Claims about Lupron made in Matt Walsh's "What is a Woman?" documentary

Mendel

Senior Member.
1. What's the risk of suicide in untreated gender dysphoria?
2. What's the risk of suicide in treated gender dysphoria?
I posted on this in https://www.metabunk.org/threads/cl...what-is-a-woman-documentary.12489/post-272880 and https://www.metabunk.org/threads/cl...what-is-a-woman-documentary.12489/post-272876 .


Among the best studies and writings I've looked at on these questions:

A large 2018 study of over 120,000 11-19 year-old ("adolescent") Americans found:

Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%).

https://publications.aap.org/pediat...76767/Transgender-Adolescent-Suicide-Behavior Content from External Source
This study does not compare treated against untreated gender dysphoria, and thus can't speak to the effect of treatment.
Article:
Participants

All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973–2003. Random population controls (10∶1) were matched by birth year and birth sex or reassigned (final) sex, respectively.


A 2011 cohort study of 324 gender-reassigned (ie, had surgery) Swedes reported 10 suicides (3.1%) compared with a control group incidence of 5 in 3,240 (0.15%). Suicide attempts were recorded as 9% (GR) and 1.4% (C) respectively:

The overall mortality for sex-reassigned persons was higher during follow-up (adjusted Hazard Ratio 2.8) than for controls of the same birth sex, particularly death from suicide (aHR 19.1). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9) and psychiatric inpatient care (aHR 2.8).

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885
this study is old, and also fails to isolate the effect of treatment; there is no before/after comparison, only a comparison to the general population.
Article:
Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population.
 

Mendel

Senior Member.
those numbers seem oddly high to me. would be nice if true, but...
Article: The study examined data from the 2015 U.S. Transgender Survey, which included nearly 20,000 participants, 38.8% of whom identified as transgender women, 32.5% of whom identified as transgender men, and 26.6% of whom identified as nonbinary. Of the respondents, 12.8% had undergone gender-affirming surgery at least two years prior and 59.2% wanted to undergo surgery but had not done so yet. Source: https://www.hsph.harvard.edu/news/hsph-in-the-news/mental-health-benefits-associated-with-gender-affirming-surgery/

@Rory now i need you to look up how many transgenders WANT surgery. because -unless my math is wrong- there are 72% in that that had surgery or want surgery.
38.8% transgender women
32.5% transgender men
----------
71.3% binary transgender participants

12.8% had surgery
59.2% want surgery
----------
72.0%

Hypothesis: most people who identify as transgender man or woman want surgery or had it, and also a small number of nonbinary people.
I do note that Harvard reported "nearly 20,000 participants" while the study writers stated "27,715". And in examining the tables and stats it seems that the numbers involved generally add up to 19,960, though this number isn't stated anywhere in the paper*.
The explanation is right there in the abstract:
Article:
Of the 27 715 respondents, 3559 (12.8%) endorsed undergoing 1 or more types of gender-affirming surgery at least 2 years prior to submitting survey responses, while 16 401 (59.2%) endorsed a desire to undergo 1 or more types of gender-affirming surgery but denied undergoing any of these.

(I guess they're using "endorse" to mean "affirm".)

The study "excluded participants who did not report desire for any gender-affirming surgeries" from the control group. This makes sense, because we need to compare before vs. after surgery, and someone who doesn't even want surgery isn't "before".
 
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deirdre

Senior Member.
Another possible explanation for at least some of the errant 7,745 responses might be that they were incomplete and deemed unusable. When I work on surveys such as these there's generally a fairly high percentage that fall into that category. But, again, I don't see it explained*.
you can google the survey they used. pretty sure there were like 1,100 questions in 32? categories. so im guessing used the skip button from time to time (it was only online because it was so huge)
 

deirdre

Senior Member.
Being an expert in transgender therapy tends to involve working with transgender kids.
Would you expect someone to be an expert on cancer if they had never actually been involved in treating a cancer patient?

Someone who does not actually work in the field they claim to be expert in have a higher hurdle to pass in establishing their experience and knowledge in this field.
why would the medical professionals have to be an expert in transgender stuff to debunk the Texas and Alabama opinion/bill?
We debunk stuff all the time we are not experts in.

Any medical professional should be able to read the studies.
 

Mendel

Senior Member.
On suicidality and puberty blockers (our topic!):
Article:
Review: Puberty blockers for transgender and gender diverse youth – a critical review of the literature

Results

Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged ‘excellent’, five studies met the majority of quality criteria resulting in ‘good’ ratings, whereas three studies were judged fair and had serious risks of bias.

The publisher wants money for access to the full text; researchgate suggests requesting a copy from one of the authors.

Btw, that study was referenced in the footnote for the corresponding claim in the Yale paper.
 
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Mauro

Active Member
Transgender kids need both medical and psychological care.
I can understand transgender kids need psychological care, expecially if they live in places where they are routinely discriminated/bullied/ostracized. But why medical care? Unless you're referring to the main danger of being transgender: being beaten up by 'good citizens' as above.
 

LilWabbit

Senior Member
In September 2019, UCLA published a study by authors Jodi Herman, Taylor Brown and Ann Haas by the title of 'Suicide Thoughts and Attempts Among Transgender Adults'.

The UCLA study revisits The 2015 U.S. Transgender Survey (USTS) data with a view "to examine the key risk factors associated with lifetime and past-year suicide thoughts and attempts among a large and diverse sample of transgender people".

The USTS 2015 was the largest survey of transgender people in the U.S. to date. Despite what seems to be a politically left-leaning study in terms of some of its conclusions, these following findings paint a more nuanced picture of a more nuanced reality than the caricatures broadcast with vitriol by ideologues on both sides.

Suicidal thoughts amongst the transgender population are, unsurprisingly, primarily associated with feelings of social disapproval from whichever community the respondents have found themselves in.

Less surprisingly:

Article:
Respondents who had been rejected by their religious communities or had undergone conversion therapy were more likely to report suicide thoughts and attempts. For instance, 13.1 percent of those who had experienced religious rejection in the past year had attempted suicide in the past year; by contrast, 6.3 percent of respondents who had experienced religious acceptance in the past year attempted suicide in the past year.


Article:
Those who had “de-transitioned” at some point, meaning having gone back to living according to their sex assigned at birth, were significantly more likely to report suicide thoughts and attempts, both past-year and lifetime, than those who had never “de-transitioned.” Nearly 12 percent of those who “de-transitioned” attempted suicide in the past year compared to 6.7 percent of those who have not “de-transitioned.”


More surprisingly (at least for me):

Article:
People who are not viewed by others as transgender and those who do not disclose to others that they are transgender reported a lower prevalence of suicide thoughts and attempts. For instance, 6.3 percent of those who reported that others can never tell they are transgender attempted suicide in the past year compared to 12.2 percent of those who reported that others can always tell they are transgender.


In other words, those who had experienced religious acceptance in the past year as well as those who have either hidden their transgender identity or have not been regarded as transgender had attempted suicide in the past year even less (at 6,3 %) than those who have transitioned and never "de-transitioned" (6,7 %). This finding would imply that for many transgender individuals there's no automatic benefit in transitioning as far as attempted suicide rates are concerned. Personally, suicide is too complex a phenomenon to be employed as a simplistic political weapon to attack one's ideological opponents irrespective of political affiliation. Hence even this finding should not be read into. But it does add nuance to the discussion.

It seems as if those who experienced social disapproval from their religious communities and were advised to receive conversion therapies had a similar rate of attempted suicide (13,1 %) as those who felt social disapproval by being always seen as transgender (12,2 %) as well as those who had "de-transitioned" and thereby experienced social disapproval probably both from within the transgender community and outside (attempted suicide rate at 12 %).

One could even be so bold as to conclude from the USTS data that all our conscious attempt to make everyone feel accepted and appreciated as equal human beings is the best predictor of lower suicide rates and lower social anxiety, irrespective of other differences in our values, world views and views on sexuality and gender.

The main findings of the USTS are of course well-known and the rates haven't significantly improved to date:
According to the USTS 48.3 % of transgender respondents had had suicidal thoughts in the past year which was significantly higher than amongst the general population (including other members of the LGBTQ+ community).
 
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Mauro

Active Member
To alleviate the consequences of experiencing gender dysphoria.
It fixes the feeling of being trapped in the wrong body.

Wouldn't be better to alleviate gender dysphoria by acceptance of transgenderism as normal?

Before veering a bit off topic this thread was concerned with Lupron (a 'puberty blocker') and its side effects: I would like everybody to keep in mind that, while there exist rare conditions where a puberty blocker has a legitimate use, ie. true precocious puberty cases, their use as a mean of repressing sexuality in children which (really or supposedly) just show trans- (or omo-, or simply etero-) tendencies is disgusting by itself, exactly as the use of potassium bromide, for the same purposes, was in late 1800 - early 1900. This thread seems to have missed this crucial distinction.
 
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deirdre

Senior Member.
It fixes the feeling of being trapped in the wrong body.
That sentence reads alot more absolute, then i think you intended. It's likely more like anti depressants.. it rarely if ever "fixes" the problem, but in many cases they make the issues more manageable.
 
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Ann K

Senior Member.
2. They work with transgender kids (vs being a neutral, guilt-free medical professional
That's where the term "guilt-free" came from. They're your words, yet you claim you "don't understand" them. That makes two of us.
 

Rory

Senior Member.
The Yale study is full of factual statements. The evidence for these statements is referenced in the numerous footnotes

They may be factual, but I think whether they actually are can only be decided after much scrutiny. As we're seeing time and again, many studies are at least open to interpretation, if not critically flawed.

There is sufficient evidence that smoking is associated with an increased risk of suicidal behaviors.

That makes sense to me: to think about what smoking actually is - purposefully introducing a toxic and damaging substance into the body, most likely with the knowledge that it has a good chance of causing serious harm and possibly leading to an unpleasant death - is a kind of "suicide" in itself.

The explanation is right there in the abstract

An explanation can be more or less inferred but I would have expected the break down to made much more explicit - ie, there should be mention of the 19,960 figure, as well as the number of those who had surgery within the last two years.

Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage.

The publisher wants money for access to the full text.

Full text available here: https://sci-hub.se/https://doi.org/10.1111/camh.12437

Seems like it could be a good and balanced study given that it mentions the pros and cons as well as that three of the nine studies "had serious risks of bias."

How did those three studies affect the results? Is there any evidence of bias in the interpretation of the data as a whole?

The UCLA study [...] revisits the largest survey of transgender people in the U.S. to date. [Their] findings paint a more nuanced picture of a more nuanced reality than the caricatures broadcast with vitriol by ideologues on both sides.

Thanks for finding that. It does indeed seem to paint a much more nuanced picture than that presented by JAMA, which leads me to further doubt the conclusions they presented. It seems there are simply too many contributing factors to be able to make the conclusive and confident statements they made. For example:
  • Suicidal thoughts decrease with age. And older people are more likely to have had surgery
  • Suicidal thoughts decrease with increased income. And people with increased income are more likely to have had surgery
  • Unhealthy people and heavy users of alcohol and drugs have more suicidal thoughts. Presumably, these people are less "together". And also presumably less together people less often get it together to organise and undergo surgery
  • Homeless people have more suicidal thoughts. And homeless people are less likely to have surgery
Et cetera, et cetera.

The full study is 36 pages long:

https://williamsinstitute.law.ucla.edu/wp-content/uploads/Suicidality-Transgender-Sep-2019.pdf

Will have a read through later. Would be amazing to look at the original data though. It wouldn't surprise me if the proposed findings regarding had/wanted surgery all but disappeared once other factors were accounted for.
 
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deirdre

Senior Member.
That makes sense to me: to think about what smoking actually is - purposefully introducing a toxic and damaging substance into the body, most likely with the knowledge that it has a good chance of causing serious harm and possibly leading to an unpleasant death - is a kind of "suicide" in itself.
there might be a very small bit of that, but smoking is an oral fixation (like sucking your thumb) that relaxes you. more like self medicating/self soothing. i assume the study is talking about cigarette smoking, although marijuana smoking is even more relaxing than cigs (unless you get one of those pot types that amp you up and sometimes pot causes some people More anxiety)
 

Rory

Senior Member.
That's a fair point - though I would then ask the question of what kind of person is relaxed by smoking cigarettes? Ie, it must be a very unrelaxed (probably anxious) person to begin with. I don't think smoking would relax me, for example, it would probably just make me sick (haven't tried).

And, yes, I know what you mean about marijuana: seems like the last time I was around people that used it (2014) something had changed. Back in the 90s people barely had a word to say; now they rabbit on like they're on speed or something.

I guess underneath it all there's a desire to get away from one's current state of being because of a dissatisfaction with it - whether that be through smoking, through pot, through changing gender, or through suicide.

My drug/escape of preference is pointless internet use. ;)
 
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deirdre

Senior Member.
That's a fair point - though I would then ask the question of what kind of person is relaxed by smoking cigarettes? Ie, it must be a very unrelaxed (probably anxious) person to begin with. I don't think smoking would relax me, for example, it would probably just make me sick (haven't tried).
maybe think of it more like people who stuff their depression with food. (again oral fixation). it makes them feel good/relax in the moment somehow.

edit add: although unlike food, cigarettes are literally suffocating you a bit. so you do get a small buzz off a cig.
 
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Rory

Senior Member.
Indeed. It's always about the underlying causes and deep down state of being as far as I'm concerned.

Also, perhaps significantly -

I was thinking of writing to the author of the JAMA paper to ask how they'd considered the complexity of contributing factors in their conclusion. What I discovered was that the first named author, Anthony Almazan, was an MD/MPH candidate - if I'm understanding that correctly, basically a post-grad student - and apparently very pro-transgender (as is the other writer).

The more I read, the more I get the sense that these findings were heavily influenced by bias and prior expectations:

“Going into this study, we certainly did believe that the gender-affirming surgeries would be protective against adverse mental health outcomes,” lead author Anthony Almazan said. “I think we were pleasantly surprised by the strength of the magnitudes of these associations, which really are very impressive and, in our opinion, speaks to the importance of gender-affirming surgery as medically necessary treatment for transgender and gender diverse people who are seeking out this kind of affirmation.”

https://www.hsph.harvard.edu/news/h...its-associated-with-gender-affirming-surgery/
Content from External Source

I also notice that they passed away last year at the age of 27.

That aside, it seems a shame that this study was presented as it was, and was subsequently reported by various news sites (and also won a prize), given the importance of the issue. The UCLA report seems many times more rigorous and objective.

Moral of the story? Harvard + paper + percentages + NBC doesn't always equal persuasive evidence (though I am still open to persuasion on this).
 
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Mendel

Senior Member.
An explanation can be more or less inferred but I would have expected the break down to made much more explicit - ie, there should be mention of the 19,960 figure, as well as the number of those who had surgery within the last two years.
Number's right there (bolded).
Of the 27 715 respondents, 3559 (12.8%) endorsed undergoing 1 or more types of gender-affirming surgery at least 2 years prior to submitting survey responses, while 16 401 (59.2%) endorsed a desire to undergo 1 or more types of gender-affirming surgery but denied undergoing any of these.
Content from External Source
3559+16401=19960, but that's a meaningless number. The two numbers reflect the size of the treatment group and the control group.
 

Rory

Senior Member.
3,559 =/= 19,960

I write survey analyses and summaries like this for a living. I can tell you very assuredly that some of their numbers were presented in a fashion I could never get away with.
 

Ann K

Senior Member.
you can stop lying. i never claimed i didnt understand my own words.
You claimed you didn't understand the question, but the question was about what you meant by those words. I'm still waiting for an answer. Alternatively I can just assume that you tend to spit out phrases at random without intending them to have any meaning. Shall I just do that instead?
 

Rory

Senior Member.
I interpreted this to mean that this number should be mentioned, and it is.

Where/what is the number of those who had surgery within the last two years?

3,559 is the number of those who had surgery "at least two years prior".
 

Mendel

Senior Member.
Thanks for finding that. It does indeed seem to paint a much more nuanced picture than that presented by JAMA, which leads me to further doubt the conclusions they presented. It seems there are simply too many contributing factors to be able to make the conclusive and confident statements they made. For example:
  • Suicidal thoughts decrease with age. And older people are more likely to have had surgery
  • Suicidal thoughts decrease with increased income. And people with increased income are more likely to have had surgery
  • Unhealthy people and heavy users of alcohol and drugs have more suicidal thoughts. Presumably, these people are less "together". And also presumably less together people less often get it together to organise and undergo surgery
  • Homeless people have more suicidal thoughts. And homeless people are less likely to have surgery
Et cetera, et cetera.
The JAMA paper accounts for some of this.
Article:
The following sociodemographic covariates were examined: age (18-44 years, 45-64 years, and ≥65 years), education level (less than high school or high school graduate up to associate degree, bachelor degree, or higher), employment status (employed, unemployed, or out of labor force), gender identity (transgender woman, transgender man, nonbinary, or cross-dresser), health insurance status (uninsured or insured), household income (<$25 000, $25 000-$99 999, or ≥$100 000), race (Alaska Native/American Indian, Asian/Pacific Islander, Black/African American, Latinx/Hispanic, other/biracial/multiracial, or White), sex assigned at birth (female or male), and sexual orientation (asexual, lesbian/gay/bisexual, or heterosexual).
 

Mendel

Senior Member.
Where/what is the number of those who had surgery within the last two years?

3,559 is the number of those who had surgery "at least two years prior".
Ok, I see what you mean now.

You may have to look at other analyses of that data set to find out; again, the number isn't important for the analysis.

The authors don't explain why they exclude respondents whose first surgery was less than 2 years ago. I assume they were looking for long-term effects of the treatment. It would certainly have been interesting to learn about the short-term efficacy of the treatment as well.
 

deirdre

Senior Member.
Transgender kids need both medical and psychological care. Would you consider it "neutral" to deny that care to a patient? (Texas actually wants to do that as a purely political move, based on the opinions of a non-medical AG, so your point number 3 seems especially misapplied.) And where does the phrase "guilt-free" enter into the matter, please?
i don't understand the question.

You claimed you didn't understand the question, but the question was about what you meant by those words. I'm still waiting for an answer. Alternatively I can just assume that you tend to spit out phrases at random without intending them to have any meaning. Shall I just do that instead?

oh you are asking me what i meant by those words. I meant doctors who aren't perhaps biased by a sense of guilt for experimenting on kids. I'm not saying they shouldn't experiment on kids (it's not like transgender doctors are the first doctors to experiment drugs on kids), i'm just saying i find it reasonable they might be subject to cognitive bias regarding the study interpretations.


Article:
Conclusions

Gender incongruence in children and adolescents is complex, and medical treatment raises several ethical considerations. Clinical decision making has been fostered by research efforts, but there are still substantial knowledge gaps that warrant examination to inform best clinical practice (panel 4). The limited available evidence suggests that puberty suppression, when clearly indicated, is reasonably safe. The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits. Further research is needed to help identify which patients benefit most, and which are at higher risk of regret, changed wishes, or poorer quality-of-life outcomes. The most appropriate time to start treatment remains to be clarified.
 

deirdre

Senior Member.
It would certainly have been interesting to learn about the short-term efficacy of the treatment as well.
it might completely freak people out psychologically. and that would skew results. i dont mean to be disrespectful, but they say if you get your leg amputated there can be phantom limb syndrome. and even if not, you are still ...i'm guessing they provide follow up therapy for after amputations no matter how much you want the amputation or happy you are you did it. it's pretty major.
 

Mendel

Senior Member.
I meant doctors who aren't perhaps biased by a sense of guilt for experimenting on kids.
The key to this is informed consent. It raises tough questions when the consenting person is a minor; typically, parental consent is also required.


it might completely freak people out psychologically. and that would skew results. i dont mean to be disrespectful, but they say if you get your leg amputated there can be phantom limb syndrome. and even if not, you are still ...i'm guessing they provide follow up therapy for after amputations no matter how much you want the amputation or happy you are you did it. it's pretty major.
Yes. It'd be interesting to see how much of an issue this is with gender surgery.
 

FatPhil

Senior Member.
That makes sense to me: to think about what smoking actually is - purposefully introducing a toxic and damaging substance into the body, most likely with the knowledge that it has a good chance of causing serious harm and possibly leading to an unpleasant death - is a kind of "suicide" in itself.

The reasonably-well established correlation is the one between smoking and risk-aversion (a negative correlation, obviously), which included having hobbies of a potentially damaging nature. Smoking just fits in as another such potentially damaging hobby, so unless you're prepared to consider enjoying bungee jumping or motorbiking as a kind of "suicide", you shouldn't consider smoking to be that (but likewise, feel free to consider them all that). Other interesting correlations that have been discovered are between smoking and tattoos/piercings, and narcissistic behaviour traits. And having a criminal record. It's quite a nexus.

Some might say that Dunkin' Donuts satisfies your definition above too; sugar really isn't good for your liver.
 

deirdre

Senior Member.
The key to this is informed consent. It raises tough questions when the consenting person is a minor; typically, parental consent is also required.
most everything in the field of psychiatry is "experimental" when viewing patients as individuals vs reading percentages in studies.

One patient might have a bad outcome if you deny treatment X, regardless of informed consent* or age.
Your next patient might have a bad outcome if you push or just suggest treatment X, regardless of informed consent or age.

35% or 10% or 70% "in the literature" really means nothing to your individual patient.

*even in adults, can a person with severe depression, anxiety and suicidal thoughts/attempts really determine what is best for them? Informed consent just means you are legally protected.

[Physical] Medical doctors (vs psychiatry professionals) don't run into these issues quite as much. Either your blood pressure is testably high and some drug intervention is actually necessary, or your blood pressure isn't high enough and doesnt warrant drugs yet.
 
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Rory

Senior Member.
The JAMA paper accounts for some of [the sociodemographic covariates]

That's true. Can you tell how they did that? Or whether they did it accurately?

Do you feel there's potential for bias to play a part there?
 

Mendel

Senior Member.
That's true. Can you tell how they did that? Or whether they did it accurately?

Do you feel there's potential for bias to play a part there?
There is potential for bias in choosing the criteria, but with those criteria as stated, you plug them into the statistics software and its algorithms compute the adjustments and how much interdependence there is.

Unless they included extensive tables in some appendix or data download, the only way to check is to gain access to the data set and re-run the analysis yourself.
Or find a similar study and compare.
 

tinkertailor

Senior Member.
It does indeed seem to paint a much more nuanced picture than that presented by JAMA, which leads me to further doubt the conclusions they presented. It seems there are simply too many contributing factors to be able to make the conclusive and confident statements they made.
I agree.

One of the things most studies don't and can't capture about treating and caring for transgender people is how complex gender issues are. A study five years ago may not include genderfluid, gender neutral, or agender people, for example. The idea that surgery is the end goal of transgender existence, that it is what will curb suicidal ideation, ignores yet more complexities. Plenty of trans people are happy with their anatomy, for a huge variety of reasons. Studies comparing suicidal ideation pre- and post- surgery aren't going to capture those people's experiences the same way.

I think that's part of why these topics are so tricky to find research on, though a search of "transgender youth" and "suicidal ideation or suicidal thoughts or suicide" brought up over 100 journal articles when I searched it in just one academic research database in just the subject of psychology.
 

Mendel

Senior Member.
Plenty of trans people are happy with their anatomy, for a huge variety of reasons. Studies comparing suicidal ideation pre- and post- surgery aren't going to capture those people's experiences the same way.
"The study didn't say anything about a question the study wasn't designed to address."

From the "Strengths and Limitations" section of the 2021 Harvard/JAMA paper:
Article:
Second, this is, to our knowledge, the first large-scale study on this subject to use the ideal control group to examine associations between gender-affirming surgeries and mental health outcomes: individuals who desire gender-affirming surgery but have not yet received it. Experts have cautioned against using comparison groups that conflate TGD people who did not undergo gender-affirming surgery because they were waiting for it with TGD people not seeking it in the first place. Inability to differentiate these 2 groups likely contributed to the lack of significant mental health benefit observed in the 2019 large-scale study on this subject.


The fact that the JAMA study doesn't say anything about the benefits of giving surgery to people who don't want it is obvious from the study design, but could have been stated more clearly in the "key points" and "findings" sections.

The authors don't explain why they exclude respondents whose first surgery was less than 2 years ago
@Rory Actually, they do, just not in the place I looked for it.
Article:
Third, although this survey-based investigation uses a cross-sectional study design, we constructed an exposure group that includes only individuals exposed to their first gender-affirming surgery prior to the window of assessment for any adverse mental health outcomes. Thus, we ensured that our exposure temporally preceded our outcomes, allowing us to better understand the direction of observed associations. These exclusions could not be performed in our post hoc analysis stratifying by degree of surgical affirmation, and that analysis should therefore be interpreted with caution.

I understand this to mean that the mental health measures captured in the (pre-existing) survey contain questions like "have you tried to kill yourself in the past 2 years", and if that includes the pre-surgery period, it could obviously mess with the results. For the analysis to be valid, the mental health assessment ("outcome") has to cover the time after the surgery ("exposure"), not before.
 
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