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Richard Bränström, Ph.D., John E Pachankis, Ph.D. Published Online:4 Oct 2019
Despite professional recommendations to consider gender-affirming hormone and surgical interventions for transgender individuals experiencing gender incongruence, the long-term effect of such interventions on mental health is largely unknown. The aim of this study was to ascertain the prevalence of mood and anxiety disorder health care visits and antidepressant and anxiolytic prescriptions in 2015 as a function of gender incongruence diagnosis and gender-affirming hormone and surgical treatment in the entire Swedish population.
This study used the Swedish Total Population Register (N=9,747,324), linked to the National Patient Register and the Prescribed Drug Register. Among individuals who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015 (N=2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming hormone and surgical treatment. Outcome measures were mood and anxiety disorder health care visits, antidepressant and anxiolytic prescriptions, and hospitalization after a suicide attempt.
Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98).
In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.
Calvin Freiburger Lifesite News, Fri Nov 15, 2019 - 5:06 pm EST
November 15, 2019 (LifeSiteNews) – For months now, the mainstream media has touted a recent study purporting to show that “gender-affirmation” treatment improves transgender mental health, but a prominent researcher argues that the study’s actual findings are very different.
On October 4, the American Journal of Psychiatry published a study by a team of Yale researchers based on more than 2.500 people diagnosed with gender incongruence between 2005 and 2015. It found, according to the abstract, that “years since initiating hormone treatment was not significantly related to likelihood of mental health treatment,” but “increased time since last gender-affirming surgery was associated with reduced mental health treatment.”
From that, the authors concluded that the “longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.”
These findings led to various headlines proclaiming things like “Long-Term Mental Health Benefits of Gender-Affirming Surgery for Transgender Individuals” (American Psychiatric Association), “Sex-reassignment surgery yields long-term mental health benefits” (NBC News), and “Transgender surgery linked with better long-term mental health, study shows” (ABC News).
Such readings are not warranted by the study itself, says University of Texas sociology professor Mark Regnerus, a prominent researcher on family and sexuality issues who analyzed the study Wednesday at The Public Discourse.
Regnerus found no fault with the authors’ data and methodology but argued the problem arises with the “scholarly interpretations of the study’s results, which are remarkably out of step with the far more modest conclusions they merit.”
“The study found no mental health benefits for hormonal interventions in this population,” he wrote. “Given the surge in interest, demand, and supply of hormonal therapies to self-identified transgender persons today, you would think that it is a solution that pays obvious benefits in reduced subsequent need — over time — for treatment of mood or anxiety disorder, or hospitalization after a suicide attempt. Yet there was no statistically significant effect. In fact, the confidence intervals actually reveal a nearly significant aggravating effect of hormonal treatment on subsequent mental health needs.
“It is the surgical effect, however, that has grabbed all the attention,” he continued. “Bränström and Pachankis detected a statistically significant effect of time since last ‘gender-affirming’ surgery on reduced mental health treatment,” meaning that the “odds of being treated for a mood or anxiety disorder (in 2015) were reduced by about 8 percent for each year since the last surgery.” However, the “linear decrease” they cite “is simply not visible in the study’s graphs.”
According to the actual data, Regnerus wrote, a clinic “may have to perform as many as 49 gender-affirming surgeries before they could expect to prevent one additional person from seeking subsequent mental health treatment. Yet that’s not what the authors say.”
A range of scientific literature indicates that reinforcing a patient’s gender confusion often fails to prevent significant emotional harm up to and including attempted suicide (with or without surgery), because fixating on “gender affirmation” tends to distract from exploring other issues that may be the actual root of a patient’s mental or emotional unrest.
“That the authors corrupted otherwise excellent data and analyses with a skewed interpretation signals an abandonment of scientific rigor and reason in favor of complicity with activist groups seeking to normalize infertility-inducing and permanently disfiguring surgeries,” Regnerus warned. “Physicians should not be pushed to prescribe such profoundly consequential treatment by threat of call-out, malpractice suits, patient demand, or — in this case — the overreaching interpretations of quality data.”
“Clinicians are being bullied into writing a radical prescription based on fear, not on sensible conclusions from empirical data,” he said. “But this reasonable position is getting more difficult to defend.”
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