Suicide rate of those who have undergone reassignment

[Wandawomble]

Noticed a comment on the Times article recently posted - “The most thorough follow-up of sex-reassigned people—extending over 30 years and conducted in Sweden, where the culture is strongly supportive of the transgendered—documents their lifelong mental unrest. Ten to 15 years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to 20 times that of comparable peers.”

Can we find more information about this?

I'd be surprised if surgery itself increased the suicide risk by 7%. If there were truth in that I think the NHS would have put the brakes on it a long time ago

But they don't do follow up from gender clinics as standard - so how would they know?

I don’t think the suicidability is just related to the SRS, but as mentioned up thread unresolved MH will also play a part. The figures are about America no UK. I seem to remember the high suicide rate post-op was what ended surgeries at J Hopkins clinic.
It’s really something that needs further research. I found this while looking for the GLAAD statistic that still eludes me:
“ Zucker and colleagues (2016) point out that while 10 of 666 (1.5%) of patients receiving SRS between 1972 and 2010 made formal regret applications, 10 of 324 (3.1%) who received SRS between 1973 and 2003 had killed themselves (Dhejne 2011, Zucker 2016). Another 29 of 324 (8.9%) receiving SRS in that period had made documented suicide attempts (Dhejne 2011, Zucker 2016).” Quite sobering.
It’s great when it works, but detransitioners and regretted need to be heard as part of figuring out what’s good for whom; as well as the how and why of best treatment.

@howmanyhats

I'd be surprised if surgery itself increased the suicide risk by 7%. If there were truth in that I think the NHS would have put the brakes on it a long time ago

But they don't do follow up from gender clinics as standard - so how would they know?

I wouldn't think that the results of coroner's inquests exist in a vaccuum. Maybe they do but, to say with any confidence that gender surgery alone correlates to a 7% increase in suicide completion I think there would need to be a not insignificant number of inquests reporting this. Personally, I only know about 10 or so post op trans women, all of who seem on the face of it to live generally happy lives. I don't think that's uncommon though.

You are right about lack of GIC follow up though. With the exception of a post surgical follow up and subsequent discharge from the GIC there has been no specialist follow up apart from if you count a private surgery some years later. Is that unusual, I honestly don't know? I had another significant surgery 15 years ago that wasn't trans related which also has had no follow up. Gender surgery is far from being alone amongst the types of cases that are discharged to general practice for long term periodic monitoring.

@Terranean

I don’t think the suicidability is just related to the SRS, but as mentioned up thread unresolved MH will also play a part. The figures are about America no UK. I seem to remember the high suicide rate post-op was what ended surgeries at J Hopkins clinic. It’s really something that needs further research. I found this while looking for the GLAAD statistic that still eludes me: “ Zucker and colleagues (2016) point out that while 10 of 666 (1.5%) of patients receiving SRS between 1972 and 2010 made formal regret applications, 10 of 324 (3.1%) who received SRS between 1973 and 2003 had killed themselves (Dhejne 2011, Zucker 2016). Another 29 of 324 (8.9%) receiving SRS in that period had made documented suicide attempts (Dhejne 2011, Zucker 2016).” Quite sobering. It’s great when it works, but detransitioners and regretted need to be heard as part of figuring out what’s good for whom; as well as the how and why of best treatment.

From my experience, my early distress was related to being trans or more specifically feeling unable to express myself in a way that made me feel comfortable. Later anxieties were centred more on the way society treated me for not conforming to what is normal so there is quite likely something in what you say about MH issues. Normal is not a word I'd use a lot though, I think we are just a less common version of the human condition. That does make some more uncomfortable than others but, I'm given to thinking it's them that have the problem.

Detransitioners should definitely be heard, their voice is important in driving improvement and they should be afforded a good level of support. However, treatment satisfaction rates regularly reported as being in the 90's if not the high 90's as a percentage make me think that they (the government) have to be careful not to let often emotive politics lead to the baby being thrown out with the bath water in order to satisfy their base at the expense of wellbeing.

I'd be surprised if surgery itself increased the suicide risk by 7%. If there were truth in that I think the NHS would have put the brakes on it a long time ago

I don't think so, because we are talking about a small increase in the rate of suicide in a relatively small number of people.

From the latest ONS release:
In 2019, there were 5,691 suicides registered in England and Wales, an age-standardised rate of 11.0 deaths per 100,000 population.

I don't know what is the total number of trans people in the UK who have undergone GRS, but I presume it is a few thousand.

Assuming a population of 10,000 such trans people (to keep the figures simple), if the rate of suicide in this group were the same as in the general population, then there would be approximately 1 per year (1 tenth of the number for 100,000 in the general population gives 1.1 per year). Increase this by 7% and it becomes about 1.18 people per year. The numbers are so small that it would be difficult to draw any conclusions, since 2 or 3 suicides in one year would skew the figures enormously, but might be due to completely different reasons than anything to do with their surgery or the fact that they are trans. It would also be skewed if there were no suicides one year, even though this is very likely in this small number of people.

The 20x figure mentioned in the OP is a completely different matter. But it's reported in that paper that:

Despite the long history of this treatment, however, outcome data regarding mortality and psychiatric morbidity are scant. With respect to suicide and deaths from other causes after sex reassignment, an early Swedish study followed 24 transsexual persons for an average of six years and reported one suicide.[5] A subsequent Swedish study recorded three suicides after sex reassignment surgery of 175 patients.[6] A recent Swedish follow-up study reported no suicides in 60 transsexual patients, but one death due to complications after the sex reassignment surgery.[7] A Danish study reported death by suicide in 3 out of 29 operated male-to-female transsexual persons followed for an average of six years.[8] By contrast, a Belgian study of 107 transsexual persons followed for 4–6 years found no suicides or deaths from other causes.[9]

At the moment, we just don't have enough data (although the numbers in the above paragraph do generally seem quite high for such a small number of people over a short period of time).

@OldCrone

I'd be surprised if surgery itself increased the suicide risk by 7%. If there were truth in that I think the NHS would have put the brakes on it a long time ago

I don't think so, because we are talking about a small increase in the rate of suicide in a relatively small number of people.

From the latest ONS release:
In 2019, there were 5,691 suicides registered in England and Wales, an age-standardised rate of 11.0 deaths per 100,000 population.

I don't know what is the total number of trans people in the UK who have undergone GRS, but I presume it is a few thousand.

Assuming a population of 10,000 such trans people (to keep the figures simple), if the rate of suicide in this group were the same as in the general population, then there would be approximately 1 per year (1 tenth of the number for 100,000 in the general population gives 1.1 per year). Increase this by 7% and it becomes about 1.18 people per year. The numbers are so small that it would be difficult to draw any conclusions, since 2 or 3 suicides in one year would skew the figures enormously, but might be due to completely different reasons than anything to do with their surgery or the fact that they are trans. It would also be skewed if there were no suicides one year, even though this is very likely in this small number of people.

The 20x figure mentioned in the OP is a completely different matter. But it's reported in that paper that:

Despite the long history of this treatment, however, outcome data regarding mortality and psychiatric morbidity are scant. With respect to suicide and deaths from other causes after sex reassignment, an early Swedish study followed 24 transsexual persons for an average of six years and reported one suicide.[5] A subsequent Swedish study recorded three suicides after sex reassignment surgery of 175 patients.[6] A recent Swedish follow-up study reported no suicides in 60 transsexual patients, but one death due to complications after the sex reassignment surgery.[7] A Danish study reported death by suicide in 3 out of 29 operated male-to-female transsexual persons followed for an average of six years.[8] By contrast, a Belgian study of 107 transsexual persons followed for 4–6 years found no suicides or deaths from other causes.[9]

At the moment, we just don't have enough data (although the numbers in the above paragraph do generally seem quite high for such a small number of people over a short period of time).

That's a really good way of offering some perspective and a clear way to look at it. I think your 10000 right may be a reasonable estimate too. I think the US would be a good place to look as there are likely to be people there who are denied healthcare due to financial reasons although the UK appears to be catching up due to capacity reasons. Even then I think it would be difficult isolate surgery alone as a cause of any increase in the suicide rates.

Normal is not a word I'd use a lot though, I think we are just a less common version of the human condition. That does make some more uncomfortable than others but, I'm given to thinking it's them that have the problem.

That. Every day, all day long. THAT @Steph751 is precisely it.

That's the conversation I have regularly (you and @BlueLipstickRocks could be my friends, your voices, what you are saying, sounds so familiar).

And that is the difference between 'old style' and the new, shoutier trans perspective. You have internalised your differences, accepted them as being part of you, distinct and somewhat dfferent from the wider society. What you want and need is what we had almost globally here in the UK, the unspoken nod of acceptance (no matter it made everyone involved feel uneasy at times) it was what got everyone through their day and, given the specific circumstances (humans can't change sex just their apearance), was a reasonable compromise for decades.

Now that is not acceptable to many. What is wanted is not that compromise, that nod and unspoken agreement. What is demanded is parity, total acceptance of the individual statement of sex. And that is what is causing issues that have ever wideining ripples, making that unspoken nod less likely, disrupting the every day lives of many more than ever before.

What we - that is society as a whole, not we women - should be discussing is those stats. Working out the truths behind healthcare for trans people and working to improve it, to make it fit for purpose. Even in these cash strapped times the NHS can and should be able to offer a more holistic service.

But then that could be said for very many aspects of everyone's life these days!

@CuriousaboutSamphire

Normal is not a word I'd use a lot though, I think we are just a less common version of the human condition. That does make some more uncomfortable than others but, I'm given to thinking it's them that have the problem.

That. Every day, all day long. THAT @Steph751 is precisely it.

That's the conversation I have regularly (you and @BlueLipstickRocks could be my friends, your voices, what you are saying, sounds so familiar).

And that is the difference between 'old style' and the new, shoutier trans perspective. You have internalised your differences, accepted them as being part of you, distinct and somewhat dfferent from the wider society. What you want and need is what we had almost globally here in the UK, the unspoken nod of acceptance (no matter it made everyone involved feel uneasy at times) it was what got everyone through their day and, given the specific circumstances (humans can't change sex just their apearance), was a reasonable compromise for decades.

Now that is not acceptable to many. What is wanted is not that compromise, that nod and unspoken agreement. What is demanded is parity, total acceptance of the individual statement of sex. And that is what is causing issues that have ever wideining ripples, making that unspoken nod less likely, disrupting the every day lives of many more than ever before.

What we - that is society as a whole, not we women - should be discussing is those stats. Working out the truths behind healthcare for trans people and working to improve it, to make it fit for purpose. Even in these cash strapped times the NHS can and should be able to offer a more holistic service.

But then that could be said for very many aspects of everyone's life these days!

I don't really see myself as old school because I'm sure the majority of people going through transition today face similar battles with society and themselves to myself. I think as a trans person it's unhelpful to distinguish any form hierarchy or encourage division. That's not to say we aren't all individuals with our own worries and opinions just that I believe in stronger together.

What I think is important for me though is deciding which hills I'm metaphorically wil!ing to die on and those which I'm not. Trans healthcare is in a dire situation and I would say that is the single most important thing that can be addressed by effective campaigning. What I'm not willing to worry about is things like pro-nouns on my email, I have a name, if somebody wants my attention they probably need to use it unless they're willing to do something crazy enough to make me look up.

As for changes in attitudes I would say life generally has become less pleasant if you are out / open about being trans. A lot of negative media attention is going to have its impact whether that be distrust, suspicion or in a few cases real hatred. That's not to say it's any more difficult than for any other particular minority group because those with power in society, mainly white men of a certain class are heavily invested in the status quo. Whether that is treading on women or demonizing minorities to ensure society remains divided enough so that no one notices or cares enough about how they continue to take us all for a ride.

Personally, I'd like to switch the clock back a few years but, I think we are too far down the rabbit hole now. If I win the lottery a small holding in the middle of nowhere with a few animals and the least human contact I can get away with is something I think I'd quite like.

I don't really see myself as old school because I'm sure the majority of people going through transition today face similar battles with society and themselves to myself. My apologies. I was trying to find a way to distinguish those trans people who are not the shouty, angry, lobbying, biology denying activists.

And if you happen to find 2 of those small holding havens let me know

Even then I think it would be difficult isolate surgery alone as a cause of any increase in the suicide rates.
That’s a key aspect of this difficult issue, specially under the current narrative that push the affirmation model to children and young people. Transition and PB are sold as the cure and ticket to a happy life away from those dangerous thoughts that makes some uncharitable associations tell a parent “better a x than a dead z”.
I think that further research should be backed rather than blocked.

@CuriousaboutSamphire

I don't really see myself as old school because I'm sure the majority of people going through transition today face similar battles with society and themselves to myself. My apologies. I was trying to find a way to distinguish those trans people who are not the shouty, angry, lobbying, biology denying activists.

And if you happen to find 2 of those small holding havens let me know

There's no need for apologies, I can see your point.

The small holding is looking better every day😊

@Terranean

*Even then I think it would be difficult isolate surgery alone as a cause of any increase in the suicide rates.* That’s a key aspect of this difficult issue, specially under the current narrative that push the affirmation model to children and young people. Transition and PB are sold as the cure and ticket to a happy life away from those dangerous thoughts that makes some uncharitable associations tell a parent “better a x than a dead z”. I think that further research should be backed rather than blocked.

Personally, I do think they can be beneficial however, I'm of the opinion that the medical care is a matter best left for them, their parents/guardians and the medics involved in their care. I feel that once outside influences are involved, whether they be pro or anti treatment, the waters are muddied and the well being of the child may not be best served.

It has been on the news how political the Tavistock care has become. I would be quite critical of self-diagnosis of any kind.

Best luck with your holding Steph!

I don't really see myself as old school because I'm sure the majority of people going through transition today face similar battles with society and themselves to myself

My experience is different. Whilst transsexualism does still exist and I do meet people who experience the same issues as I have I would have said it is very much not the majority.
Diagnostic process has changed radically, diagnostic criteria has changed and indeed even the meaning of trans has changed. To me I simply cannot relate to the average young trans person of today.

@BlueLipstickRocks

I don't really see myself as old school because I'm sure the majority of people going through transition today face similar battles with society and themselves to myself

My experience is different. Whilst transsexualism does still exist and I do meet people who experience the same issues as I have I would have said it is very much not the majority.
Diagnostic process has changed radically, diagnostic criteria has changed and indeed even the meaning of trans has changed. To me I simply cannot relate to the average young trans person of today.

Blue Do you think it's down to something you said earlier?

"It's well-established that transsexualism was manipulated into a transgender umbrella that sought to encompass transvestitism."

Because it would certainly account for the differences we often see. Including the individual experiences related by various trans people.

@BlueLipstickRocks

I don't really see myself as old school because I'm sure the majority of people going through transition today face similar battles with society and themselves to myself

My experience is different. Whilst transsexualism does still exist and I do meet people who experience the same issues as I have I would have said it is very much not the majority.
Diagnostic process has changed radically, diagnostic criteria has changed and indeed even the meaning of trans has changed. To me I simply cannot relate to the average young trans person of today.

I suppose we see the world through different eyes, that's not such a negative thing. Variety is the spice of life and there's no reason why opinion shouldn't follow suit.

I don't think the prevalence of being transsexual has changed much over the years. The information age has probably seen a rise in year on year incidence as more people have gained knowledge about how they feel and acquired the language and courage to say, 'yes, that is me.' Even so, numbers are still very small. Seeing another trans person during my daily routines is still quite unusual even in a deadly populated area.

As for diagnostic criteria, is progres away from a 'disorder to be avoided if at all possible' really that negative? The criteria as with anything else develop with improved understanding or a condition in a changing world. Our reality isn't unique in that sense. For example, we don't have to go that far back in time to see autistic children being described as having childhood schitzophrenia , the product of 'refrigerator parents.' As their diagnostic criteria developed and their treatment by society allowed them access to the main stream, we'd have never had to look too far for those who claimed their new found rights and freedoms were encroaching on the rights of the 'normal crowd'. So, yes, meanings changing doesn't have to be bad.

As for an ability to relate to the young, I wouldn't say I'm down with the youth but, I really admire them and even though I am a long way from agreeing with everything they say and want, they give me a funny kind of hope. It's clear they aren't going to hide their non conformity in a closet, or restrict themselves in the jacket of a stereotype to spare the comforts of more conservative minds or more to the point to avoid the wrath of even more conservative minds. That is a want for progress that I really do understand.

Haven't said anything about what "sort" of trans person she is, I have merely pointed out that she is wrong to describe being transsexual as a psychological disorder

Surely any extreme dysphoric condition is, by definition, a psychological disturbance. The clue is in the pre-fix 'DYS'

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder

The distress is what precedes the transition. The inability to find peace or any sense of functional reality in one's own body.

A relation on my husband's side of the family fully transitioned many years ago. They now, many years later, express regret.

One finds that life and the full gamut of human existential struggle persists even after transition. Life in the world is not just about yourself, but about relationships with other people, and about the world beyond one's own feelings and one's own sense of self.

Gender is socially constructed. Sex is observable and measurable.

Once interventions started to take effect it was more down to the way in which society treated me such as family rejection and the general animosity you can encounter when you don't confirm to the binary

How many of us conform to the " binary"?

If by binary you mean observable sex based characteristics, then that can only ever be expected, because sex is instinctively registered, and can be detected through all manner of outward manifestation: from height and gait, to bone structure, voice, and I'd suggest also an indeterminate but readily noticeable 'other' factor.

that's the crux, isn't it?

Gender is a socially constructed or/and negotiable presentation or expressive style ( which by nature is social), but sex is a measurable and observed reality that lies beneath all gendered presentations.
You cannot blame people for recognising sex.

Anyway, I didn't mean to ramble that much, I got a bit carried away, I'm just interested in what makes you feel you're old school and therefore different from those who experience a similar thing today

My perception is that these days transition is presented in a very different way; to the extent that even explorative psychological counselling is seen as being transphobic. Transgenderism is a different beast to transexualism because it relies on the notion of an inbuilt, internal sense of one's gender, rather than on a physical resolution for severe psychological distress.

The fact that you have used terms such as 'the binary' is indicative of this different approach. contemporary transgenderism comes complete with a whole catalogue of terminology which is indicative of a certain ideological construct/ formation.

@Justhadathought

Anyway, I didn't mean to ramble that much, I got a bit carried away, I'm just interested in what makes you feel you're old school and therefore different from those who experience a similar thing today

My perception is that these days transition is presented in a very different way; to the extent that even explorative psychological counselling is seen as being transphobic. Transgenderism is a different beast to transexualism because it relies on the notion of an inbuilt, internal sense of one's gender, rather than on a physical resolution for severe psychological distress.

The fact that you have used terms such as 'the binary' is indicative of this different approach. contemporary transgenderism comes complete with a whole catalogue of terminology which is indicative of a certain ideological construct/ formation.

As far as I am aware, psychological counselling and evaluation is still very much part of the transition package. Personally I am 20 odd years out of date but, my friend went through the NHS route between 2015 with surgery early last year and psychological counselling and evaluation was very much part of her treatment. If these things weren't part of the package I think it would be a one stop shop from a GP to a surgeon's table. I'm given to thinking it's a bit of an urban myth really that there is any large scale feeling amongst today's transitioners, either old or young that it's transpbobic. Perhaps it's one that some are happy to let flow as dividing a group in any sense is a good way to control them and it also allows the delusion amongst some of that group that they're the good ones.

I'm not sure about my the use of a term being indicative of a different approach. I think the approach used then was pretty similar for most of us. Transition was 24 years ago with surgery following and I've always preferred to think of myself as transgender, I don't think it's a new term. It's just how I felt, rather than transsexual which was how I was diagnosed. I felt more comfortable with that description, even then it seemed to carry less stigma. But, I can promise you, the psychological distress which required surgical intervention was no less for my choice of words.

As far as I am aware, the ICD 11 from 2022 will rely much less on looking at being trans as a mental disorder. That fills me full of hope for future generations. The less stigma around a diagnosis the better. It's not to say those future generations won't feel that same acute psychological distress and require the same surgical interventions but, I'm hopeful as a result that their paths through life will be paved with a widespread acceptance.

Not read all the comments here but as explained by the researcher themself, suicide levels dropped after transition. They dropped in comparison to trans peopel who did not transition. They still stayed above the normal suicide levels of cisgender people.

This myth and others are destroyed here in this interview with Dr. Cecilia Dhejne

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

[quote DisgustedofManchester]Not read all the comments here but as explained by the researcher themself, suicide levels dropped after transition. They dropped in comparison to trans peopel who did not transition. They still stayed above the normal suicide levels of cisgender people.

This myth and others are destroyed here in this interview with Dr. Cecilia Dhejne

www.transadvocate.com/fact-check-study-shows-transition-makes-trans-people-suicidal_n_15483.htm[/quote]
I'd have been really surprised if they didn't. Comparing post op outcomes of trans people to people who haven't experienced being trans at all would always be likely to lead to a muddying of the waters. My own experience and that of a few of my peers has been positive. I don't think we are unusual in that.

As far as I am aware, the ICD 11 from 2022 will rely much less on looking at being trans as a mental disorder. That fills me full of hope for future generations. The less stigma around a diagnosis the better. It's not to say those future generations won't feel that same acute psychological distress and require the same surgical interventions but, I'm hopeful as a result that their paths through life will be paved with a widespread acceptance.

If it's not a mental disorder, what sort of condition is it which requires a medical diagnosis?

If it is not a mental disorder, what sort of condition is it if it results in psychological distress and requires surgical intervention to relieve this distress?