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.


  1. Vivec says

    Oh my god my brain hurts.

    “Past medicine was incorrect so current practice x is also incorrect” could apply to literally any other medical practice. If that’s the standard he’s going by, why specifically point to SRS? The logic holds the same for anything you could plug into x, so why isn’t he railing against flu shots, appendectomies, or any other perfectly mundane treatments?

    “Trans people still attempt suicide after SRS so it’s useless” doesn’t follow either. Getting SRS doesn’t necessarily lessen the amount of discrimination or oppression you face, and depending on whether you were previously out and how well you pass, can actually increase it. However, consider these two outcomes.

    Trans person A doesn’t get SRS, attempts suicide because of their crippling dysphoria and the huge social consequences of being trans.

    Trans person B gets SRS, attempts suicide because of the huge social consequences of being trans but does not experience as much crippling dysphoria.

    Both register as a person attempting suicide, but person B had a demonstrably better time than A did.

  2. naturalcynic says

    Too bad a narrow mind like Esposito cannot seem to look at the problem from a different perspective. What if doing nothing or confining to a mental institution or conversion therapy was the “bloodletting”? And HRT and surgery is the “modern” treatment?

  3. Siobhan says

    Esposito’s articles could’ve been written by TERFs too, in all honesty.

    Zinnia has covered similar conversations about transitioning on her personal blag: http://genderanalysis.net/2015/09/paul-mchugh-is-wrong-transitioning-is-effective-gender-analysis-10/

    Of particular note:

    The study asserts that surgery made no difference in trans people’s overall social functioning, but it relies on criteria that fail to provide a useful measure of adjustment before and after treatment. In “Sex Reassignment: Follow-up”, the authors construct a single “Adjustment Score” from several measures. Points were added or subtracted from each subject’s score based on their interactions with law enforcement, employment status, intimate relationships, and use of psychiatric services.

    Scoring of marriage and cohabitation

    Many of the supposedly objective criteria for these measures are in fact based on subjective value judgments. One point is deducted for “nongender-appropriate” cohabitation, and two are deducted for “nongender-appropriate” marriage, while one or two points are added for “gender-appropriate” cohabitation or marriage. The authors explain that “gender-appropriate” would mean a trans woman cohabiting with or marrying a man, and a trans man cohabitating with or marrying a woman. Using this scoring, the authors considered trans people in same-sex relationships to be up to four points less “adjusted” than the others. This isn’t a measure of health – it’s a measure of heterosexuality.

    So much for that.

    I look forward to the next parts, because it’s usually too difficult for me to read studies so heavily biased and I get way too angry to write about it.

  4. Siobhan says

    Oh! And I almost forgot about this one: http://www.sciencedirect.com/science/article/pii/S1158136006000491


    On the GAF (DSM-IV) scale the female-to-male transsexuals scored significantly higher than the male-to-females (85.2 versus 76.2). While no difference in psychological functioning (SCL-90) was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors.


    While sex reassignment treatment is an effective therapy for transsexuals, also in the long term, the postoperative transsexual remains a fragile person in some respects.

  5. says

    I doubt that it’s hard to collect the data. I suspect those doing the research aren’t asking the question, either through confirmation bias or not thinking of the question themselves. They didn’t think to ask or they don’t want to know.

    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.

    There was a study on Goth subculture and suicide that produced interesting results. The study did note changes in rates of suicide attempts before and after becoming a Goth, showing the potential benefit of finding social acceptance. (“After identification as Goth” means they are still Goths, not that they quit.)

    Goth Youths Prone to Suicide Attempts and Self-Mutilation

    More than half of 19-year-olds who self-identified as Goth reported self-harming behavior, and nearly half reported a suicide attempt, said Robert Young, a research associate at the University of Glasgow. But whether participation in Goth culture leads to self-destructive behavior or whether adolescents with those tendencies gravitate to Goth is not clear….


    “One common suggestion is they may be copying subcultural icons or peers,” [Young] said. “But since our study found that more reported self-harm before, rather than after, becoming a Goth, this suggests that young people with a tendency to self-harm are attracted to the Goth subculture.”

    “Rather than posing a risk, it’s also possible that by belonging to this subculture young people are gaining valuable social and emotional support from their peers,” he suggested. “However, the study was based on small numbers and replication is needed to confirm our results.”

    And a link to the original study and the key point:

    Prevalence of deliberate self harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study


    Of 25 participants with a high identification (at some point in their lifetime) with the Goth subculture, 12 had harmed themselves; five before identification as Goth, two after, and four at about the same time (one participant had poor recall).

    I doubt one needs to be a psychologist to see the benefit to mental health by finding social acceptance, of finding people who accept and welcome others as they are without criticism or judgement.

  6. AMM says

    I can’t say I’ve tried to understand the claims and arguments here, because they sound an awful like those dreadful 1=0 proofs or the “scientific” proof that bumblebees can’t fly. If the conclusion is manifestly wrong, why bother to ferret out the logical or factual errors involved in reaching it?

    I don’t think anyone who is trans or who is involved in trans communities would give this guy’s argument the time of day. I know quite a few trans people, especially people (like me!) who are somewhere along the transition route, and I have yet to hear of someone for whom whatever surgery they chose made their lives worse. Not saying their aren’t any, but they seem to be a small enough minority that I haven’t heard of them.

    One confounding factor, of course, is the immense transphobia that’s just about everywhere. The cases I’ve heard of where people have detransitioned seem to all be due to harrassment or the difficulty of getting a job or finding any place where they would be accepted. I know an awful lot of people who really want to transition, or transition further than they have, or get SRS or whatever, who don’t because it would end their marriages or cut them off from their families or communities.

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