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This sounds like a very high rate

Results Individuals who underwent gender-affirming surgery had a 12.12-fold higher suicide attempt risk than those who did not (3.47% vs. 0.29%, RR 95% CI 9.20-15.96, p < 0.0001).

I’m not competent to deconstruct a medical paper in the same way that I sometimes to often can an economic one. Anyone with that sort of training (BiG? Grikath?) like to walk us through this?

My immediate response is that it’s not looking at those who think they are trans and don’t have surgery with those who think they are and do. But as above, what do I know?

14 thoughts on “This sounds like a very high rate”

  1. I sneeze in threes

    Those who are more mentally delusional are more likely to opt for surgery. Most mentally delusional likely to have higher levels of suicide shocker! Film at 10pm

  2. Yes – it’s no surprise that transgender / body dysmorphic patients would have a higher propensity to self-harm and suicide than the general population – after all, they have a severe mental disorder. What would have been an informative study would compare the rates of self-harm and suicide in that population, sorted by whether they had or had not undergone “affirmation” surgery. The study did not make that comparison, so it tells us very little.

  3. It says that those who had “gender-affirming surgery” had a 12.12 fold higher rate of than a control of people who had an “emergency visit” (presumably any visit to A&E/ER).
    The ideal comparator group would be those who identified as transgender but did have surgery, so this is weak but indicative maybe.

  4. Its comparing A (people who have visited an emergency room (this is US data) AND have had trans surgery) with B (people who have visited an emergency room but have not had trans surgery, and with C (people who have visited an emergency room AND have had a vasectomy/tubal ligation, but no trans surgery). So its all ER visit data. 1500 people are in A, 15m in B and 140k in C.

    So the argument would be – is the group of people who visit the ER representative of the population as a whole or not? If it is then the relative suicide rates are valid, if its not then they aren’t. I’d suggest that the average trans person who has had surgery is far more likely to make an ER visit than the average non-trans person (due to the problems of chopping your bits off and turning them inside out, or vice versa) so that alone could account for their apparent increased suicide risk.

  5. And what Jim says.
    Ideally you need suicide rates for transgender people who have and who have not had bits chopped off. These are the populations you need to compare to start to decide whether surgery saves lives.

    Comparing to the general population is clearly unhelpful since transgender people have significantly higher suicide rates.

  6. Comparisons with general population and all that.
    Shirley the “propensity to cut bits off your own body” whether for trans or other reasons is a leading indicator for propensity to suicide.

  7. The Meissen Bison

    (3.47% vs. 0.29%, RR 95% CI 9.20-15.96, p < 0.0001).

    Relative risk? What about the absolute risk?

  8. Bloke in Germany

    The absolute risks (within the time period of observation) are 3.47% and 0.29%. The ratio of those gives you the relative risk.

    Confounders already given in the comments. Causation is not correlation, causation can never be inferred from this kind of comparison, therefore neither intervention or preventing intervention is likely to meaningfully affect outcome (risk of suicide attempt) for the individual, at least not based on this dsta. In English a wannabe trans stopped from tranning will not be less likely to top themselves dor being stopped. Logically perhaps dissatisfaction with having ones penis irreplaceably amputated likely contributes to some attempts.

    Correlation of one type of self harm from mental fucked upness with another form of self harm arising from mental fucked upness is no great shock.

    The really interesting thing would be to look at outcome based on both birth sex and lived gender, since IIRC females are more likely to attempt suicide, males more likely to succeed in so doing.

  9. Bloke in Germany

    An important way in which these populations differ is 100% of those who have gone under the knife are genuinely gender dysphoric. A very high proportion of those who have not just want to win races or hang around in girls changing rooms.

  10. ‘A very high proportion of those who have not just want to win races or hang around in girls changing rooms.’

    Nice argument, BiG.

  11. You are quite correct to spot the flaw. It’s like being told when you have appendicitis that five times as many people die after having their appendix removed than after having their tonsils removed (not true – made up numbers). This is useless for helping you decide whether to have your appendix removed rather than a different treatment or merely hoping the appendicitis goes away.

    @The Meissen Bison – “Relative risk? What about the absolute risk?”

    You can work backwards from the figures given in the paper. Cohort A (had GAS) was 1501 people, so 3.47% must mean 52 had suicide attempts. Cohort B (ER visit but no GAS) was 15,608,363 people, so 0.29% means 45,264 people had suicide attempts. If cohort B were representative of cohort A except for the surgery, then we would expect about 4 people in cohort A to have had suicide attempts, so there would have been 48 more.

    The paper’s abstract says “This study evaluates the risk of suicide or self-harm associated with gender affirmation procedures.”, but that is very inaccurate. It fails to account for the fact that patients who have GAS are very much not representative of people in general, and picking cohorts B, C, and D to compare against is not justified merely by B, C, and D also being unrepresentative of people in general for different reasons.

  12. “An important way in which these populations differ is 100% of those who have gone under the knife are genuinely gender dysphoric. ”

    Thats not necessarily true. You could be in considerable mental pain and having been told that ‘transitioning into a woman/man’ will solve your problems decide to go through with the surgery. It doesn’t necessarily mean the source of your mental anguish is actually gender dysphoria. It could be something else entirely (and probably is). Equally you could be manipulated by others with agendas, as that poor lad whose mother took him to Thailand to castrate him was.

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