Reassessing Mental Health Treatment Utilization Reduction in Transgender Individuals After Gender-Affirming Surgeries: A Comment by the Editor on the Process

On October 4, 2019, we published an article by Bränström and Pachankis in which it was reported that observed reductions in mental health treatment utilization lent support to the decision to provide gender-affirming surgeries to those who seek them (1). After this article’s publication, we received several letters calling into question the statistical analyses employed and the conclusions drawn from said analyses. These letters follow this comment (2–8).

We enlisted the services of a statistical reviewer to look again at the article as well as the letters we received. We then sent the letters we received and the results of this statistical review, which called for a matched-pairs analysis, to the original authors. The study authors complied with the request to perform an additional analysis, as presented in their letter response (9).

We sent the original letters, statistical review, and author response to a second statistical reviewer. The response from this consultation convinced us that, 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 reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them” was too strong. In the August 2020 issue of the Journal, we are publishing a correction to this effect and including an addendum to the article pointing to this postpublication discussion and process, both of which were composed with contributions and approval from the original article authors.

We thank the letter writers, statistical reviewers, and the original study authors—as well as the editorialist we invited to place this study’s findings in context (10)—for helping us to make clear to our readers and for the literature what the article shows and what still remains to be investigated in future research.