Tag Archives: transgender

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality – Review of Abstract

The authors of the study suggest that gender reassignment surgery may increase psychiatric problems for some people and decrease them for other people.

The study looked at the medical records of 104 people who had sex reassignment surgery in Denmark between 1978 and 2000.

They found that there was no statistically significant difference between the number of psychiatric diagnoses before surgery and after surgery.

In addition, the people who had diagnoses before surgery were different from the people who had diagnoses after surgery. Only 6.7% of the group had a psychiatric diagnosis both before and after surgery while 27.9% of the group had a psychiatric diagnosis before surgery and 22.1% had one afterwards.

According to the authors “this suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.”

The study also found that:

Psychiatric diagnoses were over-represented both before and after surgery (i.e. the group had more psychiatric issues than the general population).

Trans men (born female) had a significantly higher number of psychiatric diagnoses overall; there were no other statistically significant differences between trans men and trans women.

At the same time “significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth.”

10 people had died at an average age of 53.5 years.

Questions for the Future

The most important question is, of course, how can we make sure that SRS does not increase psychiatric problems in the future?

Is it a question of better screening to identify gender dysphoria?

Do people need more support and counseling after surgery?

Should some people transition without getting surgery?

Were poor surgical outcomes linked to psychiatric problems?

Could low hormone levels after surgery cause problems for some people?

Were people’s problems caused by the surgery or some other aspect of transition that happened after surgery?

Or to put it another way, how do we identify which people might benefit from surgery and which might be hurt by it? or do we need to make other changes to prevent new psychiatric diagnoses after surgery?

It would also be helpful to know more about the specific psychiatric diagnoses before and after surgery. Are we seeing increases in depression, anxiety, eating disorders, or what?

How did the patients whose mental health improved compare to those whose mental health got worse? Were they older or younger? What were their life circumstances?

What does it mean that trans men had more psychiatric diagnoses before surgery? Was surgery more beneficial for them than for trans women or did trans men just have more psychiatric problems overall?

How long after surgery did people get the new psychiatric diagnoses?

More about the study:

Only the abstract of the study is available online, so it is hard to interpret some of their results.

The abstract gives few further details on their methodology, but a similar study of physical illnesses and death looked at the records of 56 trans women (born male) and 48 trans men (born female). The follow-up period began when people received permission for surgery. The group used in the other study represented 98% of all people who officially had SRS in Denmark from 1978 to 2000.

Original source:

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality by Simonsen RK, Giraldi A, Kristensen E, Hald GM in Nord J Psychiatry. 2016;70(4):241-7.

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Where to Call if you Need Help

This is not a political blog, but I think we all need a reminder to take care of ourselves right now. Reach out for help – there are people who want to help you.

And to parents who read my blog, please tell your kids you love them and will fight for them.

Sources of Help:

Trans Lifeline for trans people:

  • US number: 1-877-565-8860
  • Canadian number: 1-877-330-6366
  • and their website.

The Trevor Lifeline for LGBTQ youth (US) – 1-866-488-7386 and their website.

National Suicide Prevention Lifeline (US): 1-800-273-TALK (8255) and their website.

The International Association for Suicide Prevention – their website has an interactive map with phone numbers and locations of crisis centers.

From Maria Shriver’s blog, Powered by Inspiration.

Two Years After My Suicide Attempt, I’m Still Living and Sharing

“Waking up two years ago gave me opportunities, some of which seem obvious but some of which I’m still discovering. I have the opportunity to continue the life I began and do the things I want to do. I have the opportunity to offer help to people who would have helped me if only I had shared what was going on.”

Read more here.

Finally, some helpful tips from the website Recommendations for Reporting on Suicide:

Suicide Warning Signs

  • Talking about wanting to die
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or
    having no purpose
  • Talking about feeling trapped or
    in unbearable pain
  • Talking about being a burden
    to others
  • Increasing the use of alcohol or drugs
  • Acting anxious, agitated or recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The more of these signs a person shows, the greater the risk. Warning signs are associated with suicide but may not be what causes a suicide.

What to Do

If someone you know exhibits warning signs of suicide:

  • Do not leave the person alone
  • Remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt
  • Call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255)
  • Take the person to an emergency room or seek help from a medical or mental health professional.

Review – Diverging Eating Psychopathology in Transgendered Eating Disorder Patients: A Report of Two Cases

These are two somewhat unusual case studies from Singapore. Once again, there is a connection between eating disorders and gender identity. Once again, the connection is different from other case studies.

Case 1 – A Fluid Gender Identity and an Eating Disorder

In the first case, the patient had a fluid gender identity; sometimes he identified as a man and sometimes as a woman.

When he identified as a woman, he restricted his food and exercised excessively. He wanted to be thin and felt a kinship with emaciated women because they were infertile like him.

When he identified as a man, he tried to gain weight and muscles, but his exercise and eating habits were still pathological.

The patient was always distressed and dissatisfied with his body.

In other words, his gender identity affected the form his eating disorder took, but it was probably not the cause of it.

Case 2 – Changing Gender Identity, Changing Eating Patterns

In the second case, the patient identified as a woman when he first sought treatment for his eating disorder. However, after a year of treatment, the patient came out to his friends as gay. They were accepting of his sexual orientation and he became more comfortable with a male gender identity.

Similarly to the first case, when the patient wanted to be a woman, he tried to become thin, using restricted eating, excessive exercise, and purging. However, when he began to identify as a male, he tried to build up his muscles and he ate more.

The authors do not comment on whether or not this patient still disliked his body.

The authors suggest that gender identity influences the form of body psychopathology; constructing your gender identity is linked to constructing your body. However, they do not suggest that gender dysphoria caused the eating disorders or that treating the gender dysphoria will cure them.

These two cases support their theory, but it is important to remember that this is a case study of two people. So far, the main conclusion I can draw from various cases studies is that each person’s story is different.

From the Discussion:

“The present case series describes two transgendered biological males seeking treatment for eating disorders, whose intermittent periods of endorsing both masculine and feminine gender identities impacted significantly upon their experience of eating disorder psychopathology. The two patients indicated that during periods of endorsing a feminine gender identity, they experienced an elevated definite drive for thinness, such that their body image psychopathology was oriented towards weight loss, reporting dietary restriction and cardiovascular exercise to lose weight. Furthermore, both patients reported that during periods of masculine gender identity endorsement, their body image psychopathology was oriented towards weight gain with an emphasis on “buff muscularity,” reporting increased food intake and muscle building exercise regimens.

This case series draws attention to the potential role of masculinity and femininity in body image psychopathology amongst males. Both patients depicted reported that the variation in their eating disorder psychopathology was concordant with their preferred gender identity, suggesting that the construction of one’s gender identity and the construction of one’s body may be interrelated.”

More details on the gender shift in the second case study:

At the beginning of treatment,

“…he reported homosexual sexual orientation and described privately wondering whether he was born into the wrong gender from approximately age 6. He reported periodically ‘trying to like girls’ due to the cultural and legal ramifications of homosexuality in his country of origin [probably China], and further stated that on many occasions his sexual orientation resulted in him feeling victimized and bullied. Patient Z reported significant discomfort with his sexual orientation, although he did report a female gender identity, which allowed him to experience his secretive same sex relationships as heterosexual given his assumed female identity.”

Before treatment, when he was restricting his food and purging,

“Patient Z reported immense discomfort surrounding his emerging sexual orientation, and reported strongly endorsing a female identity which enabled Patient Z to experience his same-sex attraction as heterosexual, alleviating the subjective distress and internal conflict he experienced in his homosexual urges. Patient Z described his role models to be female supermodels, stating that he aspired to their thin and feminine frames, adding that his gaunt appearance brought about by dietary restriction ‘accentuated his cheekbones’ and helped him identify with his female role models. Patient Z reported egosynotonicity of eating disorder symptomatology, allowing him to feel ‘small and more like a woman’ which he demonstrated in a collection of drawings depicting emaciated women, which he described as his ideal body.”

But then,

“Approximately 12 months into treatment Patent Z revealed his sexuality to his friends, whose acceptance and support reportedly alleviated the internal conflict he experienced around his same-sex attraction. As a result Patient Z reported reduced ambiguity surrounding his gender identity, describing more comfort in identifying with a male gender identity. During this same period, Patient Z developed a desire for muscular development as opposed to emaciation, and started a muscle building training regimen. Furthermore, this period was also characterized by Patient Z consuming greater quantities of food in support of his desire for greater muscularity.”

Original Source:

Diverging Eating Psychopathology in Transgendered Eating Disorder Patients: A Report of Two Cases by Murray SB, Boon E, Touyz SW in Eat Disord. 2013;21(1):70-4.

Word of the Day

Geschlechtsumwandlungstreib – the drive for sex transformation.

This word was invented by Max Marcuse in 1913.

From Transgender History by Susan Stryker.

 

You can buy Transgender History:

from Seal Press (support women’s publishing)

from Barnes and Noble (support brick and mortar stores)

from Amazon (support books)

The Epidemiology of Transsexualism in Poland – A very brief review

This piece is a very brief note in the Journal of Psychosomatic Research, June 2004.

In Poland, there are three times as many trans men (born female) as trans women (born male). This is different from the West,* where there are more trans women than trans men.

Because this is just a brief note, it is not clear how they are measuring gender dysphoria. The authors refer to transsexuals they examined, so it is likely that they are talking about people who transitioned.

There is no discussion here of the age or sexual orientation of the people in this study.

The exact numbers in the study were “1454 transsexuals of whom 1125 were F/M transsexuals and only 329 M/F.” 

In other words, in Poland, about 77% of transgender people who seek treatment are trans men.

Original Piece:

The Epidemiology of Transsexualism in Poland by S Dulko and C Imielinski, in the Journal of Psychosomatic Research, Volume 56, Issue 6, June 2004, Page 637.

*By the West, I assume they mean Western Europe, the USA, and Canada.

Transgender History by Susan Stryker – book recommendation

This is a great book. Read it.

Don’t you wish you could have turned in a book report like that? Sweet and simple.

This blog is about science, but I’ve decided to throw in some occasional book recommendations. I’ll be quoting Stryker’s history from time to time as well.

Meanwhile, other people have already written thorough reviews: C. Riley Snorton at the University of Pennsylvania, A Gender Variance Who’s Who, or plain old GoodReads.

You can buy Transgender History by Susan Stryker:

from Seal Press (support women’s publishing)

from Barnes and Noble (support brick and mortar stores)

from Amazon (support books)