Yale Daily News

A new Yale-affiliated study shows that transgender individuals who have gender-affirming surgeries are less likely to need mental health services over time.

It is the first population-wide study of transgender individuals with a gender incongruence diagnosis. The researchers found that gender-affirming surgeries for transgender individuals were associated with a reduction in the use of mental health treatment services. These services included health care visits for mood or anxiety disorders, prescriptions for antidepressants or anti-anxiety drugs and hospitalizations for suicide attempts.

“Transgender individuals who sought treatment for gender incongruence, experienced significant and steady reductions in their mental health treatment utilization every year after their gender affirming surgery,” said co-author and School of Public Health associate professor John Pachankis.

Gender incongruence, also known as gender dysphoria, is a sexual health condition in which a person feels distress from an internal gender identity that does not align with their gender at birth. The American Psychiatric Association states that not every transgender person experiences gender incongruence.

Compared to the general population, transgender individuals are approximately six times as likely to have had health care visits for mood or anxiety disorders, more than three times as likely to have received prescriptions for antidepressants and anti-anxiety drugs and more than six times as likely to have been hospitalized after a suicide attempt.

In an interview with the News, Pachankis said he felt this study makes a clear case for why it is important to continue studying mental health outcomes in the transgender community.

“Transgender individuals regardless of their gender-affirming treatment status remain one of the highest risk groups for psychiatric problems,” he said.

Pachankis collaborated with Karolinska Institutet professor Richard Branström to analyze data collected between 2005 and 2015 from a Swedish population register. The duo used this data of 2,679 individuals to assess whether these individuals sought gender-affirming hormone or surgical procedures or utilized mental health treatment services.

The researchers found an eight percent yearly reduction in mental health treatment services following gender-affirming surgery over the 10-year follow-up period. The results indicated that time since a person has gender-affirming surgery, they are less likely to use mental health treatment services.

Branström stated that their study offers particularly strong support for providing gender-affirming care to individuals who seek this type of treatment.

To other scientists who study LGBTQ health interviewed by the News, the findings were a longtime coming.

The work “strengthens the case for increasing access to gender-affirming surgery,” according to Alex Keuroghlian, who is the director of the National LGBT Health Education Center at the Fenway Institute and director of the Massachusetts General Hospital Psychiatry Gender Identity and Sexual Orientation Program.

Keuroghlian also stated that it is important to have “robust data to support gender-affirming surgery as an intervention to improve mental health among gender-diverse people.”

Branström acknowledged that further work is needed to assess the impact of gender-affirming surgeries on broader populations.

“The U.S. and other European countries look so different from each other,” he said, “there is different access to health care, legislation, and population attitudes.”

Keuroghlian agreed and said that limited access to gender-affirming medical and surgical care is a unique challenge many in the U.S. face. He said while people may want to pursue gender-affirming surgery, insurance reimbursement and clinicians may be an obstacle. This “adds an extra layer to understanding the mental health implications of not being affirmed in your gender,” Keuroghlian said.

“There are major barriers, one is not having access to competent and confident clinicians who can provide gender-affirming care,” Keuroghlian said. “And then, even if you do find a competent and confident clinician, it doesn’t mean that you will have access to insurance reimbursement for those services, which is an additional barrier.”

Branström and Pachankis both have plans to continue to expand on the study’s findings. They said further research will follow individuals through the gender-affirming process and study include individuals who do not seek gender-affirming care.

Pachankis said that understanding the type of support transgender individuals may want or need, and hearing this from transgender individuals themselves, is a necessity when considering future research.

The 2015 U.S. Transgender Survey found that 55 percent of those who sought gender-affirmation surgery were denied insurance coverage in 2014.

Marissa Elliott | marissa.elliott@yale.edu