Misinformation about gender reassignment therapy (part 1)

One topic that’s shown up on Christian blogs a lot lately (because it’s been in the mainstream news a lot lately) is that of transgender people and gender reassignment surgery. I’ve been reading a lot of dubious claims from these sorts of articles, which have been ringing my Fact Check Alert bell big-time. I don’t know a great deal about transgender issues, but, as a GP, I do know that medical opinion supports the availability of gender reassignment as a treatment for gender dysphoria. So, when non-medical groups with a heavy religious-based agenda in the matter try to claim that gender reassignment is bad for transgender people and we should be banning it in their interests, that rings alarm bells for me and I want to look at the evidence.

The latest such post that I saw was Bloodletting and the Modern Trans Movement, on the Come Reason blog by Lenny Esposito. Esposito argues that because doctors once used to believe in treatments such as bloodletting which are now discredited we should therefore assume that medical advice to provide gender reassignment therapy for transgender people is similarly incorrect. Or something like that, anyway. That of course is just a logical fallacy (by the way, if anyone knows the official name for that logical fallacy feel free to shout out – I don’t keep track of logical fallacy names myself) but the bit that hit my Fact Check Alert button in this post was this:

I’ve pointed out before how we have fifty years of data under our collective medical belts on gender reassignment surgery and we know that the suicide rate for those suffering from gender dysphoria is as high after sexual reassignment surgery (SRS) as it is prior to transitioning.

The link Esposito gave there is to a post he wrote last year titled Today’s Snake Oil Includes a Scalpel: The Damaging Treatment of Transgenderism, which rang my Fact Check Alert bell several more times and needs a post or several of its own to discuss, which I fully plan to do. In the interest of speed and clarity, I’m going to leave that to further posts rather than try to cover everything here. What it did not do, even with the cherry-picked and misleading evidence it cites, was support Esposito’s statement that suicide rates are as high after gender reassignment therapy as before. The post cited one study showing much higher suicide rates among transgender people post-reassignment than in the general population (though without pointing out that these high suicide rates were seen a few decades ago when anti-transgender bias was worse than it is now, and that they don’t show up in recent years), but nothing comparing rates of suicide in transgender people pre- and post-gender reassignment. So, whatever Esposito may have convinced himself he ‘knows’, he hasn’t in fact demonstrated anything of the kind.

So, I did a bit of digging around to see whether any such statistics do exist, and, as far as I can find out, they don’t. I did find this report on rates of suicide attempts in the transgender population overall, which is frightening; transgender people were almost ten times as likely as the general population to have attempted suicide at some point. Not surprisingly, this was strongly linked with experience of discrimination, bullying, rejection by family, or even outright violence, making it clear that, for those of us concerned about suicide risk among transgender people, one of the most important things we can do is to work to increase transgender acceptance. (Which, frankly, doesn’t seem to be a strong point among conservative Christians such as Esposito.) And this article cited studies also indicating markedly increased suicide rates in the transgender population (and, again, cited evidence that showed this to be linked to experiences of discrimination and family rejection).

However, I couldn’t find anything giving comparative figures for suicide rates, or suicide attempt rates, in pre-transition and post-transition transgender people. Which isn’t too surprising, by the way, since it’s the sort of question on which it’s hard to get data; but it does mean that it is not correct to state that we ‘know’ the suicide rates to be as high after gender reassignment as before. We know nothing of the kind.

So what information is available on how gender reassignment affects transgender people? Looking, I found this article reviewing the existing evidence as to how gender reassignment affects the mental health and quality of life of transgender people overall. According to the abstract, the authors of this summary found 28 studies that followed transgender people through gender reassignment therapy (surgical and/or hormonal) comparing their mental health after the procedure with before. What they found was that, psychologically, the majority of people were better off after gender reassigment.

Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68–89%; 8 studies; I2 = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56–94%; 7 studies; I2 = 86%); 80% reported significant improvement in quality of life (95% CI = 72–88%; 16 studies; I2 = 78%); and 72% reported significant improvement in sexual function (95% CI = 60–81%; 15 studies; I2 = 78%).

So, no matter how hard conservative religious groups or other anti-transgender groups try to spin evidence to make it look as though it supports their cause, the evidence is in fact that the best thing to do to help transgender people is a) to eliminate prejudice and discrimination against them, and b) to make gender reassignment available for those who, after counselling, want it.