Key Findings

• Original 2019 AJP study claimed gender-affirming surgery reduced mental health treatment utilization by 8% per year
• After reanalysis with a control group, no statistically significant difference in mental health outcomes was found between surgery and no-surgery groups
• The AJP issued a correction in August 2020 stating no advantage of surgery was demonstrated
• Original study failed to include a control group of non-surgical gender dysphoric patients
• Original study did not correct for multiple hypothesis testing
• The study used a cross-sectional design (single year 2015) rather than prospective or randomized design
• Independent statistical review confirmed methodological concerns raised by external researchers
• The original study's conclusion was deemed 'too strong' given the study design limitations

Abstract

In October 2019, the American Journal of Psychiatry (AJP) published a study by Bränström and Pachankis reporting that 'gender-affirming' surgeries for gender dysphoric patients are associated with improved mental health outcomes. The original study looked at mental health utilization in the year 2015, finding an average 8% reduction in mental health utilization for each year following surgery. However, following a reanalysis of the data after concerns about statistical methodology were raised by multiple researchers, the AJP issued a correction stating that 'the results [of the reanalysis] demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts.' The original study lacked a control group comparing surgery patients to non-surgery patients, failed to correct for multiple hypothesis testing, and used a cross-sectional design that could not establish causation.

Summary

This is an analysis by the Society for Evidence-Based Gender Medicine (SEGM) of the correction to the Bränström and Pachankis study published in the American Journal of Psychiatry. The original 2019 study claimed that gender-affirming surgery was associated with reduced mental health treatment utilization, but after methodological concerns were raised and independent statistical review was conducted, the AJP issued a correction in 2020. The corrected analysis, which included a comparison group of gender dysphoric patients who did not receive surgery, found no statistically significant mental health advantage of surgery.

Conclusion

After reanalysis with a control group comparing gender dysphoric patients who received surgery to those who did not, no statistically significant difference was found in mental health utilization measures. The AJP correction stated the original conclusion that 'the longitudinal association between gender-affirming surgery and lower use of mental health treatment lends support to the decision to provide gender-affirming surgeries' was too strong. The Society for Evidence-Based Gender Medicine (SEGM) concluded that no mental health benefit of gender-affirming surgery was demonstrated in the corrected analysis.