December 18, 2013

Do Transgedner People Fall Back into Depression and Dysphoria After Gender Reassignment Surgery?

It is a bad habit to read news site comments threads about transgender topics, and no good can ever come from participating in what passes for conversations there. Nevertheless, many people do engage in comments thread debates,and in so doing provide an interesting snapshot of what a certain segment of the populace believes about transgender people. 

One argument I have seen repeated more than once by transphobic commenters is that transition doesn’t work and that after GRS transfolk are just as depressed and dysphoric as they were before. I have seen claims like this in numerous places recently. One such instance is this one, from a commenter in the LA Times: 

Gru, the literature rather clearly shows that transformed TGs, while professing unflagging “relief” for years following their surgery, surprisingly quickly and permanently revert to their pre-surgical general mood states. The same mood disorders with which the pre-surgery boys suffered are expressed by the post-surgery girls. The pattern appears uncomfortably similar to that which holds with those who deliberately have other body parts removed.

“[T]he literature clearly shows”? Does it, now? 

While none of these commenters ever goes so far as to provide citation of this “literature” that “rather clearly shows” their point, it’s very possible that they’re referring to this study, Dheine et al (2011). it has provided quote-mined fodder for anti-trans activists before. The study looked at a wide range of clinical and social outcomes in the Swedish trans population who were ten or more years removed from their GRS. It concluded that: 

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’s the first part of those results that anti-trans activists tend to remember, and for many it’s probably all that they’ve read. But like so many things, the devil can be in the details. Why might transfolk be at a higher risk for suicide or psychiatric disorders such as depression, even after GRS? The paper does not go so far as to speculate. But could it be that transfolk continue to be marginalized, mistreated, denied jobs, and denied medical coverage even after GRS? Those who ‘pass’ live with the fear of discovery, and those who don’t live with discrimination openly. GRS provides relief from GD, but not from transphobia or social stigmatization. And in any event, the paper did not conclude that GRS is ineffective in treating GD, only that “the need for continued psychiatric follow-up” after GRS was evident.   

Outside of Dheine et al„ recent literature quite clearly does NOT show that transition is ineffective. Quite the opposite. An older study by Kuiper & Cohen-Kettenis (1988) on a cohort of Dutch post-op transfolk concluded that “there is no reason to doubt the therapeutic effect of sex reassignment surgery,” though they, like Dheine, believed that “more attention ought to be paid to psychosocial guidance in addition to medical guidance.” Two years later, Hunt & Hampson (1990) also concluded that “surgery is still the best means of coping with transsexualism.” A long-term follow-up on German transsexuals by Jarrar, Wolff, & Weidner (1996) found that “psychosocial status showed good improvement after surgery.” Kriege et al (2001) focused on satisfaction with surgical results in transwomen and found that “None of the present patients claimed to regret their decision to undergo gender-transforming surgery.”  Lobato et al (2006) did a follow-up in Brazil and found that “the overall impact of sex reassignment surgery on this cohort of patients was positive,” including improvements in family relationships, partner relationships, and sexual experience. Johansson et al (2010) did a five year follow-up with a cohort of post-surgery transfolk in Sweden and found that “No one regretted their reassignment” and that “86% were assessed by clinicians at follow-up as stable or improved in global functioning.”

The above is only part of the supporting literature that shows positive outcomes for patients after GRS. To find truly negative research regarding GRS you have to go back more than 30 years. For example, Pauly (1981) reviewed studies from the 1960s and 1970s that “call into question the justification for sex reassignment surgery,” But these were studies written up to fifty years ago when treatment for GD and surgical techniques for GRS were much less developed and under greater debate. , 

So while it is true that transmen and transwomen don’t suddenly become “cured” of all their dysphoria and depression after transition, to use this as an argument to invalidate trans activism or to claim that it’s a reason to not transition at all is completely fallacious. GRS improves lives. it’s not a perfect treatment, nor is it the only treatment, but it is the best treatment available for many transmen and transwomen today. 

1 Comment

  • This is an excellent article. My depression has continued after my surgery but my surgery was the most appropriate medical treatment I’ve ever received in my life.

    I could not bear living as a woman with a penis. Having a penis, when I felt, looked and lived like a woman was a traumatizing experience. There was no escape and the depression was intense. Surgery freed me from this specific emotional pain but the decades of depression and sadness that preceded it had been a part of my life, for most of my life, and had ingrained a blueprint on my brain, creating a depressed ‘default’personality. Combine this with the increased risk of poverty after losing a job as well as social stigma, and if you’re a woman, sexism, then it becomes an overwhelming force that is like an uphill battle to overcome. Surgery does not cancel out the depression, it simply removes one of the many causes of depression experienced by many trans people.

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