Gender dysphoria sufferers need sound evidence to guide life-changing decisions. So a study that "lends support to the decision to provide gender-affirming surgeries" could have big clinical implications. But now, a review of it has "demonstrated no advantage of surgery”.
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The episode highlights the need for researchers in gender identity healthcare to adhere to rigorous scientific process. Studies seeking to do good may appeal to headline writers & grant-makers, but can mislead patients & clinicians, and ultimately put public trust at risk.
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The study by Bränström & Pachankis analysed population-level data & found that mental health needs fell after surgery. "No longer can we say that we lack high-quality evidence of the benefits of providing gender-affirming surgeries" said Pachankis.
medicine.yale.edu/lab/pachankis/…
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medicine.yale.edu/lab/pachankis/…
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The study sought to be influential: it "should help inform policymakers" said co-author Pachankis.
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But the study was critiqued & the authors asked to look again. They hadn't compared gender dysphoria patients with surgery vs those without. When they did, they found "no advantage of surgery in relation to subsequent mood or anxiety-disorder-related health care visits..."
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SEGM advisor @anckarsater, with Christopher Gillberg, pointed to methodological shortcomings that "preclude any statement on the suitability of early surgery" & emphasised the raised mental health needs of the transitioned population.
doi.org/10.1176/appi.a…
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doi.org/10.1176/appi.a…
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Mikael Landén said the authors merely "found what was already known": higher mental health needs of this vulnerable group vs general popn; but they didn't highlight special risk during the peri-operative transition period.
doi.org/10.1176/appi.a…
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doi.org/10.1176/appi.a…
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SEGM advisors @will_malone & @Sven_Roman drew attention to the claimed 8% annual reduction in post-surgery mental health treatments. In fact, after the 1st yr there was hardly a reduction until after 10 yrs, when the sample size was just 4 people.
doi.org/10.1176/appi.a…
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doi.org/10.1176/appi.a…
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SEGM advisor Dr Avi Ring proposed an alternative explanation for the data, that would account for the recent rise in adolescent-onset patients who have greater co-occuring mental health issues.
doi.org/10.1176/appi.a…
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doi.org/10.1176/appi.a…
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@AgnesWold observed that the risk of suicide attempts in the population who had undergone surgery was actually 2.4 higher than in those who had no surgery.
doi.org/10.1176/appi.a…
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doi.org/10.1176/appi.a…
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We hope the journal’s correction – currently behind a paywall – will be as influential as the study's original conclusion. To its credit the journal has published these critiques & others, but the original conclusion remains freely accessible.
How will others respond?
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How will others respond?
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The study was quickly repurposed as CME, teaching physicians that "The findings support the decision to offer surgery to transgender individuals seeking it, as well as policies that ensure coverage for surgery."
Will @MedscapeCME withdraw this program?
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Will @MedscapeCME withdraw this program?
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Reuters, NBC, Newsweek, Medscape & others reported the study's ground-breaking findings, ensuring it became widely known. Will this latest development prove as newsworthy?
medscape.com/viewarticle/91…
nbcnews.com/news/amp/ncna1…
newsweek.com/transgender-af…
uk.reuters.com/article/us-hea…
medscape.com/viewarticle/91…
nbcnews.com/news/amp/ncna1…
newsweek.com/transgender-af…
uk.reuters.com/article/us-hea…
Finally: the study did yield significant results: population-level data confirming (a) higher mental health needs of GD sufferers vs genl ppn, and (b) no clear mental-health benefit for gender surgery. As Pachankis said, it "should help inform policymakers". But will it?
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Sometimes in our eagerness to reach a goal, we opt for the appealing short-cut, but it takes more time in the end
Gender dysphoric people deserve high-quality healthcare. It requires rigorously-designed studies, research that follows the evidence, however hard the path
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Gender dysphoric people deserve high-quality healthcare. It requires rigorously-designed studies, research that follows the evidence, however hard the path
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SEGM is an international collective of more than 100 clinicians, researchers and others, dedicated to safe, compassionate and evidence-based gender identity healthcare, especially for children, adolescents and young adults.
To find out more, visit us at segm.org
To find out more, visit us at segm.org
