The authors of a landmark 2019 study on the effects of transgender surgery on patients’ mental and emotional health walked back their much-cited conclusion over the weekend, stating nearly a year after publication that their initial claim that their data demonstrated that transgender surgeries resulted in improved mental health was “too strong” and not supported by the data.
Richard Bränström, an associate professor at Sweden’s Karolinska Institute, and John Pachankis, an associate professor at the Yale School of Public Health, published their original study in The American Journal of Psychiatry in October 2019.
The public health experts analyzed the records of roughly 9.7 million Swedes in the Swedish Total Population Register. According to the index, 2,679 Swedes were diagnosed between 2005 and 2015 with “gender incongruence,” meaning their biological gender does not match the gender with which they identify. Of the diagnosed, 1,018 received sex reassignment surgery.
According to the authors, the data suggests that, based on therapy records for the year 2015, the odds that someone with gender incongruence suffers from mood and anxiety disorders decreases by 8% each successive year after receiving surgery. The authors initially concluded that their research “supports policies that provide gender-affirming surgeries.”
The authors walked back that claim on Saturday, posting a correction to their research in which they state that their data “demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts.” Their original conclusion, they write, was “too strong”:
Upon request, the authors reanalyzed the data to compare outcomes between individuals diagnosed with gender incongruence who had received gender-affirming surgical treatments and those diagnosed with gender incongruence who had not. While this comparison was performed retrospectively and was not part of the original research question given that several other factors may differ between the groups, the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison. Given that the study used neither a prospective cohort design nor a randomized controlled trial design, the conclusion that “the longitudinal association between gender-affirming surgery and lower use of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them” is too strong.
The authors also note in the correction that “individuals diagnosed with gender incongruence who had received gender-affirming surgery were more likely to be treated for anxiety disorders compared with individuals diagnosed with gender incongruence who had not received gender-affirming surgery.”
Heritage Foundation senior research fellow Ryan Anderson pointed out the correction in a piece for The Daily Signal.
“Gender dysphoria is a serious condition. People who experience a gender identity conflict should be treated with respect and compassion. And they deserve to know the truth,” Anderson writes. “Now the world’s largest relevant dataset reveals hormones and surgeries don’t bring wholeness and happiness. We need to find better, more humane, and effective responses to those who experience dysphoria.”
At the time the study was first published, Bränström and Pachankis’ now-retracted conclusion was promoted across a variety of media outlets.
“No longer can we say that we lack high-quality evidence of the benefits of providing gender-affirming surgeries to transgender individuals who seek them,” Pachankis said in an Oct. 3, 2019, statement announcing his research with Bränström.
Bränström and Pachankis eventually corrected their research after several others wrote to The American Journal of Psychiatry questioning the pair’s conclusions. One weakness of the study, pointed out by University of Texas sociologist Mark Regnerus, was that the 8% annual decrease in the odds of mental illness was largely based on a sample size of just 19 people whose last gender reassignment surgery took place in 2005.
“By contrast, 574 (out of 1,018 total) reported their last surgery as having been conducted less than two years ago,” Regnerus said (about 42% of those 574 sought therapy in 2015). “This means that the apparently helpful overall effect of surgery is driven by this comparatively steep drop in mood/anxiety treatment among only 19 patients.”