Does 'gender affirming' treatment really improve mental health?

Washington D.C., Nov 28, 2019 / 10:00 am

A reporter and a researcher who reviewed literature on "gender affirmation" have raised concerns about growing political and academic support for life-altering surgical procedures.

"We don't know, we don't know, we don't know," Madeleine Kearns, a William F. Buckley fellow in political journalism at the National Review Institute, told CNA of the long-term results of "gender affirmation" practices.

"And so if the answer keeps being we don't know, it does raise the rather glaring question that why on earth are we doing it? What evidence suggests this is necessary?" she asked.

Kearns wrote a Nov. 21 article in National Review, "The Tragedy of the 'Trans' Child," which discussed cases of gender dysphoria, as well as efforts to influence the debate over "gender affirmation" practices.

There are three main responses to a child exhibiting signs of gender confusion, Kearns wrote in National Review. Two of them are "talk therapy" to find out what underlying issues might be influencing the child's confusion, and "watchful waiting" to see if children "grow out" of the stage.

The third route is so-called "gender affirmation," which presents a radical departure from previously-accepted medical practice, Kearns said. It involves practices which could seriously or permanently alter a person's development.

"Gender affirmation" could involve having a child's community reinforce their desired sex to them-"a form of social-psychological treatment," Kearns said-or administering puberty-blocking drugs or cross-sex hormones followed by puberty-blocking drugs. Surgical intervention would be the most drastic action, she said.

Kearns shared her conclusions with CNA from researching various studies that purportedly showed minimal or even salutary effects of gender-affirmation on the mental health of children with gender dysphoria.

Many of these studies, she told CNA, are actually very limited in scope, because of the novelty of "gender affirmation" techniques, or they disregard other standard research safeguards, such as control groups.

Society still does not know with certainty how a child will feel 10 to 15 years after gender affirmation procedure, Kearns said.

A recent study claimed that sex-reassignment surgery might actually benefit recipients in the long-term. The American Journal of Psychiatry in October published the results of a Swedish study that aimed to discover the rates of mental health treatment for persons diagnosed with "gender incongruence" who had also undergone sex-reassignment surgery.

Persons with "gender incongruence" in the study had significantly higher rates of "a mood and anxiety disorder health care visit"-around six times that of the general population, the study said.

Yet it was another claim in the study that made headlines-that the rates of mental health visits among persons with gender incongruence who also had gender-affirmation surgery actually declined over time.

The Swedish study claimed specifically that mental health problems declined after a period of ten years post-surgery.

That claim was picked up in the press as possible support for gender affirmation. "When transgender people undergo sex-reassignment surgery, the beneficial effect on their mental health is still evident - and increasing - years later, a Swedish study suggests," Reuters reported earlier this month.

But the sample size in the Swedish study was extremely small, Professor Mark Regnerus, sociology professor at the University of Texas at Austin and a senior fellow at the Austin Institute for the Study of Family and Culture, subsequently wrote in the online journal The Public Discourse.

The Swedish study collected data of more than 9.7 million people. Only 2,679 were diagnosed with "gender incongruence," and of these, 1,018 people had undergone sex-reassignment surgery, he noted.

Out of this population of just over 1,000, only 19 people had gone more than 10 years after having surgery. Thus, the study was basing this claim upon a national sample of 19 people.

Regnerus, in his Public Discourse piece, put the numbers in perspective: "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."

"It's important to keep some perspective here-how national debates and discourses are being driven by quite small shares of the population," Regnerus said in a written statement to CNA.

And it is these types of studies that are fueling the rise of gender-affirmation of children-despite a lack of deep knowledge about the effects of these surgeries ten years down the road, Kearns said.

"Again, it's important to note that the studies related to children are very, very new," Kearns said. Children, especially those supportive of gender affirmation, may answer that they feel great after surgery.

Yet in 2016, Paul R. McHugh, M.D., the former chief of psychiatry at Johns Hopkins Hospital, and Lawrence S. Mayer, M.B., M.S., Ph.D., then a scholar in residence in the Johns Hopkins School of Medicine's psychiatry department, reviewed hundreds of scientific articles on sexual orientation and gender identity issues. 

"Compared to the general population, adults who have undergone sex-reassignment surgery continue to have a higher risk of experiencing poor mental health outcomes," they concluded.

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And as to their condition ten years later, "nobody has a crystal ball," Kearns said. And with the adult population, there is only "very ambiguous research."

Many serious medical studies include a "control group" for comparison's sake. However, some studies used to tout the positive effects of gender affirmation "completely disregard that," she said. "They don't really tell you anything except for the foregone conclusions of the ideologues running them and funding them."

The push to use limited or unsound research in favor of gender affirmation should concern everyone, she said.

"This should not be a partisan issue. This is an issue of scientific integrity," Kearns said. "This is not secular versus religious, this is not Democrat versus Republican."

"And I really do think that we are living through this tremendous medical scandal which our children's children will hang their heads in shame about."