Transgender people are more likely to reap the mental health benefits after undergoing gender reassignment surgeries, a new study suggests. Researchers from Yale University found that transgender individuals would visit their health-care provider for an anxiety or mood disorder more compared to the gender population, but long-term effects show that such treatments are reduced over time.
The results of the study, published online in the American Journal of Psychiatry, supports the idea of providing gender-affirming surgeries to transgender people who seek them. This is the first analysis that looked into the long-term effect of hormone therapy and gender-affirming surgery on the trans individual's mental health.
Gender reassignment and mental health
Although there are professional recommendations to consider gender-affirming hormone and surgical interventions for trans people experiencing gender incongruence—a marked and persistent incongruence between an individual's experienced gender and the assigned sex—the researchers note that the long-term effect of these interventions on the people's mental health remains largely unknown.
Their study aimed "to ascertain the prevalence of mood and anxiety disorder health care visits and antidepressant and anxiolytic prescriptions...as a function of gender incongruence diagnosis and gender-affirming hormone and surgical treatment."
The researchers analyzed the medical outcomes of 2,679 individuals in Sweden who were diagnosed with gender incongruence over a 10-year period (from 2005 to 2015). Among those individuals, 95 percent underwent both reaffirmation surgeries and received hormone therapy.
Results show that hormone therapy alone did not have a "significantly reduce" the likelihood of trans people diagnosed with gender incongruence to seek mental health treatment and psychiatric medications, Pink News reports. Pink News is a UK-based online newspaper marketed to the LGBT community covering politics, religion, entertainment, finance, and community news.
However, there was an eight percent drop each year in those who seek treatment for depression and anxiety disorders following the surgery.
Transgender individuals are at higher risk of psychological distress due to stress associated with stigma and lack of affirmation of their gender identity, co-author John Pachankis said in a statement, adding that: "No longer can we say that we lack high-quality evidence of the benefits of providing gender-affirming surgeries to transgender individuals who seek them."
Aside from reduced treatments for anxiety and depression disorders, the study also found that trans individuals seeking gender-affirming care were six times more likely to have a mood or anxiety disorder than the general population.
They are also three times as likely to be prescribed antidepressants and antianxiety medications and more than six times as likely to attempt suicide resulting in hospitalization.
The reductions in mental health care after gender-affirming surgeries don't eliminate the fact that trans individuals continue to exceed the general population when it comes to seeking mental health treatment.
"The data identify a clear need for expanding mental health support and other treatment options for this increasingly visible segment of the global population," said Richard Bränström, a co-author of the study from the Karolinska Institutet in Sweden.
Transgender individuals are more likely to seek alternative treatments such as unsupervised use of hormone medication or risky surgeries that increases health risks if they are denied access to gender-affirming surgeries, the researchers explained. They added that a lack of access to essential care may also intensify mental health distress, which includes heightened risk of suicide for trans people.
Pachankis also noted that the findings "should help inform policymakers of the cost-effectiveness of gender-affirming treatments given the very high cost of mental health problems to society."
The cost of gender-affirming surgeries
Around 1 million to 1.5 million people in the US are believed to identify as transgender. Despite gender-affirming surgeries being medically recommended for those who experience gender incongruence, these treatments are still either unavailable or unaffordable in certain US states and in most countries worldwide.
According to Market Watch, the cost for such treatments vary across many factors such as the procedures an individual is looking to undergo. Market Watch is an American financial information website that provides business news, analysis, and stock market data.
For instance, male-to-female and female-to-male surgeries in the Philadelphia Center for Transgender Surgery are estimated to cost more than $100,000, with bottom surgeries alone estimated around $25,000. The total costs for an individual's transgender-specific care are said to be between $25,000 and $75,000, according to the Human Rights Campaign.
A 2018 JAMA Surgery study found an increase in the number of gender-affirming surgeries between 2000 and 2014, which researchers believe is linked to the expansion of insurance coverage for these operations.
Market Watch reports large employers taking action toward inclusion in recent years. The HRC's 2019 Corporate Equality Index showed that 83 percent of companies covered at least one transgender-inclusive health-care policy, while 73 percent said they have abandoned broad exclusions of transgender-inclusive health care from firm-offered plans.
However, research on CDC data on adult transgender in the US showed that they are more likely at greater risk of poor health and more likely to be uninsured. One in four people in the 2015 US Transgender Survey also said they experienced insurance problems related to their identity and 55 percent said they were denied insurance coverage for transition-related surgery.
These problems despite insurance firms' coverage of health care expenses for transgenders being "affordable and cost-effective" with "a low budget impact on US society," as per 2015 analysis on the societal implications of health coverage for essential services in the US transgender population.