I have been saying for a long time that new research will show that gender affirming care is not beneficial and likely is more harmful. Now the research is coming in and it turns out i was right. here is the most recent research.
https://academic.oup.com/jsm/advance-article/doi/10.1093/jsxmed/qdaf026/8042063?login=true. - i did not copy and paste the entire article, but I got the highlights for those who can't read the study.
While lon[1]gitudinal data at the individual level were unavailable, mental health outcomes were assessed in a cross-sectional manner using diagnoses recorded before and after surgery within the database. Risk for mental health outcomes was assessed for all cohorts over two years following surgery, based on findings from the 2015 US Transgender Survey that high[1]lighted significant adverse mental health outcomes occurring within this timeframe [17].
Mental health outcomes were determined using validated tools administrated by the doctors and healthcare organizations, with the results recorded using corresponding ICD-10 codes.
Mental health outcomes in this study were assessed using clinician-verified International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes, as recorded in the EMRs within the TriNetX database. These diagnoses were established by healthcare professionals during clinical encounters and documented in the EMRs of participating healthcare organizations. This approach eliminates the reliance on self-report measures, ensuring that diagnoses such as depression, anxiety, suicidal ideation, substance use disorder, and body dysmorphic disorder are based on clinical evaluations rather than patient-reported symptoms or survey items. By utilizing ICD-10 codes, we sought to enhance the validity and reliability of the data, addressing the limitations of bias and subjectivity inherent in self-reported mental health measures.
∙ Cohort A: Patients documented as male (which may indi[1]cate natal sex or affirmed gender identity), aged ≥18 years, with a prior diagnosis of gender dysphoria, who had undergone gender-affirming surgery.
∙ Cohort B: Male patients with the same diagnosis but without surgery.
∙ Cohort C: Patients documented as female, aged ≥18 years, with a prior diagnosis of gender dysphoria, who had undergone gender-affirming surgery.
∙ Cohort D: Female patients with the same diagnosis but without surgery.
∙ Cohort E: Transgender male patients who underwent masculinizing gender-affirming regardless of a previous documented diagnosis of gender dysphoria
∙ Cohort F: Transgender female patients who underwent feminizing gender-affirming surgery regardless of a previ[1]ous documented diagnosis of gender dysphoria.
Results
Our team identified 107 583 patients aged ≥18 with a previous diagnosis of gender dysphoria using the TriNetX Database United States Collaborative Network. Initially, Cohort A included 2774 male patients with gender dysphoria and gender-affirming surgery; Cohort B included 48 090 male patients with gender dysphoria but no gender-affirming surgery; Cohort C included 3358 female patients with gender dysphoria and gender-affirming surgery; Cohort D included 67 579 female patients with gender dysphoria but no gender[1]affirming surgery; Cohort E included 3790 transgender male patients who underwent gender-affirming surgery but did not have a documented diagnosis of gender dysphoria; Cohort F included 4643 transgender female patients who underwent gender-affirming surgery but did not have a documented diagnosis of gender dysphoria. The demographics for each cohort before and after propensity score matching is attached to the supplementary tables. After propensity score matching of cohorts A and B, each cohort had 2774 patients of similar race, ethnicity, and age at index (Supplementary document: Table S1). Compared to male patients with a diagnosis of gender dysphoria only, those with gender affirmation surgery were at significantly higher risk for depression, anxiety, suicidal ideation, and substance use disorders. However, neither cohort was at increased risk for body dysmorphic disorder (Table 1). Male patients with gender-affirming surgery had a 25.4% rate of depression, compared to 11.5% for those without surgery (RR 2.203, 95% CI 1.477-3.287, P < 0.0001). Male patients with surgery had 4.882 times the risk of anxiety (12.783% vs. 2.618%, RR 4.882, 95% CI 4.505-5.29, P < 0.0001) compared to thosewho did not receive surgery (12.783% vs. 2.618%, RR 4.882, 95% CI 4.505-5.29, P < 0.0001). Both groups had the same risk for body dysmorphic disorder (0.4% vs. 0.4%, RR 1.001, 95% CI 0.417-2.402, P = 0.9974). After propensity score matching of Cohorts C and D, each cohort had 3358 female patients of similar age at index, race, and ethnicity (Supplementary document: Table S2). Female patients with gender dysphoria and a history of gender-affirming surgery had significantly higher risks for depression, anxiety, suicidal ideation, and substance use disorders compared to those with a diagnosis of gender dysphoria only. However, neither group was at an increased risk for body dysmorphic disorder (Table 2). Females with gender-affirming surgery had a 22.9% rate of depression, compared to 14.6% for those without surgery (RR 1.563, 95% CI 1.422-1.717, P < 0.0001). Compared to those without surgery, females who had undergone gender-affirming surgery had a 1.478 times higher risk of anxiety (10.496% vs. 7.098%, RR 1.478, 95% CI 1.214-1.797, P < 0.0001), a 2.357 times higher risk of suicidal ideation (19.811% vs. 8.402%, RR 2.357, 95% CI 1.579-3.515), and a 2.712 times higher risk of substance use disorder (19.322% vs.7.123%, RR 2.712, 95% CI 1.439-3.217). Both groups had the same risk for body dysmorphic disorder (0.3%)
(Table 2).
To assess gender disparities in mental health outcomes in transgender patients who underwent gender-affirming surgery but lacked a documented diagnosis of gender dysphoria, we compared Cohorts E and F. After propensity score matching, both cohorts included 3607 patients who were similar at index, in age, race, and ethnicity (Supplementary document:Table S3). Transgender men who had undergone gender[1]affirming surgery were at higher risk of most mental health issues compared to transgender women. Specifically, trans[1]gender men had a 1.58 times higher risk of anxiety (14.1% vs. 8. 9%, RR 1.580, 95% CI 0.845-2.134, P = 0.0002), a 1.186 times higher risk of suicidal ideation (5.5% vs. 4.6%, RR 1.186, 95% CI 0.97-1.449, P = 0.0358), and a 1.284 times higher risk of substance use disorder (14.4% vs. 11.2%, RR 1.284, 95% CI 1.137-1.45, P < 0.0001). Among the five outcomes, the relative risk was highest for depression among transgender men compared to transgender women (RR 1.783, 95% CI 1.327-2.389, P = 0.0298). Both cohorts were at the same risk for body dysmorphic disorder (Table 3)
Comparison with previous studies
When evaluating these findings within the context of previous research, it is crucial to recognize the limitations inherent in studies that rely primarily on survey data, such as those analyzed by Marano et al. and Almazan and Keuroghlian [13,23]. These studies, using data from the U.S. Transgender Sur[1]vey, underscore the psychosocial benefits of gender-affirming surgeries, including reductions in depression, anxiety, and suicidal ideation, while emphasizing the importance of align[1]ing physical appearance with gender identity to improve mental health. However, survey-based studies are limited by self-reported data, which may introduce response bias and lack clinical validation, potentially limiting the generalizabil[1]ity of their findings [24]. Our study diverges by using a national database of de-identified clinical data, enabling a more comprehensive and representative examination of real[1]world mental health outcomes across diverse demographics. This approach allows us to capture more nuanced insights into mental health risks, particularly the heightened suscep[1]tibility to depression, anxiety, suicidal ideation, and substance use disorder in transwomen individuals’ post-surgery. This divergence from survey-based findings highlights the need for gender-sensitive mental health strategies that extend beyond the surgical intervention itself.
Conclusion
Our study reveals that both male and female patients with gender dysphoria who undergo gender-affirming surgery are at significantly higher risk for adverse mental health outcomes, including depression, anxiety, suicidal ideation, and substance use disorder, compared to those who do not undergo gender-affirming surgery. This trend persists even after controlling for confounding factors through propensity score matching. Notably, transgender men showed a greater relative risk for these mental health issues compared to trans[1]gender women following gender-affirming surgery. Despite the benefits of surgery in alleviating gender dysphoria, our findings underscore the necessity for ongoing mental health support for transgender individuals during their post-surgery trajectories. These results also highlight the critical need for gender-specific care tailored to the unique experiences of male and female populations, respectively, addressing both pre- and post-surgical mental health care to improve overall well-being and prevent any mental illness or diseases.
https://academic.oup.com/jsm/advance-article/doi/10.1093/jsxmed/qdaf026/8042063?login=true. - i did not copy and paste the entire article, but I got the highlights for those who can't read the study.
While lon[1]gitudinal data at the individual level were unavailable, mental health outcomes were assessed in a cross-sectional manner using diagnoses recorded before and after surgery within the database. Risk for mental health outcomes was assessed for all cohorts over two years following surgery, based on findings from the 2015 US Transgender Survey that high[1]lighted significant adverse mental health outcomes occurring within this timeframe [17].
Mental health outcomes were determined using validated tools administrated by the doctors and healthcare organizations, with the results recorded using corresponding ICD-10 codes.
Mental health outcomes in this study were assessed using clinician-verified International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes, as recorded in the EMRs within the TriNetX database. These diagnoses were established by healthcare professionals during clinical encounters and documented in the EMRs of participating healthcare organizations. This approach eliminates the reliance on self-report measures, ensuring that diagnoses such as depression, anxiety, suicidal ideation, substance use disorder, and body dysmorphic disorder are based on clinical evaluations rather than patient-reported symptoms or survey items. By utilizing ICD-10 codes, we sought to enhance the validity and reliability of the data, addressing the limitations of bias and subjectivity inherent in self-reported mental health measures.
∙ Cohort A: Patients documented as male (which may indi[1]cate natal sex or affirmed gender identity), aged ≥18 years, with a prior diagnosis of gender dysphoria, who had undergone gender-affirming surgery.
∙ Cohort B: Male patients with the same diagnosis but without surgery.
∙ Cohort C: Patients documented as female, aged ≥18 years, with a prior diagnosis of gender dysphoria, who had undergone gender-affirming surgery.
∙ Cohort D: Female patients with the same diagnosis but without surgery.
∙ Cohort E: Transgender male patients who underwent masculinizing gender-affirming regardless of a previous documented diagnosis of gender dysphoria
∙ Cohort F: Transgender female patients who underwent feminizing gender-affirming surgery regardless of a previ[1]ous documented diagnosis of gender dysphoria.
Results
Our team identified 107 583 patients aged ≥18 with a previous diagnosis of gender dysphoria using the TriNetX Database United States Collaborative Network. Initially, Cohort A included 2774 male patients with gender dysphoria and gender-affirming surgery; Cohort B included 48 090 male patients with gender dysphoria but no gender-affirming surgery; Cohort C included 3358 female patients with gender dysphoria and gender-affirming surgery; Cohort D included 67 579 female patients with gender dysphoria but no gender[1]affirming surgery; Cohort E included 3790 transgender male patients who underwent gender-affirming surgery but did not have a documented diagnosis of gender dysphoria; Cohort F included 4643 transgender female patients who underwent gender-affirming surgery but did not have a documented diagnosis of gender dysphoria. The demographics for each cohort before and after propensity score matching is attached to the supplementary tables. After propensity score matching of cohorts A and B, each cohort had 2774 patients of similar race, ethnicity, and age at index (Supplementary document: Table S1). Compared to male patients with a diagnosis of gender dysphoria only, those with gender affirmation surgery were at significantly higher risk for depression, anxiety, suicidal ideation, and substance use disorders. However, neither cohort was at increased risk for body dysmorphic disorder (Table 1). Male patients with gender-affirming surgery had a 25.4% rate of depression, compared to 11.5% for those without surgery (RR 2.203, 95% CI 1.477-3.287, P < 0.0001). Male patients with surgery had 4.882 times the risk of anxiety (12.783% vs. 2.618%, RR 4.882, 95% CI 4.505-5.29, P < 0.0001) compared to thosewho did not receive surgery (12.783% vs. 2.618%, RR 4.882, 95% CI 4.505-5.29, P < 0.0001). Both groups had the same risk for body dysmorphic disorder (0.4% vs. 0.4%, RR 1.001, 95% CI 0.417-2.402, P = 0.9974). After propensity score matching of Cohorts C and D, each cohort had 3358 female patients of similar age at index, race, and ethnicity (Supplementary document: Table S2). Female patients with gender dysphoria and a history of gender-affirming surgery had significantly higher risks for depression, anxiety, suicidal ideation, and substance use disorders compared to those with a diagnosis of gender dysphoria only. However, neither group was at an increased risk for body dysmorphic disorder (Table 2). Females with gender-affirming surgery had a 22.9% rate of depression, compared to 14.6% for those without surgery (RR 1.563, 95% CI 1.422-1.717, P < 0.0001). Compared to those without surgery, females who had undergone gender-affirming surgery had a 1.478 times higher risk of anxiety (10.496% vs. 7.098%, RR 1.478, 95% CI 1.214-1.797, P < 0.0001), a 2.357 times higher risk of suicidal ideation (19.811% vs. 8.402%, RR 2.357, 95% CI 1.579-3.515), and a 2.712 times higher risk of substance use disorder (19.322% vs.7.123%, RR 2.712, 95% CI 1.439-3.217). Both groups had the same risk for body dysmorphic disorder (0.3%)
(Table 2).
To assess gender disparities in mental health outcomes in transgender patients who underwent gender-affirming surgery but lacked a documented diagnosis of gender dysphoria, we compared Cohorts E and F. After propensity score matching, both cohorts included 3607 patients who were similar at index, in age, race, and ethnicity (Supplementary document:Table S3). Transgender men who had undergone gender[1]affirming surgery were at higher risk of most mental health issues compared to transgender women. Specifically, trans[1]gender men had a 1.58 times higher risk of anxiety (14.1% vs. 8. 9%, RR 1.580, 95% CI 0.845-2.134, P = 0.0002), a 1.186 times higher risk of suicidal ideation (5.5% vs. 4.6%, RR 1.186, 95% CI 0.97-1.449, P = 0.0358), and a 1.284 times higher risk of substance use disorder (14.4% vs. 11.2%, RR 1.284, 95% CI 1.137-1.45, P < 0.0001). Among the five outcomes, the relative risk was highest for depression among transgender men compared to transgender women (RR 1.783, 95% CI 1.327-2.389, P = 0.0298). Both cohorts were at the same risk for body dysmorphic disorder (Table 3)
Comparison with previous studies
When evaluating these findings within the context of previous research, it is crucial to recognize the limitations inherent in studies that rely primarily on survey data, such as those analyzed by Marano et al. and Almazan and Keuroghlian [13,23]. These studies, using data from the U.S. Transgender Sur[1]vey, underscore the psychosocial benefits of gender-affirming surgeries, including reductions in depression, anxiety, and suicidal ideation, while emphasizing the importance of align[1]ing physical appearance with gender identity to improve mental health. However, survey-based studies are limited by self-reported data, which may introduce response bias and lack clinical validation, potentially limiting the generalizabil[1]ity of their findings [24]. Our study diverges by using a national database of de-identified clinical data, enabling a more comprehensive and representative examination of real[1]world mental health outcomes across diverse demographics. This approach allows us to capture more nuanced insights into mental health risks, particularly the heightened suscep[1]tibility to depression, anxiety, suicidal ideation, and substance use disorder in transwomen individuals’ post-surgery. This divergence from survey-based findings highlights the need for gender-sensitive mental health strategies that extend beyond the surgical intervention itself.
Conclusion
Our study reveals that both male and female patients with gender dysphoria who undergo gender-affirming surgery are at significantly higher risk for adverse mental health outcomes, including depression, anxiety, suicidal ideation, and substance use disorder, compared to those who do not undergo gender-affirming surgery. This trend persists even after controlling for confounding factors through propensity score matching. Notably, transgender men showed a greater relative risk for these mental health issues compared to trans[1]gender women following gender-affirming surgery. Despite the benefits of surgery in alleviating gender dysphoria, our findings underscore the necessity for ongoing mental health support for transgender individuals during their post-surgery trajectories. These results also highlight the critical need for gender-specific care tailored to the unique experiences of male and female populations, respectively, addressing both pre- and post-surgical mental health care to improve overall well-being and prevent any mental illness or diseases.
