Doctors stand up to gender transition surgeries

The original study, from Sweden, claimed improved psychiatric outcomes for those who had completed gender reassignment surgery, based more or less on one or two people who would have been expected to be in psychiatric care, but were not. Sharp eyed readers noticed, however, that this analysis was done without a control, and when a control was put together, there was no statistical difference.

The long and short of it is that there are no clear indications that gender transition surgery improves outcomes for those with gender dysphoria. Those who endorse these surgeries ought to be confronted on this. If there is indeed no benefit, that’s an awfully drastic measure to take!

The study cited indicates that post-intervention transgender individuals continue to require psychiatric or psychological support. This shouldn’t be surprising, nor should it be considered evidence that the intervention was not necessary. The state of mind leading up to transition for many transgender individuals is often dire. Transition is often a last resort to resolve gender incongruence and occurs at a point where the patient has suffered significant psychological distress. Transition merely removes the individual’s internal source of the distress but doesn’t address the distress itself. To coin a metaphor, gender dysphoria leads an individual deep into the emotional woods. You remove the internal gender dysphoria, you stop going deeper into those woods, but you’re still in the woods. The patient needs help to get out of those woods and back to health. Moreover, continued bullying, misgendering, social ostracism and financial difficulty adds an external source of distress. That transgender individuals need continuing psychological or psychiatric support should not be surprising.

Julie, there are two problems with your argument. First, the argument presented to the public is that it does help overall—when the image of the genitalia matches that of the mind, as it were, the person is supposed to be better off. Statistically speaking, that simply does not appear to be true. As I’m sure you probably know, that’s why John McHugh worked to stop the transitioning program at Johns Hopkins. Jokes to the contrary aside, doctors do indeed get tired of burying their mistakes, and that’s precisely what McHugh’s data suggested was going on.

Now thankfully, the rhetoric among the doctors working in this area is changing—no less than Mayo has admitted that it does not seem to be a panacea as well (while establishing a transitioning program themselves)—but even if we adopt your explanation that it stops a person from going further into the woods, there ought to be a statistical difference that can be measured. You would see, if not a different likelihood overall of seeking psychiatric care, a difference in the frequency and nature of care and the severity of symptoms.

Again, that’s precisely what we do not see, and we might infer that we might be able to care for gender dysphoria in a better way than we’re currently doing. I don’t know precisely what that might be, but it just might be out there and might not be hopeless.

(and no doubt, there are some people who do seem to benefit—my brother is good friends with one such person—but the statistical data simply do not back up the hypothesis. That ought to give us pause for certain therapies)