A frequently cited piece of long-term research in discussions about transgender health is a Swedish study that examined outcomes for individuals who had undergone gender-affirming surgery. Because the study is often invoked to support various arguments, it is important to look closely at its findings, methodology, and context to understand its implications for transgender healthcare.
The 2011 Swedish Cohort Study
The 2011 paper, “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” was a national cohort study that followed a group over a long period. Using Sweden’s national registries, researchers tracked 324 transgender individuals (191 trans women and 133 trans men) who had gender-affirming surgery between 1973 and 2003. For comparison, control groups from the general population were matched to the transgender individuals by birth year and birth sex.
The study measured long-term outcomes including overall mortality rates, death by suicide, suicide attempts, psychiatric hospitalizations, and criminal conviction rates. The data was adjusted for factors like immigrant status and pre-existing psychiatric conditions.
Key Findings of the Study
The results showed that the group who had undergone surgery experienced higher overall mortality compared to the control group. The adjusted hazard ratio of 2.8 indicated a nearly three times higher risk of death from any cause, with this divergence in survival rates becoming apparent about 10 years post-surgery. The risk of death by suicide was 19.1 times higher for the transgender cohort, and the risk for any suicide attempt was 4.9 times higher. The study also found that transgender individuals had a 2.8 times higher likelihood of being hospitalized for a psychiatric disorder than the control group.
In examining criminal convictions, trans women (assigned male at birth) had a higher risk than control women but a rate that was not statistically different from control men. For trans men (assigned female at birth), there was a higher risk for convictions compared to control women, but their rates were not different from control men.
Author Conclusions and Study Limitations
The study’s authors did not conclude that gender-affirming care caused these negative outcomes or was ineffective. They interpreted their findings to mean that surgery and hormone therapy, while alleviating gender dysphoria, may not be enough to address all health challenges faced by transgender individuals. The researchers stated their findings “should inspire improved psychiatric and somatic care after sex reassignment for this patient group,” suggesting a need for more robust support.
A primary limitation is that medical practices and surgical techniques for gender-affirming care have evolved considerably since the study’s period. The care protocols from that era are substantially different from today’s standards, which are more refined and integrated with mental health support.
The social environment for transgender people has also changed. The cohort lived in a time with far less social acceptance and legal protection, and the study could not control for the impact of social stigma and discrimination on health.
Broader Context and Subsequent Research
Despite the authors’ conclusions and the study’s limitations, the 2011 research has been misrepresented by some groups to argue against gender-affirming medical care. This interpretation ignores the context of outdated medical practices and societal attitudes from the data collection period.
The scientific and medical consensus has advanced considerably since the study. Major medical organizations, including the World Professional Association for Transgender Health (WPATH) and the American Medical Association, support the necessity of gender-affirming care for treating gender dysphoria. A body of more recent research demonstrates that access to this care is associated with improved mental health, including reduced rates of suicidal ideation and depression. The current understanding, supported by a wide range of studies, is that gender-affirming care is a beneficial and effective intervention for improving the well-being of transgender individuals.