Catholic Voices answers: Is affirmation the path to happiness in gender dysphoria?

By Dr Ryan Corbin

We live in a society which values its inclusivity and fluidity. An extension of this has been the global recognition of the challenges faced by those who do not conform to the classical heterosexual identity.

This is true especially for those suffering from gender dysphoria and define themselves as transsexual i.e., a person whose sex assigned at birth does not match their gender identity.

The abuse, turmoil and pain felt by these individuals have been great, fuelling the global cry for a solution. This “oppression” experienced has been so traumatising that any underlying psychological analysis is discouraged and questioning the dysphoria is seen as participating in the oppression and bigotry.

Subsequently, a new culture has developed where affirmation has become the common social/professional solution towards the ultimate goal of happiness.1 Research has been reported claiming a definitive psychological benefit from gender affirmation surgery and hormone therapy.2 However, is affirmation helping individuals who are truly in agony?

Firstly, we must understand the underlying anguish of those suffering from gender dysphoria who are searching for something common to every human: happiness. It is this desire for happiness, coupled with affirmation which motivates them to pursue surgery, seeking a cure to their misery.

Medicine is a dynamic field with evolving management strategies usually guided by strong unbiased clinical governance, i.e., evidence-based medicine.  Is this true in the case of the management of gender dysphoria?

A Google search of “benefits of gender affirming surgery” reveals many articles from reputable sites which claim the “proven” psychological benefits from Gender affirming surgery. However, further analysis reveals some key observations seemed to have been overlooked.

Studies

The top links in this Google search references the Bränström study published from Sweden in 2019 by the American Journal of Psychiatry.3 This study concluded that while gender medical affirmation (hormonal therapy) offered no benefit, gender surgical affirmation reduced mental health treatment after transitioning.

The authors further asserted this “provides timely support for policies that ensure coverage of gender affirming treatments”.3 The statistical analysis and conclusions were professionally challenged leading to the American Journal of Psychiatry then issuing a delayed major correction. The reanalysis revealed that neither medical nor surgical affirmation reduced the need to seek mental health services or had psychological benefits.4 Despite this, many reputable sites still quote the initial findings as reference for the benefits of surgical affirmation.5

The 2011 Swedish Dhejne study is valued as one of the strongest studies done investigating long-term ( >10 years) mental health effects of affirmation approaches to management.6

From the study, the sex-reassigned group had 19 times the rate of completed suicides and nearly three times the rate of all-cause mortality and inpatient psychiatric care, compared to the general population.

Further to this, a 2018 systematic review of quality-of-life studies of transitioned adults rated only two out of the 29 studies as high quality.7 With this paucity of reliable data, coupled with the strongest research showing poor psychological benefits at best, is affirmation truly the “gold standard” of treatment of gender dysphoria? Is affirmation the path to happiness?

Love can be defined as unselfishly seeking the best of another regardless of the circumstances i.e., ultimate happiness. The deepest happiness is that which addresses the core of our being: the heart. This is the most intimate element of one’s identity that connects the individual towards his/her purpose.

Those who seek surgical affirmation believe one of their primary purposes is gender transitioning. If so, why did this management not help those in the Dhejne study (Sweden)?

In a country reported by the United Nations as one of the “happiest” in the world, why are our brothers and sisters who transitioned still in turmoil? Is there, then, more to the pursuit of true happiness than affirmation?

Happiness

We have argued that happiness comes from acknowledging our deepest purpose. Let us propose that this implies our relationship with our Creator, God, therefore that pursuit of happiness is towards God.

Through humility, happiness comes firstly from finding that identity common to all humanity, our sonship/daughtership to our Father God. From this foundation we grow the tools to cope with the challenges before us, gaining peace amidst our inner turmoil and outward appearance.

It is only within this framework, the gifts of the world open to us in a true expression of freedom. This philosophy nurtures a deeper life perspective where we are not being defined by our inclinations. We begin to value the other equally important aspects of our character, shaping our holistic impression of ourselves which builds a wider foundation of our happiness.

Our friends who suffer from gender dysphoria should not feel alone in their struggle and they should be guided not by emotions but by sound evidence-based medicine.

Love is willed by all. Let us truly affirm our love by providing the best means towards lasting, fulfilling happiness.

Catholic Voices T&T positions itself as a voice of lay persons within the Church, equipped with the tools to properly and more positively address the issues presented within the local public domain. Contact: www.facebook.com/CVTnT

References:

1. What Is Gender Dysphoria? American Psychiatric Association, November 2020. www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria
2. Wernick, Jeremy A et al. A Systematic Review of the Psychological Benefits of Gender-Affirming Surgery. The Urologic clinics of North America vol. 46,4 (2019): 475-486. doi:10.1016/j.ucl.2019.07.002
3. Bränström, Richard, and John E Pachankis. Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. The American journal of psychiatry vol. 177,8 (2020): 727-734. doi:10.1176/appi.ajp.2019.19010080
4. Correction to Bränström and Pachankis. The American journal of psychiatry vol. 177,8 (2020): 734. doi:10.1176/appi.ajp.2020.1778correction
5. Gender Affirmation (Confirmation) or Sex Reassignment Surgery. The Cleveland Clinic. my.clevelandclinic.org/health/treatments/21526-gender-affirmation-confirmation-or-sex-reassignment-surgery
6. Dhejne, Cecilia et al. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PloS one vol. 6,2 e16885. 22 Feb. 2011, doi:10.1371/journal.pone.0016885
7. Nobili, Anna et al Quality of life of treatment-seeking transgender adults: A systematic review and meta-analysis. Reviews in endocrine & metabolic disorders vol. 19,3 (2018): 199-220. doi:10.1007/s11154-018-9459-y