Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden Authors: Dhejne C, Lichtenstein P, Boman M, Johansson AL, Långström N, Landén M
Good research for transgender people and mental health and physical health are sadly lacking. Long-term studies are hampered by a variety of problems. This was a study looking at post-operative outcomes for transsexuals in Sweden over a period of 3 decades. It’s an important piece of research.
There are significant problems in applying this research in the way many people do—which is to say surgery doesn’t help or doesn’t work or that this is simply a mental illness and should be treated as such.
First, this research does not compare transsexuals who received surgical treatment to transsexuals who did NOT receive surgical intervention. It compares transsexuals who received surgery with the general population. Think about that. Generally, when we want to evaluate the success, or lack thereof, of a particular procedure on a group of people, it’s compared to people with the same condition who did not receive the procedure or received some other treatment. For instance, this is like comparing people who received a kidney transplant with people who don’t have kidney problems at all.
A fair comparison would be receiving a kidney transplant or staying on hemodialysis. Then you can compare whether the surgical intervention improved the QOL over the non-surgical intervention
This study lacks that. So it cannot tell us if people who have surgery do better than those who do not because for transsexuals who persist through the system of care in Sweden, surgery is the recommended treatment for gender dysphoria. It would be immoral to deny people access to the best treatment available just to study if people do better or worse. We certainly do have evidence that transsexual people report feeling less dysphoric post-surgery.
The second issue is that by the time an individual has surgery, they have been dysphoric around gender for a very long time. They very likely have suffered discrimination, the impact of stigma, and basically lived in a psychological state of siege for much of their life. Neither hormones or surgery fix a person’s history of abuse, stigma, rejection, and marginalization. Remember, they started following folks in 1973. 1973.
Another question that I have is that when this is talking about SRS for male to female transsexuals, I want to know about FFS. I don’t know if they have data on whether or not people had facial feminization surgery (FFS) FFS is critical in assisting an individual to move through society so that they may be less likely to be perceived to be transgender and thus the target of discrimination and hate violence. So having one’s genitals altered will assist with body dysphoria, but likely will not assist with current discrimination and stigma.
So what did the study say:
The swedish study regarding post-operative outcomes
324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973–2003. Random population controls (101) were matched by birth year and birth sex or reassigned (final) sex, respectively.
Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, 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.
It also says:
“…the results should not be interpreted such as sex reassignment per se increases morbidity and mortality.”
Which is what some people go on to do when mis-using this study.
What does it say about suicide?:
First, male-to-females had significantly increased risks for suicide attempts compared to both female (aHR 9.3; 95% CI 4.4–19.9) and male (aHR 10.4; 95% CI 4.9–22.1) controls. By contrast, female-to-males had significantly increased risk of suicide attempts only compared to male controls (aHR 6.8; 95% CI 2.1–21.6) but not compared to female controls (aHR 1.9; 95% CI 0.7–4.8). This suggests that male-to-females are at higher risk for suicide attempts after sex reassignment, whereas female-to-males maintain a female pattern of suicide attempts after sex reassignment
It also says:
“Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia.,  This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit.”
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.
What does it hypothesize?
Previous reports , , ,  suggest that transsexualism is a strong risk factor for suicide, also after sex reassignment, and our long-term findings support the need for continued psychiatric follow-up for persons at risk to prevent this.
What does it say about cardiovascular disease?
Mortality due to cardiovascular disease was significantly increased among sex reassigned individuals, albeit these results should be interpreted with caution due to the low number of events. This contrasts, however, a Dutch follow-up study that reported no increased risk for cardiovascular events.,  A recent meta-analysis concluded, however, that data on cardiovascular outcome after cross-sex steroid use are sparse, inconclusive, and of very low quality.
What does it hypothesize?
There might be other explanations to increased cardiovascular death and malignancies. Smoking was in one study reported in almost 50% by the male-to females and almost 20% by female-to-males. It is also possible that transsexual persons avoid the health care system due to a presumed risk of being discriminated.
One of the other issues that I am very interested in is the Adverse Childhood Experiences studies. Basically, children who suffered from various types of abuse are more likely to have a poorer quality of life and increased health problems. For instance, inflammatory diseases, heart disease, diabetes, lung disease, etc. For many years, the amount of fibromyalgia and other illnesses in the queer community although more so the trans and lesbian communities have greatly concerned me. People who are trauma survivors have the hardest time quitting smoking, have different issues connected to obesity, etc. I would posit that this is a more important area of research for queer public health researchers and would explain a lot of the issues indicated in this study.