Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden 2011 - clarification by lead researcher Dr. Cecilia Dhejne 2015

[MoleSmokes]

There was a reference to this study in a current thread, which reminded me to post this.

The main researcher in the 2011 Swedish study "Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden by Dr. Cecilia Dhejne, et al 2011" has since clarified in 2015 that it does not prove what it seems to say that it proves.

This is what the study says (selected extracts only):

journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885

Results

The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8–4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8–62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9–8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0–3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls.

Crime rate

Transsexual individuals were at increased risk of being convicted for any crime or violent crime after sex reassignment (Table 2); this was, however, only significant in the group who underwent sex reassignment before 1989.

Gender differences

Comparisons of female-to-males and male-to-females, although hampered by low statistical power and associated wide confidence intervals, suggested mostly similar risks for adverse outcomes (Tables S1 and S2). However, violence against self (suicidal behaviour) and others ([violent] crime) constituted important exceptions. First, male-to-females had significantly increased risks for suicide attempts compared to both female (aHR 9.3; 95% CI 4.4–19.9) and male (aHR 10.4; 95% CI 4.9–22.1) controls. By contrast, female-to-males had significantly increased risk of suicide attempts only compared to male controls (aHR 6.8; 95% CI 2.1–21.6) but not compared to female controls (aHR 1.9; 95% CI 0.7–4.8). This suggests that male-to-females are at higher risk for suicide attempts after sex reassignment, whereas female-to-males maintain a female pattern of suicide attempts after sex reassignment (Tables S1 and S2).

Second, regarding any crime, male-to-females had a significantly increased risk for crime compared to female controls (aHR 6.6; 95% CI 4.1–10.8) but not compared to males (aHR 0.8; 95% CI 0.5–1.2). This indicates that they retained a male pattern regarding criminality. The same was true regarding violent crime. By contrast, female-to-males had higher crime rates than female controls (aHR 4.1; 95% CI 2.5–6.9) but did not differ from male controls. This indicates a shift to a male pattern regarding criminality and that sex reassignment is coupled to increased crime rate in female-to-males. The same was true regarding violent crime.

Conclusion

This study 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. This highlights that post surgical transsexuals are a risk group that need long-term psychiatric and somatic follow-up. Even though surgery and hormonal therapy alleviates gender dysphoria, it is apparently not sufficient to remedy the high rates of morbidity and mortality found among transsexual persons. Improved care for the transsexual group after the sex reassignment should therefore be considered.

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Cristan Williams interview with Dr. Cecilia Dhejne, 2015

I found parts of Dhejne's clarification difficult to grasp as it seems to contradict the published paper. However, it would appear that the paper was not written up with sufficient care to differentiate throughout between the two cohorts (1973 - 1988 and 1989 - 2003) so it is easily open to misinterpretation. Dhejne does not acknowledge this but it is obvious from the detailed questioning needed to winkle out the facts. Maybe being written in English rather than Swedish was a factor?

www.transadvocate.com/fact-check-study-shows-transition-makes-trans-people-suicidal_n_15483.htm

That is a long article - this is Dhejne's summary at the end (my bolding):

"The study as a whole covers the period between 1973 and 2003. If one divides the cohort into two groups, 1973 to 1988 and 1989 to 2003, one observes that for the latter group (1989 – 2003), differences in mortality, suicide attempts, and crime disappear. This means that for the 1989 to 2003 group, we did not find a male pattern of criminality.

As to the criminality metric itself, we were measuring and comparing the total number of convictions, not conviction type. We were not saying that cisgender males are convicted of crimes associated with marginalization and poverty. We didn’t control for that and we were certainly not saying that we found that trans women were a rape risk. What we were saying was that for the 1973 to 1988 cohort group and the cisgender male group, both experienced similar rates of convictions. As I said, this pattern is not observed in the 1989 to 2003 cohort group.

The difference we observed between the 1989 to 2003 cohort and the control group is that the trans cohort group accessed more mental health care, which is appropriate given the level of ongoing discrimination the group faces. What the data tells us is that things are getting measurably better and the issues we found affecting the 1973 to 1988 cohort group likely reflects a time when trans health and psychological care was less effective and social stigma was far worse. "

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This study is referenced repeatedly in articles about post-SRS criminality and suicide rates. Dhejne is aware that it is routinely misinterpreted but has not, unfortunately, taken the opportunity afforded on PLOS to add a comment to clarify how the paper should be understood.

journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885

I am no good at all when it comes to statistics so I am hoping that someone who is good at that sort of thing happens along this way!

If you put the original paper alongside the detail of Dhejne's clarification in the Cristan Willaims article and also stick to the 1989 to 2003 cohort - what does the study actually show? (Not a rhetorical question!)

Cristan's conclusion relates only to what it does not show:

"To be clear:

No, the study does not show that medical transition results in suicide or suicidal ideation. The study explicitly states that such is not the case and those using this study to make that claim are using fallacious logic.

No, the study does not prove that trans women are rapists or likely to be rapists. The “male pattern of criminality” found in the 1973 to 1988 cohort group was not a euphemism for rape.

No, the study does not prove that trans women exhibit male socialization. The “male pattern of criminality” found in the 1973 to 1988 cohort group was not a claim that trans women were convicted of the same types of crime as cis men."

No, the study does not prove that trans women are rapists or likely to be rapists. The “male pattern of criminality” found in the 1973 to 1988 cohort group was not a euphemism for rape.

Nor does it show they are any different from other males.

The study explicitly states that such is not the case

I have seen this phrase a few times but it refers to the author’s conclusion NOT the data. Conclusions are often full subjective speculation on why something may be the case and if an author has an interest to promote may well reflect that rather than the data itself. It is what the data says that is important.

“Transsexual individuals were at increased risk of being convicted for any crime or violent crime after sex reassignment (Table 2); this was, however, only significant in the group who underwent sex reassignment before 1989.”

So the earlier cohort had higher crime rates than the rest of the population.

The later group’s crime rates were what? Presumably same as the rest of the population? But I cannot see any figures where the 1989-2003 cohort was examined separately to check whether the apparent decrease to normal levels was a decrease in MtF or FtM criminality.

Have I missed something?

old.reddit.com/r/science/comments/6q3e8v/science_ama_series_im_cecilia_dhejne_a_fellow_of/
"Dear Cristan I forgot to confirm that I was not forced to be interviewed by you. Instead I was very happy that you gave me a possibility to clarify somethings. The interview was not fake. regarding your specific qustions. Regarding criminality there are only results from either both trans women and trans men and displayed for the whole period 1973-2003 and for the periods of 1973-1988 and the 1989-2003. If one is only intrested in transwomen data is only available for the whole period. For only assigned med who had transition 1973-2003 they had committed more crimes than cis women and more violent crime than cis women. The number of transwomen who had comited crime durin gthis period was 32, and the number who had comitted violent crime were 14. Most likely some of the 32 transwomen who had comitted a any crime had also comitted a violent crime sop you can not add the numbers. Having a male pattern means that they did not differ regarding any crime or violent crime if compared with cis men. However even if I can't say how it is for trans women specific one could see that if the whole group (tran women and trans men) are displayed together there is a very postive time trend. So after 1989 the transgender men and women together did not differ from cis gender men and women regarding comitting any crime or violent crime. This means that the trana population was not more criminal then the cis population after 1989. The actual number of any crimes for the transgroup is for 1973-2003 60, for 1973-1988 38 and for 1989-2003 22. The numbers of violent crimes are for 1972-2003 14, for 1973-1988 10 1989-2003 4."
The above is an answer given after the above interview by Dr Dhejne in a Science AMA Series in which she seems to imply that transwomen are no more but also no less likely to commit violent crimes than any other person who share their birth sex class. It is quite a long thread and I have not read all of it so there might be further examples given

Yes she is saying transwomen + trans women criminality = cis men + cis women criminality

Which is entirely consistent with each group retaining the criminality patterns of their sex.

A model which does not include both gender and sex is... to be honest academic dishonesty.

Excellent find 334bu

"If one is only interested in transwomen data is only available for the whole period."

Yes, that is what I had already found combing through the paper and the supplementary materials. As had many others.

So she is admitting that the paper shows exactly what it explicitly says in the paper, which she previously tried to sort of deny, that transwomen "retained a male pattern of criminality".

I have to admit, I think that her attempts to obfuscate on this are pretty appalling.

so transwomen committed all the violent crime? Are we told how many men and women are in the different time subsets? ie. can we be sure that the lower level of crime in the second subset was not due to the sex of the members of that group?

The point is that in the early group transmen adopted a male pattern of violence, and in the later group this effect disappeared, so their violence level went back to normal levels for their sex.

We only have figures for transwomen for the whole period, and their level of criminality was normal for their sex.

If you add them together, trans people as a whole have a raised level of criminality vs non-transitioned people of the same sex only in the early group. (Due to the raised level in transmen)

She has constantly conflated the two issues in order to say things that are obviously deliberately confusing on this. But whether she likes it or not, her own data shows what it shows.

Very interesting Mole, thank you.

Isn't Cristin Williams a well known, fairly militant TRA? Who relentlessly targeted Galus Meg? Is that the same guy?

The report never specified by crime. So claiming it doesn't mention rape is another strawman.

And, yes one cohort included transmen, which has been misused deliberately.

It's all a bit moot now anyway, with the number of transwomen sex offenders in prison.

The lead researcher is just that, she can’t rewrite the conclusion reached by the team of researchers, without them all reviewing the data together. She can clarify it, but that doesn’t appear to be what’s done in this interview, so the original conclusion stands.

the original conclusion stands

But that does not mean they are right, or that the data did not reveal stuff they avoided mentioning in their conclusions.

But that does not mean they are right, or that the data did not reveal stuff they avoided mentioning in their conclusions

Confused here! If Dr Dhenje didn't agree that transwomen show the same rates of criminality as men, why did she not state this in the Science AMA Series, instead of reiterating it. She had ample opportunity to reveal " stuff they avoided mentioning" but she didn't.

Birds I have zero idea, research is not all equal and all that. But unless she and other researchers get together and reevaluate and re release a new conclusion I would presume that the original stands and that comments in an interview (that may well be misrepresented/misreported/coerced or personally biased) can’t over ride the scientific conclusion.

If the lead researcher of the first big study into cigarettes and cancer had got up at the time and given an interview saying that the data didn’t really show that and the scientific/medical community accepted that as of greater value than the original conclusions in the study then where would be now?

I am confused here too!

What I am trying to say is always look at the actual data and judge whether the conclusions accurately reflect that data. Never just read the conclusions.

An example in a different field of what I mean is the conclusion the national autistic society drew from a study of language used around autism. They concluded this study showed most autistic people/people with autism preferred to describe themselves as ‘autistic’; this was because when asked how they preferred to describe themselves ‘autistic’ was the most popular response. However when you looked at the actual data only 20% chose this term; 80% chose a range of other terms (have autism, Aspie, on the spectrum...)

Totally different type of data. Nobody asked the members of this study whether they described themselves as criminals. Data was obtained from official figures. They either were or were not criminals, so drawing a conclusion that they shared male pattern criminality was based on hard facts.

I am not contesting the data. It certainly ties in with other data that transwomen retain male patterns of criminality.

Wouldn’t it be nice if we had a study of transgender males as opposed to transsexuals who’ve undergone genital SRS?

Since that’s what we’re talking about when we talk about proposed legal changes.

We’re talking about males who only twice a week identify as women (Pips Bunce), males who only alter themselves by wearing skirts and eyeliner, males who take oestrogen to promote gynecomastia in themselves, and males whose sole SRS consists of implants and and/or facial feminisation surgery.

We’re also talking about nin-binaries who choose to avail themselves of women’s facilities.

And we’re talking about males who change gender identity AFTER being convicted of crime.

THAT is the cohort whose propensity to criminality after changing identity needs studying.

Wouldn’t it be nice if we had a study of transgender males as opposed to transsexuals who’ve undergone genital SRS?

Absolutely this Bickerin.

And given that the big push now is to suggest there is a thing called “being trans” which is supposedly unrelated to MH problems, then the findings of this study - that successful life following transition is very much dependent upon continued psychiatric health care - will be increasingly ignored and the problems recorded in the earlier cohort will become more and more prevalent.

And 334bu, thanks so much for sharing that. I knew I’d read there was a significant problem with the claims she made in that interview, related to the fact that the results had not been separated by sex in the different cohorts, but I couldn’t find where that had come from.

The fact that scientists that work in this sphere are so heavily biased as to try to obfuscate the information from their own research is very significant.

"The study as a whole covers the period between 1973 and 2003. If one divides the cohort into two groups, 1973 to 1988 and 1989 to 2003, one observes that for the latter group (1989 – 2003), differences in mortality, suicide attempts, and crime disappear. This means that for the 1989 to 2003 group, we did not find a male pattern of criminality.

They didn't have enough individuals in the 1989 to 2003 cohort to make a statistical judgement. So the statement for the 1989 to 2003 group, we did not find a male pattern of criminality is very misleading. It is not like they found female pattern criminality instead or anything. They found nothing because their method made it impossible to find anything. They simply didn't have the numbers for the latter group (1989 to 2003) to make a judgement.

Maybe Dhejne doesn't understand the statistics she co-authored.

Mole thanks so much for posting this. I had a discussion with someone yesterday where he defended the "very supportive" help Mermaids gave a young girl (13) and her family when she transitions to becoming a boy. This young person had had a very complicated history of awful trauma, was diagnosed with autism - adults in their life considered that the kid's thoughts of self-harming were just about gender dysmorphia. 😡. Child is now on puberty blockers. I would really like to be able to roll out these stats to wake people up to the fact that transitioning socially or medically is NOT the go-to answer.

Also really infuriating and worrying, said trusted adult is an important person in type of adventure activity programme which currently welcomes boys and girls.