“This is not how normal medical research works.”
That’s the conclusion Mark Regnerus reached after reading and debunking another transgender study trumpeted by the news and medical media. The research supposedly showed that performing surgeries on transgender-identified people, in an effort to make them look like the opposite sex, improved their mental health.
ABC News proclaimed, “Transgender surgery linked with better long-term mental health, study shows,” while NBC News announced, “Sex-reassignment surgery yields long-term mental health benefits, study finds.” The American Psychiatric Association published this news release, “Study Finds Long-Term Mental Health Benefits of Gender-Affirming Surgery for Transgender Individuals.”
But Regnerus, who is a Professor of Sociology at the University of Texas, said that’s not really what the study shows. He explains that “the authors corrupted otherwise-excellent data and analyses with a skewed interpretation.” Instead, he suggests the researchers are abetting transgender activists and their allies who want to “normalize infertility-inducing and permanently disfiguring surgeries.”
“Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study,” was published online in the American Journal of Psychiatry. Drs. Richard Bränström and John Pachankis, from the Yale School of Public Health and the Karolinska Institutet in Stockholm, examined data from 2,679 Swedish individuals who’d received a diagnosis of gender incongruence between 2005 and 2015.
The authors looked at whether or not these individuals had received hormone blockers or opposite sex hormones, what they euphemistically labeled “hormone replacement therapy” (HRT). HRT is a term typically used to describe therapy to treat women in menopause. This leads to an obvious question: How can you replace hormones your body never produced?
The researchers also noted which individuals had surgery to look like the opposite sex, what they call “gender-affirming surgeries.” It’s interesting that it’s not called “bodily sex denying surgeries.” Such language twisting gives an indication of the researchers’ bias.
Then the authors examined the mental health outcomes of this group in three areas: psychiatric outpatient visits for mood or anxiety disorders; prescribed medication for depression or anxiety; and inpatient hospital stays after a suicide attempt. They did not count individuals who had hormones or surgery who attempted suicide and weren’t hospitalized, nor did they measure completed suicides.
Compared with the general population, the researchers explain that gender dysphoric individuals have extremely high levels of all three of these: six times the rate of visits for mood or anxiety disorders; more than three times the rate of prescriptions for depression or anxiety; and more than six times the rate of hospitalization after a suicide attempt.
The researchers say these high levels are “hypothesized to stem at least in part” from “stigma-related stress.” Or, they may be due to “a lack of gender affirmation.” They don’t even consider that higher reported rates of trauma, family problems and sexual abuse might lead to both gender confusion and other mental health issues. Nor do they acknowledge that, perhaps, rejecting your body and trying to live as the opposite sex might be a symptom of mental health problems or lead to other psychological difficulties.
Drs. Paul McHugh and Lawrence S. Mayer, both at the Johns Hopkins University School of Medicine, studied this “minority stress model” and adverse health outcomes for LGBT-identified individuals. They found, as much research has shown, that this group does have higher incidence of relational, psychological and behavioral problems. However, they found this can’t all be blamed on “societal stigma”: “Studies show that while social stressors do contribute to the increased risk of poor mental health outcomes for these populations, they likely do not account for the entire disparity.
So does giving opposite sex hormones help gender dysphoric individuals’ mental health? Bränström and Pachankis found that suppressing the body’s natural hormone production or giving cross-sex hormones did nothing, over time, to reduce the three mental health measures.
Regnerus puts it this way, “The study found no mental health benefits for hormonal interventions in this population. There is no effect of time since initiating hormone treatment on the likelihood of subsequently receiving mental health treatment.” This is very important, with the current mad rush to deliver hormone blockers and opposite sex hormones to children and teens.
But the researchers didn’t even include a bar graph showing this negative result. In fact, Dr. Bränström, lead author of the study, told ABC News the exact opposite, “This study extends earlier evidence of associations between gender-affirming treatment and improved mental health.”
And this result, showing hormones don’t help gender-dysphoric individuals, usually received just a passing mention in news stories. The fact that this study shows hormone blockers and cross-sex hormones have no effect on transgender mental health outcomes should’ve been loudly proclaimed in headlines. Instead? Crickets.
As far as surgeries to make someone look more like the opposite sex, this is what the authors and media touted as beneficial for transgender-identified individuals’ mental health. The study did find, perhaps, some modest benefits. But Regnerus argues that those results were greatly exaggerated by the authors.
As far as treatment or prescriptions for mood disorders, depression or anxiety, the first two categories, the study shows those in a range between about 32% and 37% for those who’d had surgery within the past nine years. Those are still very high levels compared to the general population. After 10 years, this dropped to 21%.
This makes it seems like surgery was somewhat helpful. But, as Regnerus states, the data show that “574 (out of 1,018 total) reported their last surgery as having been conducted less than two years ago,” while, “only 19 total respondents reported their last surgery as having been completed 10 or more years ago.” This is a very small group with which to show a long-term result, and it skews the researchers’ conclusions.
Regnerus shows the weakness of the study’s results: “If a mere three additional cases among these 19 had sought mental health treatment in 2015, there would appear to be no discernible overall effect of surgery on subsequent mental health. The study’s trumpeted conclusion may hinge on as few as three people in a data collection effort reaching 9.7 million Swedes, 2,679 of whom were diagnosed with gender incongruence and just over 1,000 of whom had gender-affirming surgery” (his emphasis).
Regnerus also crunched the data to find another number, “the NNT or ‘Number Needed to Treat.’” This number estimates “the number of patients that need to be treated in order to have an impact on one person.” From the data provided by Bränström and Pachankis, Regnerus calculated the NNT and writes, “In this study, the NNT appears to be a staggering 49, meaning the beneficial effect of surgery is so small that a clinic may have to perform 49 gender-affirming surgeries before they could expect to prevent one additional person from seeking subsequent mental health assistance.”
So “gender-affirming” treatments, such as hormone therapy and surgery really don’t help those struggling with gender confusion. Regnerus concludes that the researchers are colluding with an activist agenda, “That the authors corrupted otherwise excellent data and analyses with a skewed interpretation signals an abandonment of scientific rigor and reason in favor of complicity with activist groups seeking to normalize infertility-inducing and permanently disfiguring surgeries.”
As we quoted earlier, “This is not how normal medical research works.”