The longer ago a transgender person’s gender-affirming surgery, the less likely they are to suffer anxiety, depression or suicidal behavior, the study suggests.
Nov. 11, 2019
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.
Overall, people in the study with gender incongruence — that is, their biological gender doesn’t match the gender with which they identify — were six times more likely than people in the general population to visit a doctor for mood and anxiety disorders. They were also three times more likely to be prescribed antidepressants, and six times more likely to be hospitalized after a suicide attempt, researchers found.
But among trans people who had undergone gender-affirming surgery, the longer ago their surgery, the less likely they were to suffer anxiety, depression or suicidal behavior during the study period, researchers reported in The American Journal of Psychiatry.
Surgery to modify a person’s sex characteristics “is often the last and the most considered step in the treatment process for gender dysphoria,” according to the World Professional Association for Transgender Health.
Many transgender and gender-nonconforming individuals “find comfort with their gender identity, role, and expression without surgery,” but for others, “surgery is essential and medically necessary to alleviate their gender dysphoria,” according to the organization.
While the new study confirms that transgender individuals are more likely to use mental health treatments, it also shows that gender-affirming therapy might reduce this risk, coauthor Richard Branstrom of the Karolinska Institutet in Stockholm told Reuters Health by email.
Branstrom and colleague John Pachankis of the Yale School of Public Health in New Haven, Connecticut found that as of 2015, 2,679 people in Sweden had a diagnosis of gender incongruence, out of the total population of 9.7 million.
That year, 9.3 percent of people with gender incongruence visited a doctor for mood disorders, 7.4 percent saw a doctor for anxiety disorders and 29 percent were on antidepressants. In the general population, those percentages were 1 percent, 0.6 percent and 9.4 percent, respectively.
Just over 70 percent of people with gender incongruence were receiving feminizing or masculinizing hormones to modify outward sexual features such as breasts, body fat distribution and facial hair, and 48 percent had undergone gender-affirming surgery. Nearly all of those who had surgery also received hormone therapy.
The benefit of hormone treatment did not increase with time. But “increased time since last gender-affirming surgery was associated with fewer mental health treatments,” the authors report.
In fact, they note, “The likelihood of being treated for a mood or anxiety disorder was reduced by 8 percent for each year since the last gender-afﬁrming surgery,” for up to 10 years.
Gender identity is as strong in transgender children as it is in cisgender children (those who identify with the gender they were assigned at birth), no matter how long a child has been treated as being a gender they don’t identify with, according to initial findings from a University of Washington study that is the largest of its kind.
The results bolster earlier UW research that has found transitioning doesn’t affect a transgender child’s sense of self.
The study also found that transgender children’s gender development mirrors that of cisgender kids.
For example, just as cisgender children tend to show interest in toys and clothes that society stereotypically associates with their gender, transgender children tend to do the same for things associated with the gender they identify as.
Even if a transgender boy’s family treated him as a girl for the first few years of his life, he will notice cues about what society expects of boys and “self-socialize” to learn how to “be” the gender he identifies as instead, said Selin Gülgöz, a postdoctoral researcher in UW’s psychology department and lead author of a paper about the study, which was published Nov. 18 in the journal Proceedings of the National Academy of Sciences of the United States of America (PNAS).
“These children have a very clear understanding of the things assigned to the sexes,” Gülgöz said. “But it looks like, once they identify their gender, they are gravitating toward what society shows them.”
There is nuance when it comes to the influence of stereotypes, Gülgöz noted. How much girls like traditionally feminine things can vary, for instance, but researchers found that variance occurs to about the same extent in transgender girls as in cisgender girls, she said.
The UW researchers studied 822 children from the United States and Canada — 317 transgender children between the ages of 3 and 12, 189 of their cisgender siblings and 316 other cisgender children as a control group — and will follow them into adulthood.
Gülgöz said this study differs from other large studies of transgender children because all the children in UW’s study have socially transitioned to their present gender. Those children’s experiences might be expected to differ from those of children who are gender-nonconforming but haven’t transitioned, she said.
WASHINGTON — Nicolas Talbott, a graduate student at Kent State University in Ohio who is transgender, was told in May that because of President Trump’s transgender ban in the military, he would no longer be eligible for placement as an Army officer. He could continue participating in the Reserve Officers Training Corps program, but the benefits that he joined for — health insurance and student loan forgiveness — were no longer available to him.
“Everyone else would walk away with a job in the United States Army, and I would walk away with just more student loan debt,” Mr. Talbott said.
Mr. Talbott’s experience is just one version of a broader story unfolding across vast portions of the federal government as the Trump administration has rolled back a wide array of protections for transgender people, many of them put in place during the Obama administration. The Obama White House used its powers to declare that legal and legislative efforts to defend against sex discrimination should apply to gender identity. The Trump White House called that executive overreach — and reversed course wherever it could.
Across the country, transgender people and groups that are advocates for them have wrestled with the effect of that shift as they have learned of policy changes from the departments of Education and Labor to the departments of Health and Human Services and Housing and Urban Development, from the Pentagon to the Justice Department to the Office of Personnel Management.
Last month, a United States district judge struck down a Health and Human Services Department rule that would, among other changes, expand the protections for health care workers who refuse to treat transgender patients if it clashed with their beliefs, the third judge to do so.
But so many similar regulations are in place or pending that advocates for transgender rights are hardly relieved.
“We’ve been a priority for this administration since the day they got in the door,” said Gillian Branstetter, a former spokeswoman for the National Center for Transgender Equality, who is transgender.
As a child I learned that all bullies are the same. Those they exercise bigotry towards may change but in many ways those abuse are also all the same. Howard Fast wrote of the slave revolt in Rome, that was led by the gladiator named Spartacus. When the rebellion was crushed the Roman soldiers demand to know which one of the survivors is Spartacus. The survivors answer, “I am Spartacus.”
Then there is Tom Joad’s soliloquy at the end of “Grapes of Wrath”.
It is important to side with the bullied not the bully. The oppressed and not the oppressor. It is more important than ever to stand together and not be divided by our specific identities. To make a stand and say. “I am Spartacus.”
When I started taking classes last fall as the first step in my converting to Judaism I started wearing a Magen David pendant. My of saying as Ruth said long ago, “Your people shall be my people.”
As a mother, I’m no stranger to anxiety. Recently, I’ve been dealing with fears about my older son going to sleepaway camp for the first time next summer. I’ve found myself consumed by worry: Will he be too shy to make new friends? Will he stay up too late every night and get sick? Will he be homesick?
Then, in the midst of my anxiety, the news broke terrorists in Jersey City had intended to murder 50 Jewish children in their classrooms, just 30 minutes from my home. Then, two nights ago, a machete-wielding man attacked a Hanukkah celebration at a rabbi’s house in Monsey, New York, injuring five people. But that’s just the tip of it: Between these two horrific incidents, there were anti-Semitic attacks nearly every day in between.
I never was so scared before I became a mother. Now, it seems inescapable. The typical fears of motherhood are still there, they never really go away. Will my sons fit in with their peers? Will they treat others with kindness? Will their teachers recognize their potential? Will they look both ways before they cross the street? But now, on top of these “regular” worries, I must also ask myself, will my kids be targets of violent hatred simply because they are Jewish? Will they know where to hide when a terrorist arrives at their school?
Almost all of the attacks in recent weeks have been committed against people who are clearly identifiable as Jewish. They wear black hats and coats; their sidelocks curl and hang down to their jaw line; they cover their hair in sheitels and pillbox hats.
I’ve been told before, “But you’re not that kind of Jew.” Because I wear pants and tank tops and I don’t cover my hair. I listen to 90’s alternative rock. I can pass as merely “American.”
Years ago, on a cross-country youth trip, I once had to explain to a woman in South Dakota that yes, we are really Jews, and that no, Jews don’t really have horns. I was 14 years old, and it was the first time someone had looked at me as though I had classified myself incorrectly.
So yes, I may not be “that kind of Jew.” But my husband and my sons wear kippahs and tzitzit, which, to some, are akin to horns, and to all makes them more obvious targets.
And I do keep kosher — I have five sets of dishes, two sinks, and two dishwashers. I do put up a sukkah and have a mezuzah on every doorpost in our house. I walk to shul (when I go). I study Torah and write Midrash.
My husband does not wear a black hat and I have never owned a sheitel, but I own my Jewish name and I use it with pride.
I have never hidden who I am. My bios will tell you that I am a Jewish infertile mama. I am the daughter of a rabbi. I am a graduate of the Jewish day school system, where I met my husband, my beshert. I am a former leader of the Jewish Student Union on my college campus. I am the executive director of a Jewish nonprofit.
But still, I watch (a lot of) TV. I eat out at dairy restaurants and our kids swim and shower on Shabbat and we hand out candy on Halloween and we celebrate Thanksgiving. I am more comfortable in an egalitarian synagogue than one in which men and women are separated.
In other words, I’m not “that kind” of Jew.
And yet, when people remind me of that, it’s as if they’re saying it’s OK to target that kind of Jew. But it’s not OK, and I do worry, because I am that kind of Jew. And that’s not because you can spot the kippahs on my sons’ heads, but because I am a Jew at all. The very notion of “kinds of Jews” is what makes us vulnerable — we divide and they conquer.
HRC is deeply saddened to learn of the death of Dustin Parker, a 25-year-old transgender man fatally shot in McAlester, Oklahoma, early on New Year’s Day. He was killed while working as a taxi cab driver. Parker is believed to be the first violent death of a transgender or gender non-conforming person in 2020.
The Oklahoma State Bureau of Investigation is assisting local police in this investigation. Of the more than 150 known victims of anti-transgender violence from 2013 to present, approximately two-thirds of those killed were victims of gun violence.
“Rover Taxi is devastated at the loss of a member of our Rover family. Dustin was a steadfast friend, an amazing husband and father and generous to a fault. He loved fiercely, worked tirelessly and took on life with so much hope and enthusiasm that his presence brightened all of our lives,” said Parker’s employer in a statement. “His bright, young life was taken far too early. Please keep his loved ones in your thoughts as we all try to pull together to get through these difficult times. Dustin will be missed, but never forgotten.”
These victims are not just numbers or headlines. They were real people worthy of dignity and respect, of life and love.
There are currently very few explicit legal protections for transgender or gender-expansive people. Transgender and gender non-conforming people in Oklahoma are not explicitly protected across many aspects of daily life, including housing and employment, and are not covered under the state’s hate crimes legislation. Nationally, despite some marginal gains in state and local policies that support and affirm transgender people, recent years have been marked by anti-LGBTQ attacks at all levels of government.
We must demand better from our elected officials and reject harmful anti-transgender legislation appearing at the local, state and federal levels because it is clear that fatal violence disproportionately affects transgender women of color. The intersections of racism, transphobia, sexism, biphobia and homophobia conspire to deprive them of necessities to live and thrive.
HRC will continue to hold the Trump-Pence administration and all elected officials who fuel the flames of hate accountable at the ballot box.
This epidemic of violence that disproportionately targets transgender people of color — particularly Black transgender women — must cease.