Mental health

One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria.

One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria. Expand
One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria.

A British study [1] found that puberty blockers used to treat children aged 12 to 15 who have severe and persistent gender dysphoria had no significant effect on their psychological function, thoughts of self-harm, or body image.

However, as expected, the children experienced reduced growth in height and bone strength by the time they finished their treatment at age 16.

REFERENCES

[1] Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLOS ONE 16 (2). [Link]

Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health.

Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health. Expand
Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health.

The results of a 2021 international survey [1] of 129 female-to-male patients who underwent genital reconstruction surgery support anecdotal reports that complication rates following genital reconstruction are higher than are commonly reported in the surgical literature. 

Complication rates, including urethral compromise, and worsened mental health outcomes remain high for gender affirming penile reconstruction. In total, the 129 patients reported 281 complications requiring 142 revisions.

Another paper [2] found a 70% complication rate in one type of female-to-male genital reconstruction surgery.

Even with the “radial forearm free flap” method of creating a synthetic penis — “considered by many as the gold standard for phalloplasty” [3] — there are high rates of complications, with up to 64% urethroplasty related complications [4].

REFERENCES

[1] Robinson, I.S., Blasdel, G., Cohen, O., Zhao, L.C. & Bluebond-Langner, R. (2021). Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients. J Sex Med 18 (4): 800-811. [Link]

[2] Bettocchi, C., Ralph, D.J. & Pryor, J.P. (2005). Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 95:120–4. [Link]

[3] Rashid, M. & Tamimy, M. S. (2013). Phalloplasty: The dream and the reality. Indian J Plast Surg 46 (2): 283-293. [Link]

[4] Fang, R.H., Lin, J.T. & Ma S. (1994). Phalloplasty for female transsexuals with sensate free forearm flap. Microsurgery 15: 349–52. [Link]

Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors.

Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors. Expand
Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors.

A Swedish study [1] points out that it is “difficult to distinguish one [gender dysphoria] from the other [mental health conditions] with regard to suicide risk.”

A 2019 study [2] finds that “adolescents referred for gender dysphoria show higher rates of suicidality when compared to non-referred adolescents, but are much more similar to referred adolescents (presumably, the vast majority were cisgender) in general.”

REFERENCES

[1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

[2] Zucker, K. J. (2019). Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues. Archives of Sexual Behavior 48 (5). [Link]

People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people.

People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people. Expand
People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people.

A Swedish study [1] found that suicide rates for personality disorder, schizophrenia, substance addiction, bipolar and (among males) depression and autism were all higher than suicide rates for gender dysphoric people:

These high suicide rates for schizophrenia are confirmed by another study [2] which puts the lifetime risk of suicide death for schizophrenics at 5.6%. This study also finds “the absolute risk of suicide in different psychiatric disorders to vary from 2% to 8%, higher for men than for women and highest for men and women with bipolar disorder, unipolar affective disorder, schizophrenia, and schizophrenialike disorder.”

REFERENCES

[1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

[2] Nordentoft, M., Madsen, T. & Fedyszyn, I. (2015). Suicidal behavior and mortality in first-episode psychosis. J Nerv Ment Dis. 203 (5): 387-92. [Link]

There seems to be a connection between disordered eating patterns and gender-related distress.

There seems to be a connection between disordered eating patterns and gender-related distress. Expand
There seems to be a connection between disordered eating patterns and gender-related distress.

In a review [1] of 20 publications, a consistent theme emerged: transgender youth (aged 8 to 25) engaged in food restriction and/or compensatory eating behaviors to prevent puberty onset or progression.

The review suggested that, for some transgender youth, these behaviors may be understood as a means of coping with gender-related distress. However, the exact nature of this observed connection is uncertain.

REFERENCES

[1] Coelho, J., Suen, J., Clark, B., Marshall, S., Geller, J. & Lam, P.-Y. (2019). Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Current Psychiatry Reports 21. [Link]

Transgender-identified youth are disproportionately likely to suffer from eating disorders.

Transgender-identified youth are disproportionately likely to suffer from eating disorders. Expand
Transgender-identified youth are disproportionately likely to suffer from eating disorders.

In a review [1] of 20 publications, significantly higher rates of eating disorder symptoms were documented in transgender youth (aged between 8 and 25).

Another study [2] corroborated this connection, noting that data, while scarce, suggest “an overrepresentation of eating pathology among adolescents with GD [gender dysphoria] or transgender identity.”

REFERENCES

[1] Coelho, J., Suen, J., Clark, B., Marshall, S., Geller, J. & Lam, P.-Y. (2019). Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Current Psychiatry Reports 21. [Link]

[2] Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link]

Transgender-identified youth are prone to elevated rates of depression and/or anxiety.

Trans-identified young people are prone to elevated rates of depression and/or anxiety. Expand
Transgender-identified youth are prone to elevated rates of depression and/or anxiety.

A study [1] which compared the medical records of 1333 trans-identified children and adolescents between the ages of 3 and 17 years old with a similar cohort of non-trans-identified children and adolescents showed that 49% of males and 62% of females had depressive disorders.

An Australian study [2], with a smaller sample of gender dysphoric children and adolescents, found depression and anxiety rates of 62.0% and 63.3% respectively.

The majority of parent respondents in Littman’s 2018 study [3] – 69.4% – answered that their child had social anxiety during adolescence; 44.3% said that their child had difficulty interacting with their peers, and 43.1% that their child had a history of being isolated (not associating with their peers outside of school activities).

Similar conclusions have been found [4] for adults with gender dysphoria, who suffer from elevated rates of mood disorders (48.9% among natal males, 36.1% among natal females) and anxiety (38.8% among natal males, 33.3% among natal females). A further paper [5] found somewhat lower figures, giving a prevalence of 42.1% for mood disorders and 26.8% for anxiety disorders.

REFERENCES

[1] Becerra-Culqui, T.A. Liu, Y., Nash, R., Cromwell, L., Flanders, W.D., Getahun, D. Giammattei, S.V., Hunkeler, E.M., Lash, T.L., Millman, A., Quinn, V.P., Robinson, B., Roblin, D., Sandberg, D.E., Silverberg, M.J., Tangpricha, V. & Goodman, M. (2018). ‘Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics 141(5). [Link]

[2] Kozlowska, K., McClure, G., Chudleigh, C., Maguire, A.M., Gessler, D., Scher, S. & Ambler, G.R. (2021). ‘Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service’. Human Systems, 1(1), 70–95. [Link]

[3] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

[4] Mazaheri Meybodi, A., Hajebi, A., & Ghanbari Jolfaei, A. (2014). Psychiatric Axis I: Comorbidities among Patients with Gender Dysphoria. Psychiatry journal 2014. [Link]

[5] de Freitas, L. D., Léda-Rêgo, G., Bezerra-Filho, S., & Miranda-Scippa, Â. (2020). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and Clinical Neurosciences, 74 (2), 99–104. [Link]

People with an incongruent gender identity are over four times more likely than the general population to suffer from mental health problems.

People with an incongruent gender identity are much more likely than the general population to suffer from mental health problems. Expand
People with an incongruent gender identity are over four times more likely than the general population to suffer from mental health problems.

This finding, from an American campus survey [1], found that gender minority status was associated with “4.3 times higher odds of having at least 1 mental health problem.” Similarly, a Journal of Sex and Marital Therapy article [2] notes that “a large percentage of adolescents referred for gender dysphoria have a substantial co-occurring history of psychosocial and psychological vulnerability.”

In Lisa Littman’s seminal work [3] on rapid onset gender dysphoria, 62.5% of the young people whose parents were surveyed had at least one mental health or neurodevelopmental issue. 58.0% had a poor or extremely poor ability to handle negative emotions productively; 61.4% were overwhelmed by strong emotions and tried to avoid (or went to great lengths to avoid) experiencing them.

In a systematic review [4] of individuals diagnosed with gender dysphoria, 53.2% had at least one mental disorder in their lifetime. Such figures substantially exceed prevalence rates of comorbid psychopathology in the general population [5]: a further paper [6] studying hospital encounters found that the prevalence of mental disorder diagnoses was higher in transgender encounters (77%) than in the general population (37.8%).

A Swedish study [7] found that sex-reassigned persons had a higher risk of inpatient care for a psychiatric disorder (other than gender identity disorder) than the control population. Inpatient care for psychiatric disorders was also significantly more common among sex-reassigned persons than among controls, both before and after sex reassignment.

REFERENCES

[1] Lipson, S. K., Raifman, J., Abelson, S. & Reisner, S. L. (2019). Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses. American Journal of Preventive Medicine 57 (3): 293-301. [Link]

[2] Bechard, M., VanderLaan, D. P., Wood, H., Wasserman, L. & Zucker, K. (2017). Psychosocial and Psychological Vulnerability in Adolescents with Gender Dysphoria: A “Proof of Principle” Study. Journal of Sex & Marital Therapy 43 (7). [Link]

[3] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

[4] de Freitas, L. D., Léda-Rêgo, G., Bezerra-Filho, S., & Miranda-Scippa, Â. (2020). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and Clinical Neurosciences, 74 (2), 99–104. [Link]

[5] Zucker, K.J., Lawrence, A.A., Kreukels, B.P. (2016). Gender Dysphoria in Adults. Annu Rev Clin Psychol. 12: 217-47. [Link]

[6] Bishoy, H., Repack, D., Tarang, P., Guirguis, E., Kumar, G. & Sachdeva, R. (2019). Psychiatric disorders in the U.S. transgender population. Annals of Epidemiology 39: 1-7. [Link]

[7] Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLoS ONE, 6(2). [Link]