McHugh misquotes study in WSJ op-ed

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A 2011 study at the Karolinska Institute in Sweden produced the most illuminating results yet regarding the transgendered, evidence that should give advocates pause. The long-term study?up to 30 years?followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription.

Given the nature of sex reassignment, a double blind randomized controlled study of the result after sex reassignment is not feasible. We therefore have to rely on other study designs. For the purpose of evaluating whether sex reassignment is an effective treatment for gender dysphoria, it is reasonable to compare reported gender dysphoria pre and post treatment. Such studies have been conducted either prospectively or retrospectively, and suggest that sex reassignment of transsexual persons improves quality of life and gender dysphoria. The limitation is of course that the treatment has not been assigned randomly and has not been carried out blindly.

For the purpose of evaluating the safety of sex reassignment in terms of morbidity and mortality, however, it is reasonable to compare sex reassigned persons with matched population controls. The caveat with this design is that transsexual persons before sex reassignment might differ from healthy controls (although this bias can be statistically corrected for by adjusting for baseline differences). It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia. This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit.

The poorer outcome in the present study might also be explained by longer follow-up period (median >10 years) compared to previous studies. In support of this notion, the survival curve (Figure 1) suggests increased mortality from ten years after sex reassignment and onwards. In accordance, the overall mortality rate was only significantly increased for the group operated before 1989. However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.

Table 2 describes the risks for selected outcomes during follow-up among sex-reassigned persons, compared to same-age controls of the same birth sex. Sex-reassigned transsexual persons of both genders had approximately a three times higher risk of all-cause mortality than controls, also after adjustment for covariates. Table 2 separately lists the outcomes depending on when sex reassignment was performed: during the period 1973-1988 or 1989?2003. Even though the overall mortality was increased across both time periods, it did not reach statistical significance for the period 1989?2003. The Kaplan-Meier curve (Figure 1) suggests that survival of transsexual persons started to diverge from that of matched controls after about 10 years of follow-up. The cause-specific mortality from suicide was much higher in sex-reassigned persons, compared to matched controls. Mortality due to cardiovascular disease was moderately increased among the sex-reassigned, whereas the numerically increased risk for malignancies was borderline statistically significant. The malignancies were lung cancer (N = 3), tongue cancer (N = 1), pharyngeal cancer (N = 1), pancreas cancer (N = 1), liver cancer (N = 1), and unknown origin (N = 1).

Sex-reassigned persons had a higher risk of inpatient care for a psychiatric disorder other than gender identity disorder than controls matched on birth year and birth sex (Table 2). This held after adjustment for prior psychiatric morbidity, and was true regardless of whether sex reassignment occurred before or after 1989. In line with the increased mortality from suicide, sex-reassigned individuals were also at a higher risk for suicide attempts, though this was not statistically significant for the time period 1989?2003. The risks of being hospitalised for substance misuse or accidents were not significantly increased after adjusting for covariates (Table 2).

Transsexual individuals were at increased risk of being convicted for any crime or violent crime after sex reassignment (Table 2); this was, however, only significant in the group who underwent sex reassignment before 1989.

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.

However, McHugh says that it shouldn?t be surprising that Hopkins discontinued the surgeries, and that he still supports this decision today. He points to Meyer?s study as well as a 2011 Swedish study that states that the risk of suicide was higher for people who had the surgery versus the general population.

McHugh says that more research has to be conducted before a surgery with such a high risk should be performed, especially because he does not think the surgery is necessary.

Some clarifications regarding a study that was published in 2011 by myself and co-workers. The study showed a three times elevated hazard ration for overall mortality compared to the general population for the period 1973-2003 (i.e. the time period in the study).The main causes of death were suicide, cardiovascular disease and smoke related cancer. If the study period was divided to before or after 1989 it was evident that mortality after 1989 was not significantly different from the general population. The study was not designed to answer the question if gender confirming surgery imposed specific risks or benefits. Therefore the findings cannot be to argue for or against endocrine or surgical treatment. As pointed out earlier, the same type of outcome are observed for other diseases and no one would argue against treatment of cancer, diabetes or bipolar disorder; all demonstrate an increased overall mortality. The suggested conclusion is to focus on improvement in care. Gender confirmation surgery and endocrine treatment only aims at amelioration of gender dysphoria. Many studies and a meta-analysis confirms a decrease in gender dysphoria complaints. Individuals with gender dysphoria may also suffer from depression, PTSD, and also consequences from gender related abuse, sexual trauma, discrimination, and hate crimes. I do think we have to address these questions on a societal levels as well as in in the health care system in order to improve general health among those who suffer from gender dysphoria.

But Cecilia Dhejne has an obvious agenda. Nothing she said explains the high suicide rates of people who know they're wrong but can't climb out of their hole. McHugh is much more evenhanded and objective. Cecelia Dhejne likes The Erotica Project on her Facebook, a band promoting sexuality to eighth graders. She likes The Journal of Sexual Medicine, another perverse "academic" journal with pictures of women climaxing. All of these academic studies are led by deceitful human beings who lie and promote what they wish. Academia has turned corrupt and is not objective or trustworthy. The harsh reality of suicidal LGBT is self-explanatory, despite all scapegoats of Christians and bullies, and despite all false saviors of academia and Socialism.

A meta-analysis published in 2010 by Murad, et al., of patients who received currently excluded
treatments demonstrated that there was a significant decrease in suicidality post-treatment. The
average reduction was from 30 percent pretreatment to 8 percent post treatment.30
De Cuypere, et al., reported that the rate of suicide attempts dropped dramatically from 29.3
percent to 5.1 percent after receiving medical and surgical treatment among Dutch patients
treated from 1986-2001.31

According to Dr. Ryan Gorton, “In a cross-sectional study of 141 transgender patients, Kuiper
and Cohen-Kittenis found that after medical intervention and treatments, suicide fell from 19
percent to zero percent in transgender men and from 24 percent to 6 percent in transgender
women.32)”33

Clements-Nolle, et al., studied the predictors of suicide among over 500 transgender men and
women in a sample from San Francisco and found a prevalence of suicide attempts of 32
percent.34 In this study, the strongest predictor associated with the risk of suicide was gender
based discrimination which included “problems getting health or medical services due to their
gender identity or presentation.”35 According to Gorton, “Notably, this gender-based
discrimination was a more reliable predictor of suicide than depression, history of alcohol/drug
abuse treatment, physical victimization, or sexual assault.”36