association between gender-affirming surgeries and mental health outcomes

Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. The American Psychiatric Association has previously concluded that the quality of evidence for treatment of gender dysphoria is low, and consequently, recommendations regarding gender-affirming care have been driven by clinical consensus where empirical evidence is lacking.25 This study offers new data that substantiate the current clinical consensus by expanding the evidence base in support of gender-affirming surgical care. The process of surgical gender affirmation is individually tailored because not all TGD people desire or access these procedures.7 In the largest survey of the TGD community to our knowledge to date, 25% of respondents reported undergoing some type of gender-affirming surgery.8. State-level prohibitions against insurance exclusions for gender-affirming care have been associated with more extensive coverage of gender-affirming surgical procedures.26 In light of this studys results, such policies may be of even greater public health interest. Association Between Gender-Affirming Surgeries and Mental Health Outcomes. Associations between negative life experiences and the mental health of trans and gender diverse young people in Australia: findings from Trans Pathways. The purpose of this study is to examine associations among access to GAHT with depression, thoughts of suicide, and attempted suicide among a large sample of transgender and nonbinary youth. Although clinicians have long supported the provision of gender-affirming medical and surgical care, the practice has been challenged by health insurers asking for more evidence showing its efficacy, said study senior author Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. Weissler JM, Chang BL, Carney MJ, et al.. Gender-affirming surgery in persons with gender dysphoria. Determining the Benefits of Gender-Affirming SurgeryA Call for Action | LGBTQIA Medicine | JAMA Surgery | JAMA Network Clinical Pharmacy and Pharmacology Coronavirus (COVID-19) Diabetes and Endocrinology Equity, Diversity, and Inclusion Gastroenterology and Hepatology Genomics and Precision Health Guide to Statistics and Methods (2019). Association Between Gender-Affirming Surgeries and Mental Health Outcomes Complying with the independent statistical experts recommendations, the study authors created two equally-sized groups of patients diagnosed with gender dysphoria, the"surgery" and the"no-surgery" groups, which werematched on key demographiccharacteristics. 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 (<$25000, $25000-$99999, or $100000), 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). This study demonstrates an association between gender-affirming surgery and improved mental health outcomes. (2020). It underscores the need for researchers to engage in scientific debate in order to further the quality of scientific inquiry in the rapidly changing field of gender medicine. Brnstrm, R., & Pachankis, J. 13,14,15,16 Access to these interventions is also associated with a decreased lifetime incidence of suicidal ideation among adults who had access to PBs . www.forte.se. Conclusions and relevance: A Parent's Guide to Gender Affirming Care for Transgender Youth Endorsement of past-month severe psychological distress (score of 13 on Kessler Psychological Distress Scale), past-month binge alcohol use, past-year tobacco smoking, and past-year suicidal ideation or suicide attempt. Of the 27715 respondents, 3559 (12.8%) endorsed undergoing 1 or more types of gender-affirming surgery at least 2 years prior to submitting survey responses, while 16401 respondents (59.2%) endorsed a desire to undergo 1 or more types of gender-affirming surgery but denied undergoing any of these. Furthermore, compared to people who only received some of the gender-affirming surgeries they desired, people who received all of their desired surgeries experienced even more profound mental health benefits across every outcome. These findings are illustrated in Figure 1 above. Manuscript number: 18023-2. www.folkhalsomyndigheten.se, Bremberg, S. & Dalman, C.. (2015). and transmitted securely. Looking at mental health utilization in the year 2015, a retrospective analysis showed that the more time passed since surgery, the fewer mental services were utilized by patients,with an average 8% reduction in mental health utilization for each year following surgery. [Update November 4th,2020:We thankMedscape for taking our concern seriouslyand for initiating the process of issuing a correction, as well as notifyingthe clinicians who have alreadyreceived the CME credit associated with this studyof the significant change in the study's main conclusion.] While the authors found no evidence of benefits of hormonal treatments (adjusted odds ratio=1.01, 95% CI=0.98 - 1.03), they noted a statistically significant relationship between time since surgery and mental health status (adjusted odds ratio=0.92, 95% CI=0.87 - 0.98). Are gender-affirming surgeries associated with better mental health outcomes among transgender and gender diverse (TGD) people? This new Harvard study is the first large-scale, controlled - Reddit Some of these surgeries, such as facial . (2020). The control group included respondents who desired gender-affirming surgeries but had not yet received any. The observed associations between gender-affirming surgery, psychological distress, and suicide risk reinforce previous small-sample studies suggesting that gender-affirming surgery improves mental health and quality of life among TGD people.1,12 Our findings also reflect evidence from qualitative studies indicating perceived mental health benefits of gender-affirming surgeries among TGD people.19,20,21 In our primary analysis, although gender-affirming surgery was associated with lower odds of past-year suicidal ideation, there was no statistically significant association between gender-affirming surgeries and past-year suicide attempts. Correction of a Key Study: No Evidence of "Gender-Affirming" Surgeries American Journal Of Psychiatry, 177(8), 768-768. Kalin, N. (2020). HHS Vulnerability Disclosure, Help It uses data from the 2015 U.S. Transgender Survey and is the latest in a series of secondary analyses of the groundbreaking survey showing that transgender and gender diverse people . 2022 Apr;28(4):420-424. doi: 10.1016/j.eprac.2022.02.007. Gender-Affirming Surgeries and Improved Psychosocial Health Outcomes Why has mental illness increased among children and young people in Sweden? Swedish (Varfr har psykiska ohlsan kat hos barn och unga ?) National Health Agency, 2018. Its critical that the AJP update the original studys title and conclusion in order to reflect this critical correction. Plos ONE, 6(2), e16885. J Urol. Exposures: The Evidence for Trans Youth Gender-Affirming Medical Care A total of 27715 TGD adults took the US Transgender Survey, which was disseminated by community-based outreach from August 19, 2015, to September 21, 2015. Health News American Journal Of Psychiatry, 177(8), 764-764. The USTS survey includes responses from over 27,000 transgender people living in all 50 U.S. states, the District of Columbia, U.S. territories, and U.S. military bases abroad. 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. Connecting the dots: examining transgender womens utilization of transition-related medical care and associations with mental health, substance use, and HIV. Kim HH, Goetz TG, Grieve V, Keuroghlian AS. Tordoff DM, Wanta JW, Collin A, Stepney C, Inwards-Breland DJ, Ahrens K. JAMA Netw Open. Careers, Unable to load your collection due to an error. Patients' Perceived Level of Clinician Knowledge of Transgender Health Care, Self-rated Health, and Psychological Distress Among Transgender Adults. These limitations highlight the need for larger probability-based surveys with TGD communities, more consistent gender identity data collection across health care systems, and more comprehensive baseline health data collection with TGD populations. It was presumed that the fewer mental health events a person experienced, the better their mental health. A new study revealed an association between gender-affirming surgeries, which participants had undergone at least two years . Accepted for Publication: February 5, 2021. Keuroghlian AS, Reisner SL, White JM, Weiss RD. Mental health effects of gender-affirming surgery thus remain controversial. official website and that any information you provide is encrypted Kamran R, Jackman L, Chan C, Suk Y, Jacklin C, Deck E, Wietek N, Stepney M, Harrison C, Jain A, Rodrigues J. JAMA Netw Open. 2021 Jul 1;156(7):685-687.doi: 10.1001/jamasurg.2021.0953. Spending and Out-of-Pocket Costs for Genital Gender-Affirming Surgery in the US. The authors opined that this finding should lend support to the decision to provider gender-affirming surgeries to transgender individuals who seek them.The conclusions of the studywere widely publicized by mass media outlets. But until now there has been limited evidence that these surgeries result in better mental health outcomes.. the conclusion that "the longitudinal association between gender-affirming surgery and lower . Gender-affirming Surgery Improves Mental Health Outcomes - Legal Reader Legislation to Criminalize Gender-Affirming Medical Care for Transgender Youth. 2021 Jul 1;156 (7):611-618. Disclaimer: Publications may either be freely available or require a fee to view (or access) on the journal's website. Association Between Gender-Affirming Surgeries and Mental Health Outcomes Transgender pediatric surgical patientsImportant perioperative considerations, Pediatric Anesthesia, Volume 30, Issue 5, 520-528. https://doi.org/10.1111/pan.13845, "Importantly, surgeries for transgender individuals are medically necessary procedures, proven to improve dysphoria, mental health, and quality of life,26, 29-33 and should not be viewed as elective.14, 15", Konrad, M., & Kostev, K. (2020). Differences in alcohol use and alcohol-related health care among transgender and nontransgender adults: findings from the 2014 behavioral risk factor surveillance system. American Journal of Psychiatry, 177(8), 769-772. Main outcomes and measures: As a result, the AJP issued a correction, which states, the results [of the reanalysis] demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related healthcare visits or prescriptions or hospitalizations following suicide attempts, and given that the study used neither a prospective cohort design nor a randomized controlled trial design, the 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 to transgender individuals who seek them is too strong (2). Quote, withreference to Brnstrm &Pachankis (2019) indicated with bold, Sevelius J.M., Gutierrez-Mock L., Zamudio-Haas S., et al. Association Between Gender-Affirming Surgeries and Mental Health Outcomes. (2020). April 28, 2021 BOSTON, April 28, 2021A new study published today in JAMA Surgery found that gender-affirming surgery is associated with improved mental health outcomes among transgender people. For each surgery, respondents were able to indicate one of the following answers: Have had it, Want it some day, Not sure if I want this, or Do not want this. Respondents were included in the exposure group if they answered Have had it to 1 or more of the following types of gender-affirming procedures: breast augmentation, orchiectomy, vaginoplasty/labiaplasty, trachea shave, facial feminization surgery, or voice surgery. 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. The exposure variable was recoded as 3 categories: those who received all desired surgeries, some desired surgeries, and no desired surgeries. Facial feminization surgery This is a category of procedures that involves surgical changes to feminize the face. Therefore, prior mental health factors do not appear to confound associations between gender-affirming surgery and subsequent mental health outcomes in our study. Ministry of Health and Social Affairs, Swedish Research Council for Health, Working Life and Welfare. Alcohol research with transgender populations: a systematic review and recommendations to strengthen future studies, Tobacco use among transgender and gender non-conforming adults in the United States, Global health burden and needs of transgender populations: a review, Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7, What surgeons need to know about gender confirmation surgery when providing care for transgender individuals: a review. Conflict of Interest Disclosures: Dr Keuroghlian reported grants from Patient-Centered Outcomes Research Institute Contract AD-2017C1-6569 (PI: Sari L. Reisner) during the conduct of the study; in addition, Dr Keuroghlian stands to receive future royalties as editor of a forthcoming McGraw-Hill Education textbook on transgender and gender diverse care. They include the possibility that "gender-affirming" surgeries improve mental health, worsen mental health, or that the data are insufficient to draw conclusions about the impact of hormonal and surgical interventions on mental health. Gender Affirming Surgery in San Francisco & Sonoma County Furthermore, this study provides evidence to support policies that expand and protect access to gender-affirming surgical care for TGD communities. Report of the American Psychiatric Association task force on treatment of gender identity disorder. This is especially true for adolescents and young adults, who are currently the vast majority of patients presenting to gender clinics, and whose decisions will have profound, life-long implications. Notably, contrary to the authors claim, the analysis failed to control for differences in the baseline mental health status of the cohorts of patients seeking surgery. Our post hoc analysis demonstrates that lifetime suicidality and substance use behaviors are not associated with the exposure variable in this sample. Multivariable logistic regression models adjusted for all covariates were generated to examine whether undergoing gender-affirming surgery is associated with each of the examined mental health outcomes.16,17 To account for the surveys nonprobability sampling, all models incorporated survey weights to correct sampling biases related to age and race/ethnicity. This studys strengths include aspects of its design that address prior limitations in the existing literature on this subject. This may include reshaping features like the nose, chin, jaw, lips, and the overall proportions of the face. American Journal Of Psychiatry, 177(8), 764-765. Benefits of Gender-Affirming SurgeryA Call for Action
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