A new study, published in the American Journal of Psychiatry, investigates the association between gender-affirming treatments for transgender individuals and reduced mental health concerns. The results of the study, which utilized data from the entire Swedish population, found that providing gender-affirming surgeries to those seeking them may lower the need for mental health treatments significantly. These findings offer a timely call to policymakers and mental health works.
“Overall, this study provides timely support for policies that ensure coverage of gender-affirming treatments. Although gender-affirming treatments are recommended as a medical necessity for appropriately selected individuals experiencing gender incongruence and are a covered health benefit in most developed countries, uncertainty exists, such as in the United States, regarding federal protections of transgender employees from transgender-related exclusions in employee benefits,” write the researchers Richard Bränström and John Pachankis from Yale School of Public Health.
Individuals who identify as transgender are at significantly higher risk for mental health symptoms and psychiatric diagnoses. People that identify as transgender experience incongruity between their sex assigned at birth and their current gender identity. These individuals often face stress caused by their gender incongruence and stigma-related stress, similar to other groups that identify as minorities.
To alleviate stress related to identifying as transgender, individuals have the option of undergoing gender-affirming medical interventions, including hormone replacement and surgeries. “The World Professional Association for Transgender Health’s Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People recommends consideration of these interventions for affirming transgender individuals’ gender and alleviating gender-related stress,” write Bränström and Pachankis.
While risks are inherent in these treatments, as they are in any medically altering treatments, they may help create congruency between one’s gender identity and the gender their physical body represents. However, little is known about the long-term effects of such interventions on an individual’s stress and mental health. Insufficient evidence exists regarding associations between length of time since receiving gender-affirming interventions and treatment for psychiatric disorders among the transgender population.
“Although not all transgender individuals seek gender-affirming treatments and not all treatment-seeking transgender individuals meet diagnostic criteria for gender incongruence, findings from this unique data opportunity have timely implications for documenting the mental health of transgender individuals seeking gender-affirmative treatment and ways in which the medical profession can support this increasingly visible population,” Bränström and Pachankis explain.
The authors of the current study utilized the total population of Sweden to investigate the link between gender-affirming treatments and mental health access. To do this, researchers relied on the Swedish Total Population Register, a reflection of the total composition and identity of the Swedish population. This register also provides information connected to the Swedish Prescriber Drug Registrar, which researches utilized to understand the way individuals accessed mental health treatment after receiving gender-affirming interventions.
Researchers of the current study identified all individuals in the register with a gender-incongruence diagnosis, 2,679 individuals total. Those who received either hormone or surgical treatments were identified and coded. Just over 70% of individuals identified with the gender-incongruent diagnosis had received hormone interventions, and 48% had undergone gender-affirming surgeries at the time of the study. Years since gender-affirming treatment and likelihood of receiving mood or anxiety treatment were analyzed.
“Among those with a gender incongruence diagnosis receiving hormone treatment, years since the initiation of hormone treatment was not significantly related to the likelihood of mental health treatment. However, among those receiving gender-affirming surgical treatment, the risk of mental health treatment was significantly reduced with increased time since last surgical treatment,” the researchers report. “Specifically, the likelihood of being treated for a mood or anxiety disorder was reduced by 8% for each year since the last gender-affirming surgery.”
Results of the large population-based study not only affirm previous understandings that transgender individuals are more likely to experience mental health concerns but also suggest improved mental health outcomes for those who choose to receive interventions, specifically those who undergo gender-affirming surgeries. Although lower rates of mental health care access are not indicative of lower rates of mental health concerns overall, it is a promising finding that should pique the interest of policymakers and mental health workers globally.
However, while gender-affirming treatments were demonstrated to reduce mental health concerns for transgender individuals, authors note “even 10 years after receiving such treatments, the prevalence of mental health treatment utilization continued to exceed that of the general Swedish population, suggesting the need to address factors in addition to gender-affirming treatment availability that may strengthen transgender individuals’ mental health.”
In conclusion, gender-affirming surgeries may improve transgender individual’s wellbeing significantly, but it is not the end of the story. More systemic interventions are needed to improve the wellbeing and safety of these high-risk individuals:
“Such factors may include reductions in structural (e.g., economic inequality), interpersonal (e.g., victimization), and psychosocial (e.g., identity concealment) stressors to which transgender individuals are disproportionately exposed.”
Bränström, R., & Pachankis, J. E. (2019). Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: a total population study. American journal of psychiatry, appi-ajp. (Link)