A Karolinska Institute publishes their study in Sweden that followed 324 people for up to 30 years who had sex-reassignment surgery. The study showed that about 10 years after the surgery, transgendered people began to have increased mental difficulties. As they progressed through life, their suicide mortality rose almost 20 times above the comparable nontransgender population. Dr. Paul McHugh, a former psychiatrist in chief at Johns Hopkins Hospital and author of “Try to Remember: Psychiatry’s Clash over Meaning, Memory, and Mind“, points to the data as evidence that the high suicide rate trumps the typical surgery prescription propagated by many as the answer to gender confusion.
Context
The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person’s body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment.
Objective
To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons.
Design
A population-based matched cohort study.
Setting
Sweden, 1973-2003.
Participants
All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973–2003. Random population controls (10∶1) were matched by birth year and birth sex or reassigned (final) sex, respectively.
Main Outcome Measures
Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]).
Results
The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8–4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8–62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9–8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0–3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls.
Conclusions
Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
View Full Study Report here
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