New Data Show “Gender-Affirming” Surgery Doesn’t Really Improve Mental Health. So Why Are the Study’s Authors Saying It Does?

First of all, when you’ve got an effect close to 1, as both the hormone therapy and reassignment surgery numbers show, you’ve really got to watch out for the possibility that researchers are (accidentally or intentionally) putting their finger on the scale. The ugly reality is that no researcher gets his big promotion, doctorate, or tenure by retaining the null hypothesis—releasing research that doesn’t show anything new. There are studies out there that show that huge portions of medical studies cannot be replicated, and this is one big reason for that.

Next, note what is being said here. The argument is not made here that gender reassignment surgery greatly reduces suicide or other horrific events, but rather that it may mildly reduce the rate at which people seek treatment for mood or anxiety disorders—really the rate at which people obtain talk therapy and psychotropics like Prozac. One might reasonably wonder whether it’s the mental health equivalent of amputating an arm to deal with tennis elbow.

Another thing one might wonder is whether a general lack of mental health resources is then driving sufferers of gender dysphoria to reassignment surgery because psychiatrists, talk therapy, and the like are not available. And if it’s not available to patients who choose NOT to undergo surgery, we would wonder how good care is for those considering it. A lot of psychiatrists claim that we simply don’t have adequate resources to do mental health care well; are we mutilating a lot of people as a result?

Another possible weakness of the study; while there has been a surge in reassignment surgeries (Mayo recently started doing them, for example), the difference is drawn because after ten years, there are fewer post-op sufferers seeking mental health care. That noted, the key reason Johns Hopkins stopped doing reassignment surgeries is because they saw no difference in the suicide attempt/success rates between those who went through the surgery, and those who did not.

Is it possible that the “reduction” in mental health care sought by post-op patients was because those who would otherwise have been seeking psychiatric services had taken their lives? Something to look into, for sure. McHugh of Johns Hopkins suggested about a 40% rate of attempts—getting to 14% “success” is not out of the question here.

This isn’t too unusual in these types of statistical studies. The same problem exists in medicine. The amount of benefit often times is minimally better than the placebo, yet the study touts that a positive impact is seen. While what is treated is true, paying a lot of money that is only minimally better than a sugar pill would surprise most people. In fact, I do not that a few years ago when I was in bio statistics at a pharmaceutical company one of the interesting areas of study is the improvements that placebo’s were having in studies.