New research: depression and MH worse after surgical transition

[Pluvia]

I can't see this reported previously. A new research project in the US has studied 107+k patients with gender dysphoria over a ten year period 2014-24.

Its conclusion is that depression, anxiety, substance misuse etc is higher in those who had surgery than those who didn't:

From 107 583 patients, matched cohorts demonstrated that those undergoing surgery were at significantly higher risk for depression, anxiety, suicidal ideation, and substance use disorders than those without surgery. Males with surgery showed a higher prevalence of depression (25.4% vs. 11.5%, RR 2.203, P < 0.0001) and anxiety (12.8% vs. 2.6%, RR 4.882, P < 0.0001). Females exhibited similar trends, with elevated depression (22.9% vs. 14.6%, RR 1.563, P < 0.0001) and anxiety (10.5% vs. 7.1%, RR 1.478, P < 0.0001). Feminizing individuals demonstrated particularly high risk for depression (RR 1.783, P = 0.0298) and substance use disorders (RR 1.284, P < 0.0001).

https://academic.oup.com/jsm/advance-article-abstract/doi/10.1093/jsxmed/qdaf026/8042063?login=false

It would be interesting to hear from anyone who can shed light on the methodology and analysis used. Difficult for the average non-expert to know whether this constitutes decent quality research or not.

I can't help you with the methodology, but I have always thought that given the complications that can result from genital surgery, the claim that this is 'life-saving care' was extremely dubious. I mean, who could possibly think that a complication such as incontinence is going to help someone's mental health?

Conclusion
Gender-affirming surgery, while beneficial in affirming gender identity, is associated with increased risk of mental health issues, underscoring the need for ongoing, gender-sensitive mental health support for transgender individuals’ post-surgery.

So their conclusion is that the solution to GA surgery increasing the risk 'of significantly higher risk for depression, anxiety, suicidal ideation, and substance use disorders than those without surgery.' is ongoing MH support.

Why not conclude that GA surgery is not a good thing and should not be carried out?

Whether it's a credible study or not, it will be shouted down as 'transphobic' by TRA's.

Looks good to me. It's not quite the same as a randomised controlled trial, so is more of a correlational study. But the sheer scale of it and the use of records rather than a one shot self report method adds confidence. The authors mention uncontrolled factors that the available data didn't tell them about, like the degree of social support. Another issue that occurs to me is that the people who pressed ahead with treatment may have been more psychologically vulnerable, prone to depression and so on compared to those who didn't. After all, it's arguably a more resilient, independent person who decides to forge their own path, rather than believing that their life can only be saved with drugs or surgery. So we don't know that the groups compared were identical to begin with.

For those of us with long memories, this sort of finding was more commonplace in years gone by, before WPATH siezed the microphone and refused to let go of it. Latterly the WPATH version has been that we're not 'affirming' enough, or 'affirming' early enough in the life course, and that's why the results of the (so called 'lifesaving') interventions are disappointing. Maybe, despite the intensity of the pharmaceutical and surgical interventions brougt to bear on the matter, such treatments simply aren't much good. Limited effectiveness, technically unconvincing and with significant side effect profile.

It's rather depressing, but not really surprising to find that men who've had all sexual function removed are likely to be depressed. Nor that women who've had perfectly healthy breasts removed are, also.

It's simply depressing all round. How anybody can, in good conscience, advocate for such mistreatment of children and young people, who cannot truly understand the implications of such self harm is beyond me.

Another issue that occurs to me is that the people who pressed ahead with treatment may have been more psychologically vulnerable, prone to depression and so on compared to those who didn't.

Yes, this is what I wondered too. I know quite a number of young girls claiming a trans identity - most have not gone to take hormones, let alone surgery. The ones that have seem to have been more unstable, even before.

People who have healthy body parts removed and/or their genitals modified while taking cross sex hormones suffer from even worse mental heath issues afterwards shocker.

This can't be a surprise to anyone surely.

It's not like having a bad haircut that will grow out in 6 months. It's permanent, disfiguring and I should imagine very depressing to live with once you realise what you've done to yourself.

This is the reason why the vast majority of treatments for body dysmorphia are focussed on cbt and therapy and not surgical interventions.

It's known that it doesn't help longer term. The discomfort and obsessive thoughts return.

Hence ppl who become addicted to cosmetic surgery

I have been watching for the reaction to this research on twitter. I think there will be a push to mischaracterise this as being a ‘see we told you’ and further weaponisation of suicide.

Trans support groups probably won’t discuss the significant issues in pre-surgery treatments and therapy that should be done and is not. Or that these surgeries and hormones are brutal and have high risks associated with them and that these risks should be loudly and widely discussed and not glossed over or glamorised. Or that one procedure may lead to the realisation that the step just taken hasn’t change the impossible to being possible and that the search for the eternally elusive state that is sought will continue. And continue the dangerous cycle of expecting the next stage of gender affirmation will make a person finally a woman or a man, when they are materially not.

I hope that trans allies will stop with the ‘life saving’ falsehood to support what essentially is extreme body modifications to fit an ideal based on philosophical belief. Each week at the moment the ideological foundations supporting this belief is crumbling. The arguments that were relied on are being shown to be false or deeply flawed.

And yet we still see those mantras of ‘life saving gender affirming treatments’. And we still see the falsehoods that discussing reality and acceptance of a person’s body is conversion therapy. And that male
people who go to such lengths must be deserving of access to female single sex spaces because they must genuinely be female just born in the wrong body.

Thanks, @AlexaAdventuress, for your input. I wanted an idea of whether this was robust enough to use. There have been other reports which, when looked at for methodology or statistical analysis, haven't past the robust and reliable test.

I think perhaps this, and the growing awareness of the cost of reassignment surgery

https://www.nss.nhs.scot/publications/foi-2023-000201-transgender-related-treatment-costs-per-individual/foi-2023-000201-transgender-related-treatment-costs-per-individual-html/

and the numbers (1000+ for chest surgery in a year alone):
http://archive.today/A9m2x (archived Telegraph article)

I saw a Tweet about the cost to the NHS of hormones and other drugs for the TQ+ — more than the cost of anti-depressants and a host of other drugs. I'll post it when I can find it.

The part that's always been most surprising to me is that objectively unnecessary drugs and cosmetic surgeries suddenly started being paid for by government programs and private insurance, when they frequently deny or delay genuinely necessary treatments due to lack of resources. And not just in the UK. Just a few years ago a person would have been laughed at for suggesting it was "life saving" for a man to have a nose job and breast implants or for a young woman with healthy breasts to have a double mastectomy and that we all need to contribute to the costs of these procedures.

The thing is that this finding is in keeping with the anecdotal reports from various gender clinicians around the world. And the lack of mental health improvement has been documented previously. Including that now discredited study by Branstrom & Pachankis who over stated a conclusion that treatments improved mental health for transgender people when it showed there was no improvement at all.

https://pubmed.ncbi.nlm.nih.gov/31581798/

And the correction

https://psychiatryonline.org/doi/10.1176/appi.ajp.2020.1778correction

But it fits with Marcus Evan's paper:

www.cambridge.org/core/journals/bjpsych-bulletin/article/freedom-to-think-the-need-for-thorough-assessment-and-treatment-of-gender-dysphoric-children/F4B7F5CAFC0D0BE9FF3C7886BA6E904B

Many interesting links but worth remembering this:

Evans said: During the 1980s, I led a parasuicide service in King's College Hospital, London, and treated a number of individuals who had self-harmed or attempted suicide after gender reassignment surgery. These patients had a history of serious and enduring mental illness and/or a personality disorder. Having developed a late-onset gender dysphoria, they were often angry at the loss of their biological sexual functioning and aggrieved with psychiatric services, which they felt had failed to examine their motivations for requesting reassignment surgery and/or to adequately investigate their psychological difficulties. A common theme in their presentations was a belief that physical treatments would remove or resolve aspects of themselves that caused them psychic pain. When the medical intervention failed to remove these psychological problems, the disappointment led to an escalation of self-harm and suicidal ideation, as resentment and hatred towards themselves were acted out in relation to their bodies.

And

Winston also highlights how often medical transition may not meet the expectations of patients:
‘He said 40 per cent of people who undergo vaginal reconstruction surgery experience complications as a result, and many need further surgery, and 23 per cent of people who have their breasts removed “feel uncomfortable with what they've done”. He added: “What I've been seeing in a fertility clinic are the long-term results of often very unhappy people who now feel quite badly damaged. “One has to consider when you're doing any kind of medicine where you're trying to do good not harm, and looking at the long-term effects of what you might be doing, and for me that is really a very important warning sign.” He added that the long-term effects of taking hormones “are likely to affect reproductive function”.’

And let's not forget the it has already been published just how low the success rate for surgeries are:

pubmed.ncbi.nlm.nih.gov/33663938/

Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients

Isabel S Robinson et al. J Sex Med. 2021 Apr

Of the 1,212 patients completing the survey, 129 patients underwent genital reconstruction surgery. Seventy-nine patients (61 percent) underwent phalloplasty only, 32 patients (25 percent) underwent metoidioplasty only, and 18 patients (14 percent) underwent metoidioplasty followed by phalloplasty.

Results: Patients reported 281 complications requiring 142 revisions. The most common complications were urethrocutaneous fistula (n = 51, 40 percent), urethral stricture (n = 41, 32 percent), and worsened mental health (n = 25, 19 percent).

These results support anecdotal reports that complication rates following gender affirming genital reconstruction are higher than are commonly reported in the surgical literature. Patients undergoing clitoris burial in addition to primary phalloplasty did not report a change in erogenous sensation relative to those patients not undergoing clitoris burial. Postoperative patients report improved genital self-image relative to their preoperative counterparts, although self-image scores remain lower than cisgender males.

Here is Dr Az Hazeem saying he had about 26% of his patients regretted transitioning.

https://www.dailymail.co.uk/news/article-12623643/Being-trans-non-binary-new-sub-culture-risk-raising-nation-chemically-castrated-children-Doctor-spent-12-years-working-vulnerable-teens-Tavistock-warns-gender-ideology.html

He said 26 per cent of his patients at the Tavistock and Portman regretted transitioning.

Yes, this is what has always thrown me. I have friends in the US who seem to struggle, despite being insured, to get the full range of treatment they need while watching people having unnecessary mastectomies and having their genitalia mutilated on insurance. I presume there's money to be made for the insurance companies and doctors over the course of a lifetime.

Thanks for the reminders, Hellebore. I know Az, I know what we've all gathered over the years, from all the studies. I just wanted a more informed eye to be cast over the methodology and conclusions of this particular research because I hope to take the findings up with people who almost certainly will want to check out the analysis and will probably be looking for ways to discount the findings. I had the Brandstrom + Pachinkis one in mind: looked solid to start with (I can remember how dispirited I felt reading it) and then fell apart.

Presumably drug addiction is partially a result of taking pain medications post surgery with a long recovery period and is comprised of multiple stages to achieve the desired results. How would you not develop a level of addiction?

I think this is a good study but it is limited in using only diagnostic codes - the absence of a documented diagnosis isn't a very robust way of determining that it's not there, particularly for mental health symptoms. So it doesn't tell us if surgery has a negative effect on mental health, or if people who opted for surgery had worse mental health to start off with. Either way surgery is a rubbish way to treat a mental health problem.