Gender-confirming health care and mental illness

The often controversial guidance on “Healthcare of the Transgender Patient” by Dr. William Powers has triggered a lot of discussion. In his presentation Dr Powers does touch on many areas of care that don’t receive much discussion. This is a good thing!

On a slide titles “Mental Heath” Dr Powers proffers the following advice:
Screen for depression, anxiety, bipolar disorder or history of trauma. Refer, if needed, to a mental health provider who is capable of assessing and treating transgender people without denying their gender identity. Being transgender isn’t a mental illness, but transgender people have mental illness more than the general population ….

The prevalence of mental illness in the transgender population is something that seems to get forgotten in a rush to provide appropriate treatment for gender identity issues. It is convenient to assume that psychological issues are a result of the distress caused by years of gender dissonance. This leads to an assumption that transitioning and surgery will act as a miracle cure for any pre-existing conditions. We shun psychiatric care because we know our gender dissonance is not an illness.

Our reluctance to accept that there may be co-existing mental issues is compounded by the secrecy that shrouds outcomes of transitioning., I don’t mean here the short term surgical result, but rather the longer term mental and physical health of the transwoman or man. A Swedish study

journals.plos.org/plosone/article?id=10….journal.pone.0016885 is often quoted as it found

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population.

But in such a complex and diverse population one study is hardly definitive.

Whilst I don’t for one moment dispute that there are many happy stories out there that we don’t get to hear, I’m increasingly convinced that hormone therapy, transitioning and sex reassignment is not as certain to be the win/win dream change we may hope for. Where follow-up studies have been reported they often identify that trans women are not assured a feeling of gender congruence, and many will still have diagnosable psychiatric conditions. And the spectre of suicide continues to haunt us. It seems to me that addressing our mental health is a key part of gender confirming health care that we may ignore.