New Study Re: Harmful Effects of Trans Surgery

[ttribe]

8 hours ago, Bernard Gui said:

….thus fulfilling Gui’s Law. 

[smac97]

2 hours ago, Benjamin McGuire said:

In any case, getting back to the OP -

2024: Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Antidepressant Use in Patients with Gender Dysphoria

This article is interesting: Association Between Mental Health Conditions and Postoperative Complications After Gender-Affirming Surgery - the interesting part of it was the statistic that they looked at involving pre-surgical mental health conditions:

...

This study: Association Between Gender-Affirming Surgeries and Mental Health Outcomes took a different approach. Instead of using the broad comparison taken in the OP of everyone with a dysphoria diagnosis, it compared those who wanted surgery and got it with those who wanted surgery and didn't.

Thank you for sharing these.  I will review them.

Thanks,

-Smac

[teddyaware]

22 minutes ago, ttribe said:

What blind arrogance! What in the world should one expect other than defenses of church doctrine coming from testimony bearing church member participants on a dialogue board that’s specifically focused on the beliefs and teachings of the Church of Jesus Christ of Latter-Day Saints? Yet you’re somehow perplexed and exasperated that believing members of the restored church of Christ would actually have the nerve to dare to defend the church leaders against attacks coming from mockers who shout insults and scripturally indefensible positions from the windows of the large and spacious building?

All human beings—male and female—are created in the image of God. Each is a beloved spirit son or daughter of heavenly parents, and, as such, each has a divine nature and destiny. Gender is an essential characteristic of individual premortal, mortal, and eternal identity and purpose.

In the premortal realm, spirit sons and daughters knew and worshipped God as their Eternal Father and accepted His plan by which His children could obtain a physical body and gain earthly experience to progress toward perfection and ultimately realize their divine destiny as heirs of eternal life. The divine plan of happiness enables family relationships to be perpetuated beyond the grave. Sacred ordinances and covenants available in holy temples make it possible for individuals to return to the presence of God and for families to be united eternally. (The Family, A Proclamation to the World)

So even though the Latter-Day Saint believers on this discussion board fervently acknowledge that we accepted God’s wise plan of salvation in the preexistence — an eternal plan of happiness that’s inextricably tethered to the immutable truth that “gender is an essential characteristic of individual premortal, mortal, and eternal identity and purpose —” nevertheless we’re supposed to just casually cast aside these beautiful and perfectly logical truths in order to satisfy the itching ears of self-assured unbelievers, many of whom don’t even believe in God?

I believe one of the the main obstacles that stands in the way of unbelievers embracing the teachings of the church on gender is their belief that the world, in its present fallen state of nature, will never be redeemed and transformed to a higher state of holiness and happiness through the infinite and eternal power of the atoning sacrifice of Jesus Christ. 

[ttribe]

2 minutes ago, teddyaware said:

What blind arrogance! What in the world should one expect other than defenses of church doctrine coming from testimony bearing church member participants on a dialogue board that’s specifically focused on the beliefs and teachings of the Church of Jesus Christ of Latter-Day Saints? Yet you’re somehow perplexed and exasperated that believing members of the restored church of Christ would actually have the nerve to dare to defend the church leaders against attacks coming from mockers who shout insults and scripturally indefensible positions from the windows of the large and spacious building?

 

All human beings—male and female—are created in the image of God. Each is a beloved spirit son or daughter of heavenly parents, and, as such, each has a divine nature and destiny. Gender is an essential characteristic of individual premortal, mortal, and eternal identity and purpose.

In the premortal realm, spirit sons and daughters knew and worshipped God as their Eternal Father and accepted His plan by which His children could obtain a physical body and gain earthly experience to progress toward perfection and ultimately realize their divine destiny as heirs of eternal life. The divine plan of happiness enables family relationships to be perpetuated beyond the grave. Sacred ordinances and covenants available in holy temples make it possible for individuals to return to the presence of God and for families to be united eternally. (The Family, A Proclamation to the World)

So even though the Latter-Day Saint believers on this discussion board fervently acknowledge that we accepted God’s wise plan of salvation in the preexistence — an eternal plan of happiness that’s inextricably tethered to the immutable truth that “gender is an essential characteristic of individual premortal, mortal, and eternal identity and purpose —” nevertheless we’re supposed to just casually cast aside these beautiful and perfectly logical truths in order to satisfy the itching ears of self-assured unbelievers, many of whom don’t even believe in God?

I believe one of the the main obstacles that stands in the way of unbelievers embracing the teachings of the church on gender is their belief that the world, in its present fallen state of nature, will never be redeemed and transformed to a higher state of holiness and happiness through the infinite and eternal power of the atoning sacrifice of Jesus Christ. 

Wooo! That set me straight! Do you feel better now? Did you satisfy your need to feel superior?

How about you show me where, in all of this conversation, there has been any direct attack on the Church of Jesus Christ of Latter-day Saints?  I'll wait....

[Tacenda]

1 hour ago, smac97 said:

Thank you for sharing these.  I will review them.

Thanks,

-Smac

Hope so!

[Kenngo1969]

3 minutes ago, Tacenda said:

Hope so!

Do you think he's lying when he says he will consider something?  If so, why?

[smac97]

5 hours ago, Benjamin McGuire said:

In any case, getting back to the OP -

2024: Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Antidepressant Use in Patients with Gender Dysphoria

Seems like the study is behind a paywall.

I am curious as to the design of the study.  Was it observational?

If the study shows an association between gender-affirming surgery and improved mental health outcomes, does that establish causation?

The study used "Propensity Score Matching," which seems to have some substantial problems.

I am also wondering about potential "self-selection bias."  Patients who underwent surgery were, per the conclusion, "appropriately selected," which may mean they were already been in a better mental and financial position than those who did not undergo surgery.  Put another way: Did the medical treatment cause the improvement in mental health, or were the people who were more stable to begin with simply more likely to undergo surgery?

The study relied on "{a} national insurance claims-based database," meaning it only captured diagnosed and treated mental health conditions.  What about patients who stopped seeking care for depression or anxiety post-surgery?  Was it because they had improved due to the surgery?  Or was it because they lost their insurance, or because they felt discouraged from seeking mental health care, or because they had untreated symptoms that were no longer coded in the database, etc.?

What is the duration of the follow-up?  The study does not specify long-term outcomes.  In my review of various materials, it seems pretty clear that mental health improvements post-surgery may be temporary, with issues like regret, continued dysphoria, or other stressors emerging later.  As the article in the OP noted:

Quote

Florida neurosurgeon Dr. Brett Osborn, who also was not part of the study, agreed that "surgery is no guarantee of happiness."

"We’re often told that gender-affirming surgery is essential for alleviating gender dysphoria — but what happens when the euphoria fades?" he said in an interview with Fox News Digital.

"The key question remains: Is the surgery itself causing distress, or are preexisting mental health issues driving people toward it? Correlation or causation? No one knows."

Also, the study does not examine whether mental health conditions were already improving before surgery.  If so, the post-surgery improvements may not be due to the surgery itself.

Then there's the "publication bias" issue.  Positive outcomes from gender-affirming care are more likely to be published, while studies with neutral or negative findings may be underreported or dismissed.

Meanwhile, I continue to come across articles like this:

Misrepresentations of evidence in “gender-affirming care is preventative care”

Quote

Restar significantly mispresents the evidence used to support numerous claims on at least five occasions in “Gender-affirming care is preventative care.”¹

Firstly, when referring to reference 8,² the author states that “use of hormones was associated with less depression, and trans people not on hormones had 4-fold increased risk of depressive disorder.” Restar fails to note, however, that the cross-sectional nature of this study was inherently unable to determine the direction of the effect—specifically, that better psychological wellbeing may be the cause of patients embarking upon cross-sex hormone treatment or, as implied by Restar, a consequence of this.

Secondly, to support the claim that “GAC [gender-affirming care] is linked to improved quality of life and mental health among trans people”, and GAC is “an integral protective factor for trans people's mental health,” Restar refers to a systematic review (reference 6)³ of only three uncontrolled prospective cohort studies, which only followed-up participants from between 3 and 6 months and 12 months after baseline, and of which only two found statistically significant improvements in psychological functioning after initiating hormone therapy. The review's authors stated that the results “demonstrate low quality evidence” that “is unable to offer conclusive evidence regarding the effects of hormone therapy on quality of life for transgender individuals.”

Thirdly, Restar also refers to a total population prospective study (reference 7)⁴ to support the claim that “GAC is linked to improved quality of life and mental health among trans people”, yet this study did not include a comparison group of individuals who had sought but not yet received GAC, meaning those who had not received treatment because they were waiting for it could not be distinguished from those who were not seeking it at all, which is essential for tracking mental health before and immediately after treatment.

Fourthly, to further support the claim that GAC is “an integral protective factor for trans people's mental health,” Restar refers to a systematic review of 20 studies (reference 10),⁵ 85% of which had a moderate, high or serious risk of bias in their study designs. Small sample sizes, and confounding with other interventions, severely limited the confidence of the review's conclusions, and no conclusions about participant death by suicide could be drawn by the authors.

Fifthly, Restar also states that a study (reference 9)⁶ reported suicidal ideation in 3.5% of participants, then claims that this is “a comparable rate to the U.S. general population rate of 4.6%” (using reference 3 as support).⁷ However, reference 3 states that 4.6% is the lifetime suicide attempt rate in the whole U.S. population, while the study (reference 9) reported suicidal ideation (3.5%) and completed suicide (0.63%) within only the first two years of receiving “gender-affirming hormones” in participants who were only 12–20 years of age (the suicide rate for 15–24 year old in 2021 in the U.S. was only 0.02%).⁸

If totalising claims—such as “Gender-affirming care is preventative care”—are to be published in highly influential medical journals, it is of paramount ethical importance that they are accompanied by accurate, transparent, verifiable, and honest interpretations of the evidence used to support them. Without this, such claims constitute nothing more than misleading and discrediting ideological dogma which, as with Restar's Comment, have no place in The Lancet publications, and should thus be entirely disregarded.

And this one: The gender-affirming model of care is incompatible with competent, ethical medical practice

Some excerpts:

Quote

The assumption that there is no pathology involved in the development of gender diversity is a necessary precondition for the unquestioning affirmation of self-reported gender identity. Cases where psychosis is the undeniable cause of gender diversity demonstrate this assumption is categorically false. To protect this false assumption, gender-affirming guidelines forbid the application of the core psychiatric competencies of phenomenology and psychopathology to the assessment of gender diversity. They substitute the political goal of expanding personal liberty for the evidence-based medicine processes of clinical reasoning, rendering them incompatible with competent, ethical medical practice.

Given the almost complete lack of high-quality evidence regarding the nature and treatment of the experiences currently clustered under the title gender diversity,^1–4 the rapid increase in presentations and the resources allocated to them in Australia is remarkable.^5,6 Clinical guidelines describing the dominant treatment paradigm for gender diverse patients, the gender-affirming model of care (GAMOC), assert without evidence that pathology plays no part in the development of gender diversity.^1,7
...
In the absence of models of the phenomenology and psychopathology of gender diversity, it is impossible to meaningfully judge what proportion of cases involves pathology or assess the role of pathology in individual patients. Unquestioning gender-affirming care is therefore unable to exclude the possibility that it is reinforcing the pathologies of some, most, or all of its patients. This is unethical, and it is the responsibility of psychiatrists to ensure that no patients are harmed by this dangerous model of care.

"They substitute the political goal of expanding personal liberty for the evidence-based medicine processes of clinical reasoning, rendering them incompatible with competent, ethical medical practice."

I am concerned this is a widespread thing.

One of the first order pieces of evidence is, well, reactions such as I have seen in this thread.  Shrill accusations of bigotry and hatred in lieu of substantive and evidence-based discussion.  Emotionalisms and vitriol abound.  These are the tools of censorship and suppression, not reasoned inquiry.

5 hours ago, Benjamin McGuire said:

This article is interesting: Association Between Mental Health Conditions and Postoperative Complications After Gender-Affirming Surgery - the interesting part of it was the statistic that they looked at involving pre-surgical mental health conditions:

As with the first article above, this appears to be an observational study, purporting to identify an association between mental health conditions and postoperative complications.  It does not seem to establish causation.

Also, the study relies on an insurance dataset.  Diagnoses and complications may be underreported or misclassified in billing records, and the study wouldn't know, since it did not actually interact with any of the actual patients.  

Also, the study does not include detailed patient evaluations or direct clinical data.  Just extrapolations from insurance data.

Also, the study, being based on insurance data, necessarily excludes undiagnosed conditions.  Many mental health issues go undiagnosed or untreated, so the study may underestimate the actual prevalence.

Also, the study does not distinguish between types or severity of mental health issues (that is, mild anxiety and severe schizophrenia are jumbled together).

Also, the study apparently does not control for patients receiving, or not receiving, treatment for their mental health issues, which could impact outcomes.

Also, as with so many of these studies, this one is apparently short-term.  It only tracks complications within 90 days of surgery.  Many complications, particularly mental health-related ones, can arise months or years later.  Consequently, the short-term follow-up term means the study may miss long-term complications or delayed improvements.  This defect is particularly concerning to me, as it is so prevalent in these studies that I can't help but wonder if the researchers are doing it intentionally.  That is, they are rushing to capture "positive" data that they know is more likely in the short-term period immediately following medical treatment, and deliberately ignoring longer-term data.  Is it because longer-term data contravenes the researchers' preferred narrative and outcome?

Also, the study compares patients who had diagnosed mental health conditions with people who did not.  Is there a "selection bias" issue here?  People with more serious mental health conditions may have been denied surgery altogether, leading to an underestimation of risks.  

Also, there does not seem to be a control group.  The study only compares gender-affirming surgery ("GAS") patients with versus without mental health conditions.

Also, the study itself acknowledges its limitations:

Quote

The limitations of this study include potential confounding (eg, present but undiagnosed mental health conditions) and selection bias; as such, future studies may replicate our findings in other cohorts.

These seem like some pretty serious limitations.

5 hours ago, Benjamin McGuire said:

This study: Association Between Gender-Affirming Surgeries and Mental Health Outcomes took a different approach.

Hmm.  Quite a few questions here.

The study is observational and cross-sectional, meaning it only addresses associations at a single point in time.

It does not appear to present evidence of causality (that is, that GAS causes improved mental health outcomes).  Improvements might also be attributable to natural developments over time, or increased social support after GAS, or that the patient was already improving prior to the surgery, or some combination of these.

And the self-selection bias is here again.  The study compares people who chose to undergo GAS to those who wanted it but did not get it.  The former group may be more financially stable, more socially supported, and in better overall mental health before surgery.  If so, these factors could materially skew the post-GAS results.  That is, the folks reporting better mental health outcomes may have that result not due GAS, but rather to underlying advantages.

The article also relies entirely on self-reported data.  Lots of biases here, and also a lack of clinical validation.

Also, the study relies on a very questionable dataset, namely, the 2015 U.S. Transgender Survey (USTS), which was not conducted using random sampling.  It was self-selected, meaning that only people who chose to participate were included, such that the sample may not be representative of the broader transgender population.   It also increases the likelihood of participants with certain experiences (that is, positive views of GAS) being overrepresented.  Non-random, non-probability sampling is a big issue.

Also, the study cites a 2019 Swedish study which purported to show improved outcomes, but it notably fails to mention that a correction to the study removed evidence of a mental health benefit when compared to controls.

5 hours ago, Benjamin McGuire said:

These kinds of studies show that the study referenced in the OP isn't revealing anything new or unusual.

These studies do not resolve my concerns, but rather corroborate them.

5 hours ago, Benjamin McGuire said:

Those who get gender affirmation surgery are generally starting from a worse mental health standpoint among those with gender dysphoria than those who don't.

Not sure you can say that.  Lots of factors are in play.

5 hours ago, Benjamin McGuire said:

However, the conclusion that it is the surgery itself that causes the high rate of mental health issues is wrong - those that get the surgery tend to show pronounced improvements in mental health - especially when the procedures go well.

Well, maybe.  In the short term.  For some.

5 hours ago, Benjamin McGuire said:

But, they do still have to deal with the societal issues that follow in our current context. The "trans-surgeries" themselves are not the source of harm that Spencer suggests they are in the threads title.

I want people with Gender Dysphoria to have a better quality of life.  I question whether gender-affirming surgery is facilitating that, or if it is doing more harm than good.

If we were having a discussion about, say, disputed issues touching on medical interventions in pediatric oncology, I think this discussion would be going very differently.  Any such disagreements would be about the data, the real-world efficacies.  There would not be hysterics and vitriol in which a disagreement is chalked up to "Well, it's obvious that you are bigoted towards children with cancer."

And yet when GAS is under discussion, responding to disagreement by throwing out baseless accusations of bigotry and hatred is standard fare from you and yours.  This makes me think the issue is more ideological and dogmatic than it is about reason and evidence. 

Again, I want people with Gender Dysphoria to have a better quality of life.  I hope we can set aside ideological and sociopolitical factors and improve our assessment of whether GAS facilitates that. 

Thanks,

-Smac

Edited March 7, 2025 by smac97

[Tacenda]

18 minutes ago, Kenngo1969 said:

Do you think he's lying when he says he will consider something?  If so, why?

No I just hoped so. Sometimes I say I'll look into something and something gets in the way and I might have had good intentions but forget about it.

[smac97]

1 hour ago, Tacenda said:

No I just hoped so. Sometimes I say I'll look into something and something gets in the way and I might have had good intentions but forget about it.

I have reviewed them a bit, see above.

Alas, we have a hard time discussing these things.  In my view, disagreeing with some (though not all) aspects of transgender ideology does not equate to disliking or hating transgender people. However, in today's discourse, even reasoned, evidence-based critiques are often labeled as "bigotry."  This thread is an clear example of that.

We should have compassion for people struggling with identity issues.  I respect and value transgender individuals, but I believe certain claims within gender ideology are logically inconsistent. I think I should be able to express those ideas without being vilified as a bigot.  I believe people should be free to express themselves.  

Respectfully, I submit that there are substantial internal contradictions in trans ideology.  

"Gender identity" lacks an objective definition, and is susceptible to equivocation. 

Equivocation and circular reasoning are also inherent in discussions about the definition of "woman."

Although subjective inner-held feelings can and should be acknowledged, biological sex remains a meaningful category regardless of identity.

If gender and sex are truly separate, then trans women would not need to insist they are female.

If gender is socially constructed, a person cannot be "born" in the wrong gender.

If sex is a spectrum, then there is no "male" and "female."

If gender identity, which is entirely subjective and not empirically ascertainable, is the basis of womanhood, nothing stops a man from arbitrarily claiming it.

I understand this is a sensitive topic, and I want to approach it with reason and respect. I am not questioning anyone’s dignity, only the logic behind certain claims.  

Thanks,

-Smac

Edited March 7, 2025 by smac97

[smac97]

3 hours ago, SeekingUnderstanding said:

Do you acknowledge that the study you linked to in the OP does not follow people before and after surgery and therefore says nothing about the efficacy of said surgery? 

Well, the article is behind a paywall, but you may well have a point.  The same goes for the articles Ben has cited.

3 hours ago, SeekingUnderstanding said:

If yes, how is the article titled “Trans surgeries increase risk of mental health conditions, suicidal ideations: study” anything other than anti-trans propaganda? How does you sharing it without even a modicum of thought or critical thinking make you anything but a propagandist?

See my prior comments about attempting to have a discussion without being branded a bigot, shouted down as a "propagandist," etc.

3 hours ago, SeekingUnderstanding said:

If after reading the study you actually believe it shows “Trans surgeries increase risk of mental health conditions, suicidal ideations” you are just willfully ignorant at this point.

I have worked hard to educate myself on these issues.

3 hours ago, SeekingUnderstanding said:

So thoughtless dialogue would be pointless.

I assume you meant thoughtfull dialogue.  

But as you please.  You have no obligation to have any discussion with me.

3 hours ago, SeekingUnderstanding said:

You know how when some evangelical anti-Mormon comes on here and everyone gangs up on him, including the post Mormons?  That’s you on this issue.

Respectfully, I disagree. 

3 hours ago, SeekingUnderstanding said:

Engaging with willfully ignorant people is pointless. That just leaves the name calling. 

More ad hominem.

I have done quite a bit of reading and thinking on these issues.

3 hours ago, SeekingUnderstanding said:

This is a complex issue for sure, one that deserves nuance.

Then you and yours shouting down efforts at substantive discussion are counterproductive.  And yet here we are.

3 hours ago, SeekingUnderstanding said:

If you think you can advance that conversation by posting inflammatory propaganda then you are not very good at dialogue. 

Says the guy endorsing "name calling."

Thanks,

-Smac

[SeekingUnderstanding]

19 minutes ago, smac97 said:

but you may well have a point.

So no remorse for sharing hateful propaganda. No introspection. The article you shared did not reflect the abstract. You come on here and do nothing but share “big list” links to articles written by people who intentionally misrepresent their sources. You may not have had access to the full research study in question, but a quick read of the abstract was enough to show it didn’t support your propaganda article. The sources you choose to share, intentionally misrepresent the research. When this is pointed out to you, you play the victim. Take ownership and responsibility for your actions. 

Edited March 7, 2025 by SeekingUnderstanding

[SeekingUnderstanding]

21 minutes ago, smac97 said:

See my prior comments about attempting to have a discussion without being branded a bigot, shouted down as a "propagandist," etc.

Stop willfully spreading propaganda. The OP was just propaganda. FoxNews, which you willfully parroted did not even attempt to faithfully represent the study in question. If you thoughtlessly spread propaganda that makes you a propagandist. If you claim that you didn’t know it was propaganda, that makes you a bigot. Because for anyone that cares about what’s actually going on, it was painfully clear that your OP was propaganda. So you you missed it, you are extremely blinded (bigoted) on this issue. 

[smac97]

3 minutes ago, SeekingUnderstanding said:

Quote

but you may well have a point.

So no remorse for sharing hateful propaganda.

The article I provided was neither hateful nor propaganda.

Once again, this sort of vitriol is an impediment to discussion.

3 minutes ago, SeekingUnderstanding said:

No introspection.

Yes, some. 

3 minutes ago, SeekingUnderstanding said:

The article you shared did not reflect the abstract.

You mean the article that is behind the paywall, which I think neither you nor I have read?

You mean the article to which I provided an in-front-of-the-the-paywall link?

You mean the abstract that states in part: "Gender-affirming surgery, while beneficial in affirming gender identity, is associated with increased risk of mental health issues, underscoring the need for ongoing, gender-sensitive mental health support for transgender individuals’ post-surgery."?

3 minutes ago, SeekingUnderstanding said:

You come on here and do nothing but share “big list” links to articles

I do a lot more than that.  I provide links, and then I parse them out and present my thoughts on them.  I also provide additional resources.  The OP did not include a "big list."  It was one article discussing one study.

3 minutes ago, SeekingUnderstanding said:

written by people who intentionally misrepresent their sources.

Respectfully, I don't think so.

3 minutes ago, SeekingUnderstanding said:

You may not have had access to the full article in question,

Nor do you have access.

But I did provide a link to the abstract.

3 minutes ago, SeekingUnderstanding said:

but a quick read of the abstract was enough to show it didn’t support your propaganda article.

Again, from the abstract: "Gender-affirming surgery, while beneficial in affirming gender identity, is associated with increased risk of mental health issues, underscoring the need for ongoing, gender-sensitive mental health support for transgender individuals’ post-surgery."

From the article: "Trans surgeries increase risk of mental health conditions, suicidal ideations."

We can certainly discuss nuance, such as whether "associated with increased risk" (from the abstract) is accurately described as "Trans surgeries increase risk."  Alas, however, your vitriol impedes such efforts and exploring nuance.

3 minutes ago, SeekingUnderstanding said:

The sources you choose to share, intentionally misrepresent the research.

Respectfully, I disagree with this characterization.

3 minutes ago, SeekingUnderstanding said:

When this is pointed out to you, you play the victim.

Not really.  I dislike being called a bigot, but even then you and yours have played that out too much, so it lacks potency.

3 minutes ago, SeekingUnderstanding said:

Take ownership and responsibility for your actions. 

Here I am, discussing my actions.

Thanks,

-Smac

[SeekingUnderstanding]

28 minutes ago, smac97 said:

The same goes for the articles Ben has cited.

This is where you completely loose the plot and your blatant bigotry is on full display. Your opening post took research and willfully and blatantly misrepresented it. OTOH, Ben’s links represent good faith efforts to understand what’s going on. They are not the end all and be all of what’s going on  FURTHER STUDY IS NEEDED. These studies acknowledge this. But what Ben’s links don’t do is blatantly lie like this: “

Trans surgeries increase risk of mental health conditions, suicidal ideations: study”

When your headline is a blatant misrepresentation of everything that follows, you’re really off to a bad start. 
 

That you think there’s some kind of equivalent going on here displays your bigotry.

 

[Benjamin McGuire]

23 minutes ago, smac97 said:

I am curious as to the design of the study.  Was it observational?

Given that none of these studies (the one you offered included) involves any direct access to the subject cohorts, they can all be considered observational. In this specific article the data is pulled from data that was anonymized and provided by health insurance providers.

26 minutes ago, smac97 said:

The study used "Propensity Score Matching," which seems to have some substantial problems.

Perhaps. What did the study use that you reference in the OP? I am asking because it seems clear to me that you are applying a standard of analysis here that you didn't begin to use toward the material that you referenced.

27 minutes ago, smac97 said:

I am also wondering about potential "self-selection bias."  Patients who underwent surgery were, per the conclusion, "appropriately selected," which may mean they were already been in a better mental and financial position than those who did not undergo surgery.  Put another way: Did the medical treatment cause the improvement in mental health, or were the people who were more stable to begin with simply more likely to undergo surgery?

I think that this is a valid question. This study was included in the list because it directly contradicts the findings of the study that you referenced. However, we can add a caveat to this - which is that we are dealing with insurance company records, and consequently have some expectation that there is a little more uniformity here than in the study referenced in the OP. But likewise, we can ask the same questions about the study that you referenced - and you were certainly quick to jump to the conclusion that it was the surgery that caused harm, and not some other existing condition.

35 minutes ago, smac97 said:

The study relied on "{a} national insurance claims-based database," meaning it only captured diagnosed and treated mental health conditions.  What about patients who stopped seeking care for depression or anxiety post-surgery?  Was it because they had improved due to the surgery?  Or was it because they lost their insurance, or because they felt discouraged from seeking mental health care, or because they had untreated symptoms that were no longer coded in the database, etc.?

The study doesn't include individuals without a full data set. This is part of the reason why we get to these oddly specific numbers in the cohorts - in this case, 3134.

41 minutes ago, smac97 said:

As the article in the OP noted:

Yes, celebrity doctors ... - it's not that I don't agree with him, he's right on this point, but, the same could be said of just about anything.

42 minutes ago, smac97 said:

Also, the study does not examine whether mental health conditions were already improving before surgery.  If so, the post-surgery improvements may not be due to the surgery itself.

Right. That's the second study that I linked to. There is this problem in that we are only now starting to gather the longitudinal data that we need to really understand this issue well. But what we can say is that all of these comments can be turned around on the study you reference in the OP. And that is the real point of this first study.

44 minutes ago, smac97 said:

Then there's the "publication bias" issue.  Positive outcomes from gender-affirming care are more likely to be published, while studies with neutral or negative findings may be underreported or dismissed.

And now we are getting in to your proverbial ad hominem, right? The Journal for the American Society of Plastic Surgeons probably has its biases - but I doubt very much that they are significantly more biased than The Journal of Sexual Medicine. But who knows. How much research did you do into the Journal of Sexual Medicine before posting your comments?

48 minutes ago, smac97 said:

Meanwhile, I continue to come across articles like this:

Misrepresentations of evidence in “gender-affirming care is preventative care”

Yeah, there's just not much there, is there ... This isn't research. And, I don't think that anyone here has been arguing that gender-affirming care is preventative care. In fact, we have been discussing something that is just the opposite - that when you have significant gender dysphoria, gender affirming surgery is a way of reducing that dysphoria. This views the mental health concerns as symptoms of the dysphoria, of course. So your throwing this out there isn't helping this discussion at all - it is just creating a distraction. I don't think that most of the participants would disagree with the author - that without evidence, it is unethical to claim that gender affirming care is preventative in some sense. No one here believes that if you are perfectly healthy (no diagnosis at all) that somehow gender-affirmation surgery will make you a happier person.

1 hour ago, smac97 said:

One of the first order pieces of evidence is, well, reactions such as I have seen in this thread.  Shrill accusations of bigotry and hatred in lieu of substantive and evidence-based discussion.  Emotionalisms and vitriol abound.  These are the tools of censorship and suppression, not reasoned inquiry.

The moment that you stop with abusive language, the moment that you stop with the false narratives, that is when I will stop labeling your behavior as bigotry. It is that simple. You are the one introducing the vitriol and the emotionalism. You are appealing to the often false narratives. You aren't presenting reasoned inquiry. And if you took the same level of scrutiny towards your own sources as you are trying to take to mine, I think that we might get much less of it.

1 hour ago, smac97 said:

As with the first article above, this appears to be an observational study, purporting to identify an association between mental health conditions and postoperative complications.  It does not seem to establish causation.

I don't disagree. If I were terribly interested in their conclusions (and I'm not), I might urge caution. But the reality is that it is widely recognized that mental health concerns can have a significant impact on post-operative complications regardless of the kind of surgery. In that respect, it's just not that interesting. What is interesting here is that it gives us a baseline for mental health concerns for those who get gender affirming surgery - prior to that surgery. And so if we compare that to the post-surgery mental health numbers provided in the survey that you link to, what we can see is that as a group, those individuals see a collective increase in mental health and not a decline. And that points to the problem in the research that you link to. The baselines for everyone with a gender dysphoria diagnosis is nowhere near as bad as the baseline for those with gender dysphoria who get surgery. So the conclusions drawn by the FOX News article are way off course from reality. That is the point of my inclusion of this research. Now, if those who get the surgery had a similar baseline to that of the entirety of those diagnoses with gender dysphoria, your article might have a point. But as it is, it seems to be some really bad reporting.

1 hour ago, smac97 said:

Also, the study, being based on insurance data, necessarily excludes undiagnosed conditions.  Many mental health issues go undiagnosed or untreated, so the study may underestimate the actual prevalence.

But since we are comparing studies, this sort of thing is an irrelevancy. Again, your source does all of these same things. You didn't volunteer any of this sort of skepticism though, did you.

1 hour ago, smac97 said:

These seem like some pretty serious limitations.

Ok. And your study was better in what way? It is a real question, and I would like a real answer.

1 hour ago, smac97 said:

The study is observational and cross-sectional, meaning it only addresses associations at a single point in time.

This is not an abnormality. It reflects the limitations at this time in longitudinal data.

1 hour ago, smac97 said:

It does not appear to present evidence of causality (that is, that GAS causes improved mental health outcomes).  Improvements might also be attributable to natural developments over time, or increased social support after GAS, or that the patient was already improving prior to the surgery, or some combination of these.

I don't think that you can get evidence for causality in the sense that you seem to be asking for here. This includes the study that you refer to in the OP. There is no evidence in the study for causality (it's why you should read that study as well).

1 hour ago, smac97 said:

And the self-selection bias is here again.  The study compares people who chose to undergo GAS to those who wanted it but did not get it.  The former group may be more financially stable, more socially supported, and in better overall mental health before surgery.  If so, these factors could materially skew the post-GAS results.  That is, the folks reporting better mental health outcomes may have that result not due GAS, but rather to underlying advantages.

I am not sure this is as meaningful as you think it is. Just how would this skew the outcome in a way that would make your case salvageable? The study that you put forward in the OP has the same self-selection bias, right? And you are arguing that those who get the surgery are so well off - so financially supported, and so much better off in terms of overall mental health before surgery that it affects the outcomes here in ways that are the complete opposite of how it affects the outcomes in your studies? And yet, across the board, those who get surgery have (as we saw above) a relatively high incidence rate of problems. So no matter how we slice this loaf of bread, we can say with some certainty that your thread title is clearly not supported by the data. I will say, though, that around 25 percent of gender affirmation surgeries use medicaid as their payer source. This is hardly a group that is in a more financially stable state ...

1 hour ago, smac97 said:

Also, the study relies on a very questionable dataset, namely, the 2015 U.S. Transgender Survey (USTS), which was not conducted using random sampling.  It was self-selected, meaning that only people who chose to participate were included, such that the sample may not be representative of the broader transgender population.   It also increases the likelihood of participants with certain experiences (that is, positive views of GAS) being overrepresented.  Non-random, non-probability sampling is a big issue.

Most social science research is conducted with these kinds of data sets. It's hard to imagine how you would get your data otherwise - especially at the level of granularity you need to answer these kinds of questions. What you don't have though, is a reasonable explanation of how or why this would make them unrepresentative of the broader transgender population. We actually have the same problem at the root level for any study (including the one that you provide in the OP) in that getting a diagnosis generally requires interactions with health care workers and self reporting. We don't (in the health care field) simply discount this sort of data. So yes, there could be all sorts of variables in here. But those kinds of variables work across the board. The uncertainty here (whatever it is you imagine) is at work in the study you reference in the OP. So how do you deal with that? Do you see the irony of your list of challenges in light of your not even accepting the data in the study, but the FOX News summary of that data?

1 hour ago, smac97 said:

I want people with Gender Dysphoria to have a better quality of life.  I question whether gender-affirming surgery is facilitating that, or if it is doing more harm than good.

I think that this is highly disingenuous. You have a clear ideological position on the practice that is not rooted at all in evidence based research. You may question this, but you aren't challenging any statement that would suggest that it is doing harm (which is where your ideological belief stands). So I am skeptical.

1 hour ago, smac97 said:

If we were having a discussion about, say, disputed issues touching medical interventions in pediatric oncology, I think this discussion would be going very differently.  Any such disagreements would be about the data, the real-world efficacies.  There would not be hysterics and vitriol in which a disagreement is chalked up to "Well, it's obvious that you are bigoted towards children with cancer."

If we were having that discussion, you would be posting material of an entirely different character. So your hysterics (and yes, your use of language fits that description) wouldn't exist.

1 hour ago, smac97 said:

And yet when GAS is under discussion, responding to disagreement by throwing out baseless accusations of bigotry and hatred is standard fare from you and yours.  This makes me think the issue is more ideological and dogmatic than it is about reason and evidence. 

And here is the kicker - my comments are not baseless. This must really drive you nuts apparently, to be called out for your offensive behavior and language. Perhaps you thrive on it - I don't know - I really don't care. But I stand by my characterizations.

1 hour ago, smac97 said:

I hope we can set aside ideological and sociopolitical factors and improve our assessment of whether GAS facilitates that. 

Normally, part of this process would be to let it play out while we collect better data, and while we determine the necessary data that we need to collect. But this isn't your call to action. Your call to action is to eliminate GAS entirely. I say that tongue in cheek because of course you aren't really interested I think in targeting GAS. After all, the most common GAS is breast removal. And the studies we have say that roughly 80 percent of breast removals in cisgendered adult men are performed for individuals who identify as male. In minors, that number climbs to over 96%. I think that you would find GAS in that context to be just fine. And this comes back to the problem that you don't really want to set aside your ideological and sociopolitical factors - you just want your opponents to do that.

[SeekingUnderstanding]

3 minutes ago, smac97 said:

Gender-affirming surgery, while beneficial in affirming gender identity, is associated with increased risk of mental health issues, underscoring the need for ongoing, gender-sensitive mental health support for transgender individuals’ post-surgery."

From the article: "Trans surgeries increase risk of mental health conditions, suicidal ideations."

These are NOT the same. And if you weren’t blinded by bigotry it would be obvious to you.

[smac97]

7 minutes ago, SeekingUnderstanding said:

Stop willfully spreading propaganda.

Stop trying to suppress viewpoints with which you disagree.

7 minutes ago, SeekingUnderstanding said:

The OP was just propaganda.

Respectfully, no.  It was a news item.

7 minutes ago, SeekingUnderstanding said:

FoxNews, which you willfully parroted did not even attempt to faithfully represent the study in question. 

I think it did.  Moreover, I looked for, found and provided a link to an abstract of the study.  And I provided my own thoughts and commentary.  So I did not "parrot" anything.

7 minutes ago, SeekingUnderstanding said:

If you thoughtlessly spread propaganda that makes you a propagandist.

"If."

My post was not thoughtless, and the article is not "propaganda."

It would be nice if you could get past ad hominem stuff.

7 minutes ago, SeekingUnderstanding said:

If you claim that you didn’t know it was propaganda, that makes you a bigot.

And more ad hominem.

7 minutes ago, SeekingUnderstanding said:

Because for anyone that cares about what’s actually going on,

I care about what is going on.

I care enough to post articles in a forum where I know people such as you, Ben, Nehor, etc. are going to resort to ugly personal attacks, which I take as an attempt to suppress speech which you dislike. 

I invite you to consider what has been called the "Counterspeech Doctrine."  See, e.g., here:

Quote

The counterspeech doctrine posits that the proper response to negative speech is to counter it with positive expression. It derives from the theory that audiences, or recipients of the expression, can weigh for themselves the values of competing ideas and, hopefully, follow the better approach.

The counterspeech doctrine is one of the most important free-expression principles in First Amendment jurisprudence. 

See also this sage observation from Justice Brandeis:

Quote

Justice Louis D. Brandeis established it in his classic concurring opinion in Whitney v. California (1927), when he wrote:

“If there be time to expose through discussion, the falsehoods and fallacies, to avert the evil by the processes of education, the remedy to be applied is more speech, not enforced silence.”

As we are in an online forum, physical violence is not really a part of the calculus (though Nehor has ominously declared that "secur{ing}" "{t}ransgender rights" "requires" (his wording) "fighting, shooting authoritarians and fascists, ... burning things, throwing pies into the faces of bigots, and all the rest").

Also, since you and your fellows don't own the board, you cannot get me booted from it.

That leaves the "Great & Spacious Building" approach to seek "enforce silence": coercion and suppression through shame.  Hence the various and repeated vitriolic accusations of "bigotry," "hate" "propaganda" and all the rest.

7 minutes ago, SeekingUnderstanding said:

it was painfully clear that your OP was propaganda. So you you missed it, you are extremely blinded (bigoted) on this issue. 

And more ad hominem.

Thanks,

-Smac

[smac97]

16 minutes ago, SeekingUnderstanding said:

This is where you completely loose the plot and your blatant bigotry is on full display.

And more ad hominem.

16 minutes ago, SeekingUnderstanding said:

Your opening post took research and willfully and blatantly misrepresented it.

Respectfully, I did no such thing.

16 minutes ago, SeekingUnderstanding said:

OTOH, Ben’s links represent good faith efforts to understand what’s going on.

So are mine.

16 minutes ago, SeekingUnderstanding said:

They are not the end all and be all of what’s going on  FURTHER STUDY IS NEEDED.

I agree.

16 minutes ago, SeekingUnderstanding said:

These studies acknowledge this. But what Ben’s links don’t do is blatantly lie like this: “

Trans surgeries increase risk of mental health conditions, suicidal ideations: study”

When your headline is a blatant misrepresentation of everything that follows, you’re really off to a bad start. 

That you think there’s some kind of equivalent going on here displays your bigotry.

And more ad hominem.

Thanks,

-Smac

[smac97]

1 hour ago, Benjamin McGuire said:

The moment that you stop with abusive language,

I don't think I have used "abusive language."  That's your gig.  And SU's.  And Nehor's.

1 hour ago, Benjamin McGuire said:

the moment that you stop with the false narratives,

I don't think I have posted any "false narratives."

These are difficult issues, and reasonable minds can disagree about them.

1 hour ago, Benjamin McGuire said:

that is when I will stop labeling your behavior as bigotry. It is that simple.

And more ad hominem.

Nobody likes being publicly disparaged in the ways you and Nehor mete out.  And all I have to do to avoid it is . . . submit.  Knock on your door and ask you to not call me a bigot.  Conform.  "Think the way you want me to think."  Capitulate.  Praise the emperor's beautiful clothes.  Don't speak.  Don't give voice to my thoughts.  Don't do these things, or else Ben will publicly disparage my character.  "It is that simple."

I'll pass.

1 hour ago, Benjamin McGuire said:

You are the one introducing the vitriol and the emotionalism.

Respectfully, I am not.  The vitriol has been from you, SU, Nehor, etc.

1 hour ago, Benjamin McGuire said:

You are appealing to the often false narratives.

Labeling viewpoints you disagree with as "false narratives" puts the cart before the horse.

1 hour ago, Benjamin McGuire said:

You aren't presenting reasoned inquiry.

I think I am.  I am providing links to studies and news items, commenting on them, etc.

1 hour ago, Benjamin McGuire said:

And if you took the same level of scrutiny towards your own sources as you are trying to take to mine, I think that we might get much less of it.

I started this thread to have a discussion.  And we are having it.  I would like to have it without the vitriol.

1 hour ago, Benjamin McGuire said:

Again, your source does all of these same things. You didn't volunteer any of this sort of skepticism though, did you.

I brought it here and opened it for discussion.

1 hour ago, Benjamin McGuire said:

Quote

These seem like some pretty serious limitations.

Ok. And your study was better in what way? It is a real question, and I would like a real answer.

It's not my study.  I didn't write it.  I brought it here for discussion, knowing that it would be picked apart.  And it has been.

1 hour ago, Benjamin McGuire said:

This is not an abnormality. It reflects the limitations at this time in longitudinal data.

Which lack (of longitudinal data) has been a substantial concern of mine for quite a while.

1 hour ago, Benjamin McGuire said:

Quote

I want people with Gender Dysphoria to have a better quality of life.  I question whether gender-affirming surgery is facilitating that, or if it is doing more harm than good.

I think that this is highly disingenuous.

And more ad hominem.

I am the world's leading authority on what I think.

1 hour ago, Benjamin McGuire said:

You have a clear ideological position on the practice

Yes.  Here is that position: I want people with Gender Dysphoria to have a better quality of life.  I question whether gender-affirming surgery is facilitating that, or if it is doing more harm than good.

1 hour ago, Benjamin McGuire said:

that is not rooted at all in evidence based research.

I think we are mostly lacking in "evidence based research."  That said, I have done a lot of reading and thinking and writing on this stuff.

I think some appreciable portions of the extant "research" are ideologically compromised. There is strong evidence of ideological/sociopolitical influences/pressures on this area of medical care.

I think we are lacking in meaningful longitudinal data.

I think these absences essentially negate the possibility of "informed consent."

I think comorbidities are not getting nearly enough attention as they deserve.

I think there is cause for real concern re: "social contagion" aspects of this issue.

I think these medical treatments are largely irreversible, often result in permanent sterilization, often require lifeline medical regimens, and so on.  

I think many people, including you, are ignoring these concerns, and that you are also attempting to suppress or censor discussion of them by shouting them down with accusations of "bigotry," "hatred," and so on.

Again, I want people with Gender Dysphoria to have a better quality of life.  I question whether gender-affirming surgery is facilitating that, or if it is doing more harm than good.

1 hour ago, Benjamin McGuire said:

Quote

If we were having a discussion about, say, disputed issues touching medical interventions in pediatric oncology, I think this discussion would be going very differently.  Any such disagreements would be about the data, the real-world efficacies.  There would not be hysterics and vitriol in which a disagreement is chalked up to "Well, it's obvious that you are bigoted towards children with cancer."

If we were having that discussion, you would be posting material of an entirely different character.

Probably so, since the "material" would not be nearly as prone to being compromised by ideological/sociopolitical influences/pressures on medical care, which influences/pressures are far more apparent and forceful as regarding GAS.

1 hour ago, Benjamin McGuire said:

So your hysterics (and yes, your use of language fits that description) wouldn't exist.

I haven't called anyone a bigot, hater, propagandist, etc.  That's all you and yours.

1 hour ago, Benjamin McGuire said:

And here is the kicker - my comments are not baseless.

Well, yes, they are.

1 hour ago, Benjamin McGuire said:

This must really drive you nuts apparently, to be called out for your offensive behavior and language.

Not really.  I'm objecting, but that's about it.

1 hour ago, Benjamin McGuire said:

Perhaps you thrive on it - I don't know - I really don't care. But I stand by my characterizations.

Yes, i see that.

Meanwhile, despite your attempt to speak for me, I'll lay out my general position: I want people with Gender Dysphoria to have a better quality of life.  I question whether gender-affirming surgery is facilitating that, or if it is doing more harm than good.

1 hour ago, Benjamin McGuire said:

Normally, part of this process would be to let it play out while we collect better data, and while we determine the necessary data that we need to collect. But this isn't your call to action.

Yes, it is.  I have noted, many times in many posts in many threads over many years, the absence of useful longitudinal data, and our need for it.

1 hour ago, Benjamin McGuire said:

Your call to action is to eliminate GAS entirely.

Um, no.  I've never said that.  I expressly deny and reject any such a thing.

If someone wants GAS, and if comorbidities are absent or sufficiently managed, and if meaningful longitudinal data is available and validated, and if the patient can provide informed consent, and if the person has the financial means to endure the lifelong medical regimen that follows some GAS, and if the person is aware of the irreversibility and sterilization effects (part of having "informed consent"), and if proper authorities and experts have approved a GAS as being medically ethical and legally authorized, then I think individuals ought to have that option.  We're in a free country.

My concern, though, is that comorbidities are not absent or sufficiently managed, and meaningful longitudinal data is not yet available and validated, and I am concerned that patients are not situated to give informed consent, and so on.

And for voicing these concerns, you and yours label me a bigot.

1 hour ago, Benjamin McGuire said:

I say that tongue in cheek because of course you aren't really interested I think in targeting GAS.

I have substantially larger concerns with GAS as pertaining to minors.

1 hour ago, Benjamin McGuire said:

After all, the most common GAS is breast removal.  And the studies we have say that roughly 80 percent of breast removals in cisgendered adult men are performed for individuals who identify as male. In minors, that number climbs to over 96%. I think that you would find GAS in that context to be just fine.

Assuming comorbidities are absent or sufficiently managed, meaningful longitudinal data is available and validated, and the patient has provided informed consent (I question whether minors can do this, but mentally competent adults can), sure.  

1 hour ago, Benjamin McGuire said:

And this comes back to the problem that you don't really want to set aside your ideological and sociopolitical factors - you just want your opponents to do that.

Again: I want people with Gender Dysphoria to have a better quality of life.  I question whether gender-affirming surgery is facilitating that, or if it is doing more harm than good.

Thanks,

-Smac

Edited March 7, 2025 by smac97

[smac97]

56 minutes ago, SeekingUnderstanding said:

These are NOT the same. And if you weren’t blinded by bigotry it would be obvious to you.

And more ad hominem.

Thanks,

-Smac

[The Nehor]

3 hours ago, teddyaware said:

What blind arrogance! What in the world should one expect other than defenses of church doctrine coming from testimony bearing church member participants on a dialogue board that’s specifically focused on the beliefs and teachings of the Church of Jesus Christ of Latter-Day Saints? Yet you’re somehow perplexed and exasperated that believing members of the restored church of Christ would actually have the nerve to dare to defend the church leaders against attacks coming from mockers who shout insults and scripturally indefensible positions from the windows of the large and spacious building?

Wait….are you under the impression that church leaders wrote the article that started this thread?

[The Nehor]

3 hours ago, Kenngo1969 said:

Do you think he's lying when he says he will consider something?  If so, why?

Yes. Past experience.

[The Nehor]

3 hours ago, smac97 said:

Seems like the study is behind a paywall.

I am curious as to the design of the study.  Was it observational?

If the study shows an association between gender-affirming surgery and improved mental health outcomes, does that establish causation?

The study used "Propensity Score Matching," which seems to have some substantial problems.

I am also wondering about potential "self-selection bias."  Patients who underwent surgery were, per the conclusion, "appropriately selected," which may mean they were already been in a better mental and financial position than those who did not undergo surgery.  Put another way: Did the medical treatment cause the improvement in mental health, or were the people who were more stable to begin with simply more likely to undergo surgery?

The study relied on "{a} national insurance claims-based database," meaning it only captured diagnosed and treated mental health conditions.  What about patients who stopped seeking care for depression or anxiety post-surgery?  Was it because they had improved due to the surgery?  Or was it because they lost their insurance, or because they felt discouraged from seeking mental health care, or because they had untreated symptoms that were no longer coded in the database, etc.?

What is the duration of the follow-up?  The study does not specify long-term outcomes.  In my review of various materials, it seems pretty clear that mental health improvements post-surgery may be temporary, with issues like regret, continued dysphoria, or other stressors emerging later.  As the article in the OP noted:

Also, the study does not examine whether mental health conditions were already improving before surgery.  If so, the post-surgery improvements may not be due to the surgery itself.

Then there's the "publication bias" issue.  Positive outcomes from gender-affirming care are more likely to be published, while studies with neutral or negative findings may be underreported or dismissed.

Meanwhile, I continue to come across articles like this:

Misrepresentations of evidence in “gender-affirming care is preventative care”

And this one: The gender-affirming model of care is incompatible with competent, ethical medical practice

Some excerpts:

"They substitute the political goal of expanding personal liberty for the evidence-based medicine processes of clinical reasoning, rendering them incompatible with competent, ethical medical practice."

I am concerned this is a widespread thing.

One of the first order pieces of evidence is, well, reactions such as I have seen in this thread.  Shrill accusations of bigotry and hatred in lieu of substantive and evidence-based discussion.  Emotionalisms and vitriol abound.  These are the tools of censorship and suppression, not reasoned inquiry.

As with the first article above, this appears to be an observational study, purporting to identify an association between mental health conditions and postoperative complications.  It does not seem to establish causation.

Also, the study relies on an insurance dataset.  Diagnoses and complications may be underreported or misclassified in billing records, and the study wouldn't know, since it did not actually interact with any of the actual patients.  

Also, the study does not include detailed patient evaluations or direct clinical data.  Just extrapolations from insurance data.

Also, the study, being based on insurance data, necessarily excludes undiagnosed conditions.  Many mental health issues go undiagnosed or untreated, so the study may underestimate the actual prevalence.

Also, the study does not distinguish between types or severity of mental health issues (that is, mild anxiety and severe schizophrenia are jumbled together).

Also, the study apparently does not control for patients receiving, or not receiving, treatment for their mental health issues, which could impact outcomes.

Also, as with so many of these studies, this one is apparently short-term.  It only tracks complications within 90 days of surgery.  Many complications, particularly mental health-related ones, can arise months or years later.  Consequently, the short-term follow-up term means the study may miss long-term complications or delayed improvements.  This defect is particularly concerning to me, as it is so prevalent in these studies that I can't help but wonder if the researchers are doing it intentionally.  That is, they are rushing to capture "positive" data that they know is more likely in the short-term period immediately following medical treatment, and deliberately ignoring longer-term data.  Is it because longer-term data contravenes the researchers' preferred narrative and outcome?

Also, the study compares patients who had diagnosed mental health conditions with people who did not.  Is there a "selection bias" issue here?  People with more serious mental health conditions may have been denied surgery altogether, leading to an underestimation of risks.  

Also, there does not seem to be a control group.  The study only compares gender-affirming surgery ("GAS") patients with versus without mental health conditions.

Also, the study itself acknowledges its limitations:

These seem like some pretty serious limitations.

Hmm.  Quite a few questions here.

The study is observational and cross-sectional, meaning it only addresses associations at a single point in time.

It does not appear to present evidence of causality (that is, that GAS causes improved mental health outcomes).  Improvements might also be attributable to natural developments over time, or increased social support after GAS, or that the patient was already improving prior to the surgery, or some combination of these.

And the self-selection bias is here again.  The study compares people who chose to undergo GAS to those who wanted it but did not get it.  The former group may be more financially stable, more socially supported, and in better overall mental health before surgery.  If so, these factors could materially skew the post-GAS results.  That is, the folks reporting better mental health outcomes may have that result not due GAS, but rather to underlying advantages.

The article also relies entirely on self-reported data.  Lots of biases here, and also a lack of clinical validation.

Also, the study relies on a very questionable dataset, namely, the 2015 U.S. Transgender Survey (USTS), which was not conducted using random sampling.  It was self-selected, meaning that only people who chose to participate were included, such that the sample may not be representative of the broader transgender population.   It also increases the likelihood of participants with certain experiences (that is, positive views of GAS) being overrepresented.  Non-random, non-probability sampling is a big issue.

Also, the study cites a 2019 Swedish study which purported to show improved outcomes, but it notably fails to mention that a correction to the study removed evidence of a mental health benefit when compared to controls.

These studies do not resolve my concerns, but rather corroborate them.

Not sure you can say that.  Lots of factors are in play.

Well, maybe.  In the short term.  For some.

I want people with Gender Dysphoria to have a better quality of life.  I question whether gender-affirming surgery is facilitating that, or if it is doing more harm than good.

If we were having a discussion about, say, disputed issues touching on medical interventions in pediatric oncology, I think this discussion would be going very differently.  Any such disagreements would be about the data, the real-world efficacies.  There would not be hysterics and vitriol in which a disagreement is chalked up to "Well, it's obvious that you are bigoted towards children with cancer."

And yet when GAS is under discussion, responding to disagreement by throwing out baseless accusations of bigotry and hatred is standard fare from you and yours.  This makes me think the issue is more ideological and dogmatic than it is about reason and evidence. 

Again, I want people with Gender Dysphoria to have a better quality of life.  I hope we can set aside ideological and sociopolitical factors and improve our assessment of whether GAS facilitates that. 

Thanks,

-Smac

When it agrees with you you are willing to write up a thread title that is a lie and fawn over its wisdom without any critical thought or study.

When it disagrees with you you argue that we don’t yet have enough evidence to support this, there are minor concerns with the data, and we need more study.

You swallow outright lies that tell you what you want to hear while downplaying actual evidence as completely insufficient even though the evidence is overwhelming compared to the propaganda tripe you feed on.

Then you demand reasoned discourse based on evidence. The devil has taught you well.

[Bernard Gui]

5 hours ago, ttribe said:

Yes, that is quite apropos. I wish I had thought of it. Just a few pages in, and smac is called a pervert, a liar, and a bigot while defending a moral position. This always happens here. 

Edited March 7, 2025 by Bernard Gui

[The Nehor]

27 minutes ago, smac97 said:

And more ad hominem.

You really need to learn what that fallacy is. You almost never use it correctly.

Ad hominem means attacking the person instead of their argument or the evidence supporting it. Lots of people actively tore down your ‘evidence’ and exposed it as lies. Speculating about why you are presenting and defending lies is not an ad hominem attack. Even saying someone regularly lies and therefore what they say cannot be trusted is not an ad hominem attack. Credibility is important.

If I said you are secretly a drag queen, use orphans as slave labor, kick puppies, or even just that you are a member of the Church so feel compelled to take this stance that would be an ad hominem. It is not relevant to figuring out the truth. That you are posting misinformation is, however, very relevant and ranting about snark and ad hominem and how mean everyone is for exposing falsehoods is just petulant and infantile.