE LOG

14 April Corrected the original date of the first study in my article, which I said was in 2020, to the actual original date, October 2019