Psychosocial Functioning in Transgender Youth after Two Years of Hormones, New England Journal of Medicine (NEJM), January 2023, Chen et al.

Study Claims: “Gender-affirming” medical interventions (GAM) reduces mental health issues in trans-identifying youth (ages 12-20). The study consisted of a survey given at the start and then every six months, over two years, to 315 participants (60% female) who had taken puberty blockers or opposite-sex hormones at four prominent gender clinics—Ann and Robert H. Lurie Children’s Hospital of Chicago, UCSF Benioff Children’s Hospitals, Boston Children’s Hospital, and Children’s Hospital Los Angeles. “Our results provide a strong scientific basis that gender-affirming care is crucial for the psychological well-being of our patients,” said a principal investigator for the study.

Study Flaws:

• Biased selection of study participants or cohort: only trans-identifying youth receiving blockers/hormones were included. There was no similar group who did not use these medications for comparison (control group).

• Inconsistent or inappropriate measurement: 6 out of 8 (75%) of the variables in the study protocol submitted to the Institutional Review Board (IRB) for approval were not reported in the final paper including, most notably, suicidality and self-harm, but also quality of life and gender dysphoria itself! The paper doesn’t address whether these variables were studied and results were simply not reported or whether they encountered problems with their study design or implementation, raising significant questions about why these results were omitted or dropped. Notably, the researchers state, "The authors vouch for the accuracy and completeness of the data and for the fidelity of the study to the protocol." NEJM did not respond to complaints about this issue.

• Confounding: The study design doesn’t allow us to conclude whether improvements are due to simply getting older, family support, counseling, or factors other than the effects of blockers or opposite-sex hormones.

• Other: Because no control group was included, and therefore no comparison to trans-identifying youth that are not taking hormones could be made, no conclusions can be made about the effectiveness of hormones. Shockingly, even though kids with serious psychiatric problems at intake, including suicidality, were excluded from participating, two study participants died from suicide during the course of the study, one after six and another after 12 months of follow-up calling into question the claim that these treatments prevent suicide. Researchers didn’t respond to inquiries from journalists. The study team included clinicians that strongly support the use of hormones: this leads to, at minimum, an appearance of bias as well as a conflict of interest. The reported improvements were small and seen only in female participants. For example, at the start of the study, 18.6% of female participants reported moderate depression; after two years, 10% still reported moderate depression. For those with severe depression, only 1.9% showed improvement. Both of these decreases could have easily been the result of expected placebo effects. Males showed no psychosocial improvements.

Rebuttals:

Biggs, Jorgensen, Hare, and Barker and Thompson (2023) Four formal Letters to the Editor, New England Journal of Medicine.

Singal, J. (2023) On Scientific Transparency, Researcher Degrees Of Freedom, And That NEJM Study On Youth Gender Medicine. Singal-Minded.

Singal, J. (2023) The New, Highly Touted Study On Hormones For Transgender Teens Doesn’t Really Tell Us Much Of Anything. Singal-Minded.

Ferguson, C. J. (2023) Does Gender-Affirming Medicine Help Trans-Identifying Youth ? Pubpeer (2023) The importance of transparency in research on trans care. Psychology Today.

r/medicine (2023) The Chen 2023 Paper Raises Serious Concerns About Pediatric Gender Medicine Outcomes, reddit.

Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care, Journal of the American Medical Association, February 2022, Tordoff et al.

Study Claims: This study found that “gender-affirming” medical interventions (GAM) (specifically puberty blockers and opposite-sex hormones) were associated with lower odds of depression and suicidality over 12 months. Conducted at Seattle Children’s Gender Clinic, self-reported surveys were completed by trans-identifying youth seeking “gender-affirming care” from August 2017 to June 2018. The study surveyed 104 participants aged 13 to 20 years (61% female). According to the study press release “the investigators reported that gender-affirming care was associated with a 60% reduction in depression and a 73% drop in harmful or suicidal thoughts among the participants.”

Study Flaws:

• Loss to follow up: of the initial 104 participants, 63 remained at the end of the analysis, a loss of almost 40%; 80% of the kids who didn’t go on GAM had dropped out of the study by the final wave of data collection, leaving just seven remaining (a high rate of loss that the study doesn’t evaluate). It's impossible to know whether those that dropped out of the study had something in common. It's possible that some or all of those lost to follow-up had increased depression or thoughts of self-harm, which would significantly change the study conclusions. Also we learn nothing about whether kids who didn’t go on GAM did worse or better.

• Short follow-up times: a 12-month evaluation is not sufficiently long to evaluate outcomes from powerful drugs like puberty blockers or opposite-sex hormones.

• Biased selection of study participants or cohort: according to the researchers, “there was likely selection bias toward youths with supportive caregivers who had resources to access a gender-affirming care clinic.” This means that the results cannot be applied to other youth. Significantly, “supportive” is undefined but its use suggests author bias.

• Inconsistent or inappropriate measurement: instead of tracking responses to each survey question separately at each phase of measurement, researchers averaged all survey answers over the course of the study. This approach doesn’t allow for conclusions to be drawn vs the more typical approach of comparing before and after responses.

• Small number of participants: of the initial 104 participants, data was initially collected for 99 (some of whom weren’t on opposite-sex hormones). This too-small sample cannot demonstrate the effectiveness of hormones for all trans-identifying youth.

• Confounding: the researchers acknowledge that they couldn’t determine whether participants were taking psychotropic medications that could be influence study outcomes and that the study didn’t include any evaluations by mental health practitioners to “track depression, anxiety, gender dysphoria, suicidal ideation, and suicide attempts during gender care.”

• Correlation vs causation: the researchers claim that GAM improves outcomes, but this conclusion is contradicted by their findings. The psychological function of kids on GAM in this study did not, in fact, improve. Their claim is based on the finding that kids not taking GAM got slightly worse, but only seven of these kids remained by the end of the study, a significant drop-out rate. In addition, they gave no explanation why some participants went on GAM and others did not. There is simply no basis for their conclusion.

• Other: Contrary to the claim in press releases and the published study conclusion, the study data show no statistically significant mental health improvement for kids taking hormones during the study. Study data have not been made available and people are directed to rely on the Methods section of the report. Study findings were exaggerated — for example, “depression rates plummeted!” — and the university’s press office had to revise their PR materials in response to criticism. Despite the revisions, five months later the University and researchers were still publicizing their unfounded conclusions.

Rebuttals:

Abbruzzese, E., Levine, S.B., & Mason, J.M. (2023) The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies and research that has followed. Journal of Sex and Marital Therapy. 1-27.

Singal, J. (2022) Researchers Found Puberty Blockers And Hormones Didn’t Improve Trans Kids’ Mental Health At Their Clinic. Then They Published A Study Claiming The Opposite; A critique of Tordoff et al. (2022)

Singal-Minded.

Sapir, L. (2022) The Distortions in Jack Turban’s Psychology Today Article on ‘Gender Affirming Care’. Reality's Last Stand. (study #16)

Singal, J. (2022) The University of Washington Is Putting Trans Kids At Risk By Distorting Suicide Research

Association of Gender-Affirming Hormone Therapy with Depression, Thoughts of Suicide, and Attempted Suicide among Transgender and Nonbinary Youth, December 2021, Journal of Adolescent Health, Green et al.

Study Claims: The purpose of the study was to see if opposite-sex hormones improved mental health among trans-identifying youth. Data were collected in 2020 via one 142-question online survey. 34,759 lesbian, gay, bisexual, transgender, queer, and questioning youth 13–24 years old participated, including 11,914 who self-identified as trans or “nonbinary.” Among the trans/nonbinary respondents, half reported that they were not using hormones but would like to, 36% were not interested in using hormones, and 14% were using hormones. According to the authors: “…findings support a relationship between access to [hormones] and lower rates of depression and suicidality among transgender and nonbinary youth.”

Study Flaws:

• Loss to follow-up: of the 11,914 self-identified transgender or nonbinary youth, survey responses were missing for 2,895 (24%) of participants.

• Biased selection of study participants: study participants were recruited via ads targeted to LGBTQ+ youth on Facebook, Instagram, and Snapchat. Using social media to recruit participants likely skews the results because such respondents are among the most likely to be enthusiastic about their identities and have been repeatedly told that hormones will resolve their mental health challenges. Further, this method of recruiting participants (referred to as “convenience sampling”) is known to generate low-quality data because those included are not the most representative, but rather the easiest for the researcher to access.

• Confounding: gender-confused youth are repeatedly told that hormones are life-saving (a claim for which there is no evidence), so it is not surprising that within the self-selected sample participants expressed a desire to start on hormones. Additionally, the study doesn’t explore whether poor mental health preceded the respondent’s trans identity and assumes that the lack of hormones is the most likely reason. Other interventions that could affect depression and suicidality, including therapeutic support or antidepressants, were not accounted for, which could significantly affect outcomes.

• Other: The researchers’ affiliation with the Trevor Project demonstrates bias and a clear conflict of interest. This affiliation isn’t disclosed in the study. According to the study, “each question related to mental health and suicidality was preceded by a message stating: ‘If at any time you need to talk to someone about your mental health or thoughts of suicide, please call The Trevor Project [an advocacy organization for LGBTQ youth] at 1-866-488-7386.’” This primes participants to repeatedly consider suicide, an irresponsible approach to a population prone to depression. Outcomes reflect the "nocebo effect," where a negative outcome (depression and suicidality) occurs due to a belief that the intervention (not having access to hormones) will cause harm.

Rebuttals:

Sapir, L. (2022) The Distortions in Jack Turban’s Psychology Today Article on ‘Gender Affirming Care’. Reality's Last Stand. (study #14).

Genspect (2021) A Parent Responds To TIME Article On Poorly Designed Trevor Project Survey.

Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults, September 2022, JAMA Pediatrics, Ascha et al.

Study Claims: The study sought to find out whether “gender-affirming top surgery” (cosmetic double mastectomy) improves three measures: (1) “chest dysphoria” (discomfort with developing breasts); (2) gender congruence; and (3) body image. Patients completed a 10-minute survey before surgery and three months after surgery and included females aged 13-24 with “transmasculine” and “nonbinary” identities. Some of the individuals included in the survey did not undergo surgery and thus were only surveyed once. Most, but not all, participants were taking testosterone. The study did not attempt to assess participants’ mental health before or after surgery.

Study Flaws:

• Loss to follow-up: 81 patients were surveyed (36 of whom underwent surgery) and 11 (13.5%) did not complete the survey/s (six in the surgery group).

• Short follow-up times: patients were surveyed a mere three months after surgery, barely enough time for scars to heal and physical function to return, much less for a patient’s feelings to solidify.

• Inconsistent or inappropriate measurement instruments: the study asked very superficial questions (essentially, “Are you more satisfied without the breasts you hated and are you satisfied now that you look less obviously female?”) but didn’t survey mental health either before or after surgery. The study authors concede that “the Chest Dysphoria Scale is not yet validated, and may not represent distress or correlate with validated measures of quality of life, depression, anxiety, or functioning.” The original study protocol indicated that researchers were also interested in measuring gender dysphoria and presumably collected this data, but didn’t include it in the final study. Arguably, relief from gender dysphoria would be a much more important outcome than the measures that were studied and reported.

• Small number of participants: 70 completed surveys is not sufficient to make conclusions about the larger population.

• Other: The study states that “there is no evidence to support delaying surgery for eligible patients based on age,” a conclusion that calls into question claims that no minors ever receive “gender-affirming” surgeries. The study was partly funded by the Plastic Surgery Foundation and an American Association of Pediatric Plastic Surgery Combined Research grant, posing a conflict of interest.

Rebuttals:

Clayton, A. (2022) The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine?. Arch Sex Behav 51, 691–698

Singal., J. (2022) Maybe It’s A Bad Idea To Give A Bunch Of Kids Double Mastectomies Without Checking Whether It Helps Them. Singal-Minded.

Singal., J. (2023) Here’s More Evidence That Youth Gender Medicine Researchers Might Be Hiding Unfavorable Data From The Public. Singal-Minded.

Sex Assigned at Birth Ratio Among Transgender and Gender Diverse Adolescents in the United States, Pediatrics, August 2022, Turban et al.

Study Claims: This study claims to disprove that (1) there is an increase in the number of adolescent females identifying as transgender, and (2) that the increase is due to peer pressure, social media, etc. (social contagion), a phenomenon some refer to as “rapid onset gender dysphoria.” Study data come from a survey of US high school students conducted by the Centers for Disease Control and Prevention every other year to assess risk behaviors among United States adolescents. The data came from the 2017 and 2019 surveys and included the 16 states that asked a question about gender identity.

Study Flaws:

• Sampling bias: The study estimates the ratio of males to females based on responses from 16 states. In 2017, the 16th state was Delaware and in 2019 the 16th state was New Jersey. However, in 2017, only 10 states asked the question about gender identity and of those, only 9 published their data. (Not all states make their data publicly available.) In 2019, only 14 states with published data asked about gender identity. Given the very limited states where this data were collected, the sample can't be generalized to the larger population of teens.

• Inconsistent or inappropriate measurement instruments:

  • The relevant survey questions ask respondents whether they are transgender and “What is your sex?” Responses from those who identified as trans (2.4% in 2017, 1.6% in 2019) were included. Responses from teens who chose “I don’t know” were excluded, resulting in an undercount by potentially discarding a much larger group that may actually include trans-identifying youth who hadn’t yet made up their mind, those that identify as “nonbinary,” and other youth with novel identities.

  • It is not clear how a trans-identifying teenager would respond when you ask them their “sex.” According to study critic Leor Sapir, “Turban assumes that respondents understand this second question to mean ‘sex assigned at birth’ rather than ‘gender identity,’ and cites three studies to confirm that that is how teenagers ‘are likely to understand’ the word ‘sex.’ Yet the first two citations say nothing of the sort, and the third only weakly hints in that direction. No less damning, the researcher who developed the questionnaire for the CDC has herself emphasized the ‘uncertainty as to whether transgender students responded to the sex question with their sex or gender identity.’ Another critic, Jesse Signal notes “If even a relatively modest percentage of kids interpreted ‘sex’ to mean ‘gender identity’ rather than ‘biological sex,’ it would massively change the results.”

Rebuttals:

Sapir (2022) Advocates of pediatric gender transition publish a fatally flawed study purporting to debunk the social-transition hypothesis. Eye on the news.

Biggs (2022) Turban et al.’s incredible assumptions about sex. Figshare.

Singal, J. (2022) The New Study On Rapid-Onset Gender Dysphoria Published In “Pediatrics” Is Genuinely Worthless. Singal-Minded.

Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence, Plastic and Reconstructive Surgery (a publication of the American Society of Plastic Surgeons), March 2021, Bustos et al.

Review Description & Claims: This review evaluated regret in trans-identifying people who had cosmetic surgery to make them look more like the opposite sex. The review looked at data from 27 existing studies about regret after surgery, and included 7,928 trans-identifying patients who underwent any type of "gender-affirming surgery” (GAS). Based on this analysis, researchers found that 77 patients expressed regret and concluded that the number of trans-identified patients who regret their surgery is very low. (This study is the basis of the oft-quoted "1% regret rate.")

Review Flaws:

• Loss to follow-up: Of the 27 studies included, one contributed almost half of the participants. In that study, 36% of those surveyed were lost to follow-up. This includes patients who might have stopped coming to the clinic for hormone treatments because they detransitioned. Other studies had a loss to follow up of more than 40% including those who died from surgical complications or by suicide, the latter possibly due to regret. Because of the very high loss to follow-up, the studies with short follow-up times could only estimate (rather than enumerate) regret.

• Short follow-up times: It can take many years for someone who had sex-trait modification surgery to experience regret. The typical time is about eight years after surgery. None of the studies included in this review had a long enough follow-up period — many only included the experiences of patients one or two years after surgery and some didn’t specify a follow-up time at all. Due to these short (and missing) follow-up times, the odds of regret are likely underestimated, undermining the authors’ claims.

• Biased selection of study participants: The type of patient with gender dysphoria today (mostly adolescent females) is vastly different from those analyzed in this review (mostly adult males). Over half the studies included were completed before 2011 (approximately when those claiming a trans-identity started shifting from male to female). Therefore, even though the study was published in 2021, its conclusions cannot be reliably used to estimate surgery regret for today’s patients.

• Inconsistent or inappropriate measurement instruments: There is no standardized definition of, or way to measure, “regret.” For the review, the way regret was measured was inconsistent across studies, and the way it was defined increased the likelihood that cases of regret were missed. One included study only looked at whether people regretted the type of procedure, not whether they regretted undergoing the surgery itself. Further, one response to the analysis noted “significant data extraction errors, leading to erroneous conclusions." For example, in the largest study included, the number of patients was 2,627 but was reported as 4,863.

• Quantity vs. quality: While this review seems reliable because it includes data for a large number of patients, the flawed methods in the various studies resulted in unreliable data. The quality of most of the studies ranged between “poor” and “fair.” Five studies, representing only 3% of the total participants, were rated better than “fair,” but these had significant loss to follow-up. As JL Cederblom has noted, at least ten other studies that fit the authors’ criteria were either missed or excluded, which introduces publication bias and, therefore, an unreliable conclusion.

• Other: Changes to the approval process for GAS since the data for these studies was analyzed means that the review’s conclusions cannot be applied to other GAS patients.

Rebuttals:

Expósito-Campos, Pablo MA, D’Angelo, Roberto PsyD (2021) Letter to the Editor: Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence

Cohn, J. (2023) The Detransition Rate Is Unknown

Cederblom, J. L. (2022) At what point does incompetence become fraud? — Genspect

Alleva, M. (2023) Loss to Follow-Up and Transition Regret: Examining 27 studies used in a 2021 meta-analysis on post-surgical regret

The Evidence for Trans Youth Gender-Affirming Medical Care, Psychology Today, January 2022, Turban, J.

Review Description & Claims: This article by Jack Turban, a researcher, medical journalist, and assistant professor of child and adolescent psychiatry at University of California San Francisco, reviews 16 studies on the impact of “gender-affirming medical care” for adolescents. According to the author, when taken together, the studies “indicate that these interventions result in favorable mental health outcomes.”

Review Flaws:

• Not all medical studies are created equal. The widely used GRADE system ranks the quality of evidence in medical studies by ranking them using four categories: high, moderate, low, and very low. Of the 16 studies in Turban’s article, seven used evidence ranked “very low,” and one used evidence ranked “low.” Another two studies did not show any benefit of treatment at all. Of the six remaining studies, “five could not show cause and effect” because of flawed study design (Genspect). In the article introduction Turban writes, “As you read, please keep in mind that all studies have methodological strengths and weaknesses and conclusions must be drawn from all of these studies together.” However, simply combining the results of multiple weak studies—15 out of 16 in this case—does not provide evidence for the claim that taken all together, these multiple weak studies provide meaningful evidence in support of a treatment. For an analysis of each included study, please see the Rebuttal by Leor Sapir below.

Turban correctly notes that the American Medical Association, American Academy of Pediatrics (AAP), and American Psychiatric Association oppose legislative bans on puberty blockers, opposite-sex hormones, and “gender-affirming” surgeries. While it sounds like an impressive point, this is a fallacy known as an appeal to authority.

These eminent organizations are made up of and support practitioners, not patients – the members themselves make money from providing “gender-affirming care” (GAC). The AAP currently relies on a 2018 statement in support of GAC which was drafted by one man, Jason Rafferty. The leadership has repeatedly ignored subsequent requests from other AAP members to review the policy and available evidence.

In 2023, AAP leadership agreed to conduct a systematic review (following the lead of many European countries) but also reaffirmed their 2018 policy — a political decision that undermines confidence in the process.

Turban makes the unfounded claim that, in the case of gender dysphoria, using randomized controlled trials to test the efficacy of puberty blockers and opposite-sex hormones is unethical. Randomized controlled trials—in which a randomly selected subset of study participants receive a medical intervention and are compared to the other study participants who do not receive this intervention (or receive a different intervention)—provide the best possible foundation for evaluating a medical treatment’s effectiveness. While it is unethical to withhold a treatment that has clearly been shown to be beneficial, the medical interventions for gender dysphoria backed by Turban have never been shown with solid evidence to provide clear benefits, let alone benefits that outweigh their risks. Only randomized controlled trials could determine whether such interventions are in fact efficacious. Turban simply assumes these treatments are beneficial to argue that randomized controlled trials should not occur.

In other words, Turban:

• claims that withholding puberty blockers is unethical, even though they are an experimental treatment—precisely because the studies in his own article provide very weak evidence they provide any benefit;

• neglects to share the strong evidence that most young people’s gender dysphoria resolves when they undergo puberty (see here, here, here, and here);.

• fails to acknowledge that a majority of children who experience gender dysphoria as youth turn out to be same-sex attracted and stop identifying as trans after undergoing puberty;

• expresses no concern whatsoever about the fact that almost all young people put on puberty blockers proceed to opposite-sex hormones, which put fertility at risk and create lifelong dependence on medical care.

We argue that artificially suppressing puberty is unethical because it causes lasting physical and mental harms and, in many cases, “transes the gay away.”

If published today, we would hope that Turban’s article would address the fact that systematic reviews in other countries have found so little evidence for puberty blockers (and in some cases, for opposite-sex hormones) that they have restricted their use outside of strictly controlled trials. This includes countries like Finland, Sweden, Norway, and most recently and comprehensively, England (see Cass Review, April 2024).

Rebuttals:

Genspect (2022) Constructive Criticism For Psychology Today.

Sapir, L. (2022)The Distortions in Jack Turban’s Psychology Today Article on ‘Gender Affirming Care’. Reality's Last Stand.

Gender Identity 5 Years After Social Transition, Pediatrics, July 2022 Olson, K.R., et al.

Study Description & Claims: Social transition refers to living as if one were the opposite sex: changing clothing, hairstyles, and names, and requesting that others use opposite sex pronouns. Some have raised concerns that those who undergo social transition in early childhood might later revert to presenting as their birth sex which could be distressing. The study attempted to estimate the number of youth that stop identifying as the opposite sex after social transition (patients had socially transitioned before the start of the study). To make this estimate, researchers surveyed the current gender identities of 317 trans-identifying youth (about 65% boys) who socially transitioned as young children (median age around 3 years old). They found that about 5 years after their initial social transition, 7.3% of youth had stopped identifying as transgender at least once, and at the end of the 2-year study period, 94% of the participants identified as transgender, including 1.3% of those who previously stopped. Based on this analysis, the researchers claim that children who socially transition prior to puberty persist in their opposite-sex identification.

Study Flaws:

• Loss to follow-up: 8% of participants failed to return questionnaires in the 2-year survey period.

• Short follow-up times: Participants (children) were surveyed over a period of two years, too short a time period to understand what may happen in the future. Though trans identity was reported to persist at the age of 11-12, there is no way of knowing whether the identity will continue as the children mature.

• Biased selection of study participants or cohort: The 317 participants had childhood- onset trans identification and were mostly male. This is not applicable to the more common presentation during the study period—adolescent onset and predominantly female. Further, according to a critique from the Society for Evidence Based Gender Medicine (SEGM), “Since this study did not require the diagnosis of gender dysphoria, it is unclear whether its findings are applicable to the population of gender-dysphoric youth. The lack of diagnosis also makes it unclear how this study could be reproduced.” Finally, the demographics of the study participants was not representative—among other findings, 35% of participants came from families earning over $125k/year—so the findings may not be applicable to other groups.

• Small number of participants: 317 participants with childhood onset gender dysphoria is too few subjects to allow researchers to make claims about this particular group (and as stated previously, these claims cannot be applied to all trans-identifying youth).

• Confounding: Most participants started puberty blockers and/or opposite-sex hormones during the study. The effects of social transition on persistence of transgender identity cannot be separated from the effects of these medications.

• Other: According to study critic Leor Sapir, “the study’s major flaw is that it fails to consider that ‘social transition’ may itself contribute to the persistence of gender dysphoria—something that the Dutch pioneers of pediatric gender transition, as well as the recently published Cass Review study of the U.K.’s Tavistock Clinic, have both emphasized. In other words, the Olson study treats the practice of giving children a new name, using pronouns and words like ‘son’ and ‘daughter’ in accordance with the opposite sex, dressing them as that sex, and encouraging them to engage in activities conventionally associated with that sex, as mere background supports rather than as an active form of intervention in a child’s psychosocial development.”

Rebuttals:

Sapir. L. (2022) A cause, not a cure: Though the New York Times touts its findings, a new study provides further evidence that “gender-affirming” therapy creates or prolongs the very problem it purports to solve. City Journal.

SEGM (2022) Early Social Gender Transition in Children is Associated with High Rates of Transgender Identity in Early Adolescence: A new study lends credibility to concerns that early social gender transition can lead to persistence of pediatric gender dysphoria.

Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study, American Journal of Psychiatry, October 2020, Bränström, R., et al.

Study Description & Claims: This study from the Karolinska Institute in Sweden and the Yale School of Public Health analyzed the health records of 95% of the Swedish population (9.7 million individuals) and found 2,679 Swedes with a diagnosis of gender dysphoria between 2005 and 2015. Researchers looked at whether “gender-affirming care” improved the mental health of people with gender dysphoria by counting “mental health events,” defined as mental health-related doctor visits, psychiatric medication prescriptions, and hospitalizations following suicide attempts, during the year 2015.

Researchers claim that people who had undergone a “gender-affirming” surgery further in the past had fewer “mental health events” than those who had such surgery more recently. On this basis, they 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.” Importantly, they found no data to support the use of opposite-sex hormones.

Study Notes and Significance:

After the study was published and the results widely reported by the mass media, the American Journal of Psychiatry (AJP) received a large amount of feedback pointing out serious problems that challenged the study’s conclusion. Based on this feedback, an official correction was published completely reversing the claimed findings: it turns out that when gender dysphoric patients who received surgeries were compared to those who did not have surgeries, there was no statistically significant difference in mental health events. However, the original study remains on the AJP website (albeit with a link to the correction) and was featured as part of a course for practitioners on Medscape (which also remains on their website though the course is no longer available).

Rebuttals:

Correction to Bränström and Pachankis (2020) American Journal of Psychiatry.

Regnerus, M. (2019) New Data Show “Gender-Affirming” Surgery Doesn’t Really Improve Mental Health. So Why Are the Study’s Authors Saying It Does? Public Discourse.

SEGM (2020) Correction of a Key Study: No Evidence of “Gender-Affirming” Surgeries Improving Mental Health.

Letters to the AJP Journal:

• Anckarsäter,H, Gillberg, C (2020) Methodological shortcomings undercut statement in support of gender-affirming surgery

• Curtis, D. (2020) Study of transgender patients: conclusions are not supported by findings

• Wold, A. (2020) Gender-corrective surgery promoting mental health in persons with gender dysphoria not supported by data presented in article

• Ring, A. & Malone, W. (2020) Confounding effects on mental health observations after sex reassignment surgery

• Landén, M. (2020) The effect of gender-affirming treatment on psychiatric morbidity is still undecided

• Malone, W. J., Roman, S. (2020) Calling into question whether gender-affirming surgery relieves psychological distress