Paul McHugh's one source

I have been reading a lot of people citing Paul McHugh's argument that transgenderism be treated with psychotherapy instead of surgery.  McHugh is the Harvard educated distinguished Professor of Psychiatry at Johns Hopkins University School of Medicine.  In the last, year or so, McHugh has been writing to challenge the prevailing treatment of gender dysphoria.  However, in his June piece, he only cited one scientific source, an analysis of Swedish gender reassigned transgenders from 1973-2003.

When “the tumult and shouting dies,” it proves not easy nor wise to live in a counterfeit sexual garb. The most thorough follow-up of sex-reassigned people—extending over thirty years and conducted in Sweden, where the culture is strongly supportive of the transgendered—documents their lifelong mental unrest. Ten to fifteen years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to twenty times that of comparable peers.

True, the paper, Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden  does note the suicide rate for those after surgical reassignment is twenty times that of their comparable peers, but more on that later.  McHugh is also correct that the long term follow up and the use of a control group make this the most thorough study to date.

However, McHugh leaves out some important pieces of information that dispute his conclusion that sex reassignment is ineffective.  First, the authors noted that there was a difference between the data before 1989 and the data after.

Sex-reassigned transsexual persons of both genders had approximately a three times higher risk of all-cause mortality than controls, also after adjustment for covariates. Table 2 separately lists the outcomes depending on when sex reassignment was performed: during the period 1973-1988 or 1989–2003. Even though the overall mortality was increased across both time periods, it did not reach statistical significance for the period 1989–2003.

 This 1989 rule was almost across the board.  Suicide:

In line with the increased mortality from suicide, sex-reassigned individuals were also at a higher risk for suicide attempts, though this was not statistically significant for the time period 1989–2003.

Crime:

Transsexual individuals were at increased risk of being convicted for any crime or violent crime after sex reassignment (Table 2); this was, however, only significant in the group who underwent sex reassignment before 1989.

The researchers hypothesized why things peaked in 1989 and then plummeted after.

In accordance, the overall mortality rate was only significantly increased for the group operated before 1989. However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.[35]

Often upon further investigation, we find out that papers often do not say what right-wing researchers say they say.  This is McHugh's source.  This is the paper that he wants us to read.   Yet, it does not merely say, "Ten to fifteen years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to twenty times that of comparable peers.  The paper says these increased rates only occurred in those that had their surgical reassignment before 1989.

The researchers also are not arguing against surgical reassignment.  They note that this is beyond the scope of their paper.

It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia.[39], [40] This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit.

Still, they point to several studies that demonstrate that surgical reassignment improves transgendered lives.

Given the nature of sex reassignment, a double blind randomized controlled study of the result after sex reassignment is not feasible. We therefore have to rely on other study designs. For the purpose of evaluating whether sex reassignment is an effective treatment for gender dysphoria, it is reasonable to compare reported gender dysphoria pre and post treatment. Such studies have been conducted either prospectively[7], [12] or retrospectively,[5], [6], [9], [22],[25], [26], [29], [38] and suggest that sex reassignment of transsexual persons improves quality of life and gender dysphoria. The limitation is of course that the treatment has not been assigned randomly and has not been carried out blindly.

 I like to think of myself as one that follows the evidence where ever it may lead.  This study shows that from 1989-2003, Swedish transgender people post sex surgery did not have statistically significant higher morbidity than their non-transgendered peers.  Also there is a myriad of evidence that sex reassignment surgery is therapeutic to transgendered individuals.