A popular notion about transgender individuals is that sex-reassignment surgery reliably relieves the mental distress associated with being transgender. But researchers who have actually studied transgender individuals postsurgery have arrived at a different conclusion. As one investigator found, “even once the transsexual has achieved sex reassignment, the figure of being trapped in the wrong body, or being wrongly encased, continues to be evoked.”
Transgender adults who begin receiving hormonal therapy do benefit, on average, from that therapy: one year after starting hormonal therapy to transition to the desired gender, the rates of anxiety, depression, and impairment among transgender individuals are significantly reduced. Nevertheless, even after sex-reassignment surgery and hormone treatment, the rate of mental illness such as anxiety, depression, and bipolar disorder among transgender individual remains much higher than among the general population. “Sex reassignment is associated with more serious psychological sequelae and more prevalent regret than had previously been supposed,” conclude other reviewers. In the largest and longest follow-up available, researchers studied everybody who underwent sex-reassignment surgery in Sweden between 1973 and 2003: 191 MtF individual and 131 FtM individuals. These investigators found that 19 percent of MtF clients and 17 percent of FtM clients had been hospitalized for psychiatric problems prior to undergoing sex reassignment, compare with less than 4 percent of matched controls. After sex-reassignment surgery, transsexual clients were still nearly three times more likely than controls to be hospitalized for psychiatric problems other than gender dysphoria, even after adjustment for prior psychiatric problems. There was some benefit from sex-reassignment surgery, to be sure. Transsexuals who had undergone sex-reassignment surgery reported feeling less gender dysphoria – less of a sense of being trapped in the wrong body – and were somewhat less likely to be hospitalized for psychiatric problems than they were before the surgery.
But only somewhat. Even after sex-reassignment surgery, transsexual clients were still nearly five times more likely to have made a suicide attempt and nineteen times more likely to have died from suicide than were matched controls, again after adjusting for prior psychiatric problems. The researchers did not find any significant differences between MtF individual and FtM individuals on any of these outcomes. Being transgender, even in Sweden and even after having sex-reassignment surgery, puts you at much greater risk of having major psychiatric problems, including death by suicide. This finding is consistent with multiple other studies.
Leonard Sax – Why Gender Matters p.270
We know that most young boys who say that they are girls grow up to be men who do not think they are women and who do not want to be women. We now have many studies in which researchers have followed such boys for fifteen or twenty years, well into adulthood. In every study, the great majority of such boys grow up to be men who have no interest in becoming women. In one of the largest such studies, of 139 boys who insisted in childhood that they were really girls trapped in the bodies of boys, only 12 percent still felt that way as adolescents or adults. In other words, 88 percent of the boys grew out of it. Many of those boys grew up to be gay men. Some grew up to be straight men. But they are mend. They don’t need hormone supplements or surgery. They are capable of fathering children.
In other words, for the majority of young boys who say they are really girls, the desire to be a girl is just a phase. For such boys, allowing the boy to present himself as a girl will be a major stumbling block on his road to becoming a man (whether a gay man or a straight man)…
The most common outcome for the five-year-old boy or eight-year-old boy who says that he is really a girl, twenty tears down the road is a boy who grows up to be a gay man… Most five-year-olds, and even most eight-year-olds, have little sense of their own sexual orientation prior to the onset of puberty. Many kids in that age group, when presented with the facts of life, just pronounce it all to be “yucky.” Heterosexual intimacy and homosexual intimacy seem equally strange, and repellent, to many prepubescent kids. So it’s very difficult for that eight-year-old boy who loves to dress up as a princess, who believes himself to be a girl, to know whether he might grow up to be a gay man and feel right as a gay man. Being a girl may seem more real and more comprehensible.
Leonard Sax – Why Gender Matters p.261
The transgender activists seem to be motivated not primarily by data or research but by a belief: the belief that transgender is a normal variation. If that’s true – if being transgender is a normal variation, just like being left-handed – then any effort to align a patient’s gender identify with their biological sex would clearly be misguided, just as trying to make a left-handed person write with their right hand is misguided.
But transgender is not a normal variation. People with normal variations such as left-handedness do not require any professional intervention. But a transgender individual will require treatment with sex hormones and perhaps even sex-reassignment surgery in order to live in the other-sex role. Left-handed people don’t need prescription medications or surgical intervention in order to live as left-handed people. But a transgender individual will need lifelong treatment with cross-sex hormones in order to pass as a member of the other sex.
Prior to 1942, prescription female hormones were not available. And without prescription hormones, an adult male wearing a dress looks like. . . a man in a dress. The modern conception of transgender – the notion that a child born male can, as an adult, be made to look like a woman and “pass” as a woman – rests on the ready availability of intervention such as electrolysis, plastic surgery, and prescription hormones. It is as much a creation of the modern world as the telephone and the digital computer.
Leonard Sax – Why Gender Matters p.259