Research on trans

A combination of hormone therapy and surgery improves gender dysphoria and other areas of psychosocial functioning. So says WPATH, the World Professional Association for Transgender Health. You would think they should know, and would back up their assertion with evidence; you would be right.

A study may consider patients through the treatment process, or assess patients after treatment. Because the researchers are making the assessment at all times, a prospective study is more reliable. A prospective study of 325 patients reported in 2005 that psychological function improved after therapy, as did body-satisfaction. Surgery alleviated gender dysphoria, and fewer than 2% expressed regret after therapy.

I went to the study abstract. It is even more positive: After treatment the group was no longer gender dysphoric. F-M and “homosexual” (ie, F-M attracted to women, M-F attracted to men) functioned better than non-homosexual and M-F. Two non-homosexual M-F people expressed regrets. Clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance, says the abstract, who may require more therapeutic guidance.

That is, people need support throughout the treatment process. It is not a mere medical matter of administering hormones and surgery, but psychotherapy. Perhaps psychotherapy without gatekeeping or assessment for hormones: a claim of gender dysphoria should be sufficient to get hormones.

Surgery has continually improved, and there has been a steady increase in satisfaction with its outcomes, especially after the Standards of Care were published. Johns Hopkins University medical school ceased to provide treatment after its study found no improvement after treatment; but that study was in 1979. Even in 1981, before the Standards of Care, in a retrospective study of 283 MtFs 71% reported improved social and emotional adjustment.

I wondered if the reference to “observational” studies meant that outcomes were discerned by the researchers, rather than reported by the subjects. That does not appear to be the case: an observational study is one where the researcher cannot randomise assigning the subjects to a control group or a treatment group. Patients would not participate in a study where they could be refused treatment, and researchers could not be unaware which patients had received treatment and which had not, so a randomised controlled trial is impossible as well as unethical. In a review of studies conducted between 1961 and 1991, involving over two thousand patients, 86% were assessed by researchers as stable or improved in “global functioning”. 14% were worse, but who could know how they would have progressed without treatment?

We live in society, where we do not fit. We transition whether we receive hormones and surgery or not, though many are encouraged to transition by medical support. The real control would be a society where diversity was welcomed as the gift it is.

Treatment is justified, and is improving. Doctors providing treatment act ethically. You can entrust yourself to their care.