Examining gender-specific mental health risks after gender-affirming surgery: a national database study
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Study is "new" - dated Feb 25, 2025.
https://pubmed.ncbi.nlm.nih.gov/39996623/
100,000+ patients
Aim: To evaluate mental health outcomes in transgender individuals with gender dysphoria who have undergone gender-affirming surgery, stratified by gender and time since surgery.
Methods: This retrospective study utilized the TriNetX database, analyzing U.S. patients aged ≥18 with gender dysphoria (International Classification of Diseases, Tenth Revision [ICD-10] F64) between June 2014 and June 2024. Six cohorts were created based on gender and surgery status: Cohorts A-D included patients with or without surgery, and Cohorts E-F allowed for gender comparison among those with surgery. Propensity score matching controlled for age, race, and ethnicity. Mental health outcomes included depression, anxiety, suicidal ideation, substance use disorder, and body dysmorphic disorder, assessed over two years post-surgery using clinician-verified ICD-10 codes. Body dysmorphic disorder (BDD) was analyzed separately and not conflated with gender dysphoria cohorts to ensure the distinction between these conditions. Statistical analysis employed risk ratios, with P < 0.05 deemed significant.
Outcomes: Primary outcomes were differences in mental health disorders, specifically depression, anxiety, suicidal ideation, body-dysmorphic disorder, and substance use disorder, among transgender individuals' post-surgery.
What results?
First - I highlighted their phrase, "assessed over two years post-surgery".
They looked at what happens after surgery - Up to 2 years.
"Clinician-verified ICD 10 codes" means that, ordinarily, or majority of the time, patient, clinician, & clinic or insurance provider were able to agree on what happened after.
Results: From 107 583 patients, matched cohorts demonstrated that those undergoing [sic; those who underwent] surgery were at significantly higher risk for depression, anxiety, suicidal ideation, and substance use disorders than those without surgery. [Biological] Males with surgery showed a higher prevalence of depression (25.4% vs. 11.5%, RR 2.203, P < 0.0001) and anxiety (12.8% vs. 2.6%, RR 4.882, P < 0.0001). [Biological] Females exhibited similar trends, with elevated depression (22.9% vs. 14.6%, RR 1.563, P < 0.0001) and anxiety (10.5% vs. 7.1%, RR 1.478, P < 0.0001). Feminizing individuals demonstrated particularly high risk for depression (RR 1.783, P = 0.0298) and substance use disorders (RR 1.284, P < 0.0001).
Post-surgery, "significantly higher risk for depression, anxiety, suicidal ideation, and substance use disorders".
"Conclusion" section, is where they throw in some verbiage that activists & hospital corporations would want:
Clinical implications: Findings suggest the necessity for gender-sensitive mental health support following gender-affirming surgery to address post-surgical psychological risks.
Strengths and limitations: By leveraging ICD-10 codes, we provide a more accurate representation of patient demographics and clinical outcomes, minimizing recall and reporting biases that often limit survey-based research. Limitations include the inability to account for unmeasured confounders such as social support.
Conclusion: Gender-affirming surgery, while beneficial in affirming gender identity, is associated with increased risk of mental health issues, underscoring the need for ongoing, gender-sensitive mental health support for transgender individuals' post-surgery.
I call it verbiage because it assumes (rather than shows or proves) that surgery HAD TO be the right move & surgery's worse outcomes MUST merely be lack of "ongoing mental health support" or "social support".
In other words: They appear to not consider that surgery could be wrong move.
To contemplate that surgery never should have been done, would go against revenue interests of insurance corporations & large hospital corporations.
But here is the undeniable part - undeniable from their own data, given earlier:
Surgery often either leaves people mentally & emotionally worse off, or at least, achieves no improvement.