Effects of treatment versus psychotherapy on mental health of transgender people

Question

Has any reliable study been done to compare mental health (e.g. depression or suicide rate) of transgender people before and after procedures (hormone or surgery) intended to change their bodies to have characteristics that match their gender identity compared with psychological therapy intended to try and make them more comfortable with their biological sex?

I have heard some people claim that John's Hopkins used to perform sex-change procedures but stopped after failing to find it benefiting the mental health of those who they were performed on. But I have also heard people claim that these treatments really do cause a practical improvement in the mental health of transgender people. I'm not sure who, if either side or both, to trust.

Please avoid political discussion or debate on whether a transgender person can actually switch sexes or if it's a delusional disorder, even if your opinion on that might inform what you think the proper way of treating transgender people is. I'm just curious about reliable data on the psychological effects of the alternatives.

Answer 1

Johns Hopkins did stop doing gender reassignment surgery and one of their psychiatrists apparently says that

The suicide rate among transgendered people who had the surgery is 20 times higher

He also apparently says that

transgenderism is a “mental disorder” that merits treatment, that sex change is “biologically impossible,” and that people who promote sexual reassignment surgery are collaborating with and promoting a mental disorder.

According to this website, the Johns Hopkins psychiatrist involved has a history of speaking out against transgendered people.

On the flip side, the DSM-5 (5th Edition of the Diagnostics and Statistics Manual) in 2013 added Gender Dysphoria as the new term for Gender Identity Disorder in order to try and prevent stigma; and current case reports offer no evidence that psychotherapy offers total and long-standing change of gender dysphoria.

Answer 2

TL;DR: There's many studies which point to better mental health outcomes as a result of treatment, such as hormones and surgery, of transgender individuals.

It's also important to consider that there's a range of gender identities and a range of treatments which are tailored to the individual. There's a lot of factors to consider.

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WPATH Standards of Care

The best place to start would be the WPATH Standards of Care, available from www.wpath.org. I'll quote from this:

Although Harry Benjamin already acknowledged a spectrum of gender nonconformity (Benjamin, 1966), the initial clinical approach largely focused on identifying who was an appropriate candidate for sex reassignment to facilitate a physical change from male to female or female to male as completely as possible (e.g., Green & Fleming, 1990; Hastings, 1974). This approach was extensively evaluated and proved to be highly effective. Satisfaction rates across studies ranged from 87% of MtF patients to 97% of FtM patients (Green & Fleming, 1990), and regrets were extremely rare (1-1.5% of MtF patients and <1% of FtM patients; Pfäfflin, 1993). Indeed, hormone therapy and surgery have been found to be medically necessary to alleviate gender dysphoria in many people (American Medical Association, 2008; Anton, 2009; The World Professional Association for Transgender Health, 2008).

It's also worth noting that there's a range of treatments which are individualized:

Treatment is individualized: What helps one person alleviate gender dysphoria might be very different from what helps another person. This process may or may not involve a change in gender expression or body modifications. Medical treatment options include, for example, feminization or masculinization of the body through hormone therapy and/or surgery, which are effective in alleviating gender dysphoria and are medically necessary for many people. Gender identities and expressions are diverse, and hormones and surgery are just two of many options available to assist people with achieving comfort with self and identity.

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Example research papers

There's many research papers which compare mental health of transgender people before and after procedures. For example:

In a sample of 359 gender-dysphoric persons who completed "several psychometric measures":

... during [cross-sex hormonal treatment], [gender-dysphoric persons (GDs)] reported a significant reduction of general psychopathology, depressive symptoms, and subjective GD, whereas social and legal indicators of GD showed a significant increase across time ...
_{Fisher et al., Cross-Sex Hormone Treatment and Psychobiological Changes in Transsexual Persons: Two-Year Follow-Up Data, The Journal of Clinical Endocrinology & Metabolism, 2016.}

In a sample of 61 participants who were surveyed:

The present study suggests a positive effect of hormone therapy on transsexuals' QoL after accounting for confounding factors. These results will be useful for healthcare providers of transgender persons but should be confirmed with larger samples using a prospective study design.
_{Gorin-Lazard et al., Is Hormonal Therapy Associated with Better Quality of Life in Transsexuals? A Cross‐Sectional Study, The Journal of Sexual Medicine, 2012.}

Here, QoL = Quality of Life.

In a meta review for transgender men:

Multiple studies have shown the positive effect of gender affirming hormonal therapy and gender affirming surgery on quality of life of trans persons and several studies describe an increase in their psychological wellbeing. In addition, satisfaction rates after gender affirming surgery are high and surgery is rarely regretted. However, as only one study has addressed cost-effectiveness of gender affirming treatment in trans men, further research is necessary. _{Defreyne et al., Healthcare costs and quality of life outcomes following gender affirming surgery in trans men: a review, Expert Review of Pharmacoeconomics & Outcomes Research, 2017.}

There's many more I haven't listed; they can be found by searching PubMed.

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Johns Hopkins

Also note that Johns Hopkins have subsequently reaffirmed their stance:

We have committed to and will soon begin providing gender-affirming surgery as another important element of our overall care program, reflecting careful consideration over the past year of best practices and the appropriate provision of care for transgender individuals.
_{Johns Hopkins Medicine's Commitment to the LGBT Community, October 7, 2016.}