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The general belief, at least amongst the LGBT community, is that gender reassignment surgery will increase the quality of life of transgender individuals. Obviously those that undergo the surgery believe so.

I've seen conflicting results as to the accuracy of this statement. Some studies seem to suggest this may not always be the case

https://web.archive.org/web/20140701194727/https://waltheyer.typepad.com/blog/2013/11/20-regret-changing-genders-over-40attempt-suicide-and-even-after-surgery-a-large-number-remain-traum.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/

However, this article is dedicated to trying to refute the same claims

http://www.huffingtonpost.com/brynn-tannehill/myths-about-transition-regrets_b_6160626.html

I would like to get the best assessment of the viability of reassignment surgery as a treatment for Gender Dysphoria.

For the sake of this question I am interested in a treatment of those who already identify as transgender and are perusing other treatments (such as hormones). I consider the surgery to be successful if the quality of life for a transgender individual is better post surgery, even if it is still lower then your average non-transgender individual.

For instance it seems pretty well agreed that suicide rates of post-surgery individuals are still far higher than suicide rate of non-transgender individuals. However, since suicide rates are higher amongst all transgender individuals, regardless of reassignment surgery, that statistic means nothing to me until compared to suicide rates of those transgender who have not undergone surgery.

I'm not quite sure how to better define quality of life, even though I know I need a more exact definition. If anyone can suggest good criteria as a basis to use I'll be happy to update the question with something more exact. For now, I'm interested in how happy, or depressed, the individual is pre- or post-surgery; including how content they are with themselves and their body; via whatever criteria one would use to judge such criteria.

I realize that all things considered there is limited data available, owing to the very small number of individuals who perform the surgery, difficulty of setting up anything like a control or double blind study, and disappearance of patients after the study completes. I'm hoping to get data as accurate as possible, understanding that there is an inevitable level of uncertainty due to limited ability to do thorough studies.

Edit: as culture can be a factor in such answers, let's focus on transgender people in USA, Canada, and/or England (who all, I feel, share similar enough culture for the sake of this question).

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    Surely considerable aspects of "quality of life" are subjective. Do you propose a way to objective tell someone that they are wrong about their own feeling?
    – dmckee --- ex-moderator kitten
    Commented Jun 16, 2015 at 23:08
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    @dmckee as I said, I am open to any more objective definitions you can think of. If you can suggest a good objective definition I'm happy to consider updating my question to match it. Any suggestions?
    – dsollen
    Commented Jun 17, 2015 at 12:50
  • No, I have no better suggestion. I see quality of life as a primarily subjective in nature.
    – dmckee --- ex-moderator kitten
    Commented Jun 17, 2015 at 14:28
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    those transgendered who have not undergone surgery, reliable numbers on those will be impossible to obtain, as those might be from cultures where transgender is a taboo and they might have been hiding it from everyone (possibly including themselves).
    – gerrit
    Commented Jun 17, 2015 at 15:09
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    @gerrit I did update the question to focus on western cultures to try to limit culture differences affecting the result. However, Since I limited my question to comparing post surgery transgender to transgender who were receiving treatment specifically I think your concern is addressed. Those who have not expressed their identity, to their psychiatrist already, would be excluded from my criteria and thus don't matter for answers. I'm interested in what helps those seeking treatment now, surgical options hardly matters to those not seeking treatment anyways after all.
    – dsollen
    Commented Jun 17, 2015 at 15:39

3 Answers 3

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Studies

The Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People has a good summary of studies (starting at page 229 (PDF page 65)). All quotes are from the standard of care (not in order though), and I linked to those studies that I could find freely available online for easy reference.

These studies measure more concrete things than "quality of life", including rate of regret (relevant as your blog article mentions this), mental and physical health, sexual satisfaction, etc.

Since the Standards of Care have been in place [meaning since 1979], there has been a steady increase in patient satisfaction and decrease in dissatisfaction with the outcome of sex reassignment surgery

[...]

This study [J. K. Meyer & Reter, 1979 [only abstract]] focused on patients’ occupational, educational, marital, and domiciliary stability. The results revealed several significant changes with treatment. These changes were not seen as positive

[...]

Participants in that study [Pauly, 1981] had much better outcomes: Among 83 FtM patients, 80.7% had a satisfactory outcome (i.e., patient self report of “improved social and emotional adjustment”) [...] Among 283 MtF patients, 71.4% had a satisfactory outcome

[...]

The findings of Rehman and colleagues (1999) and Krege and colleagues (2001) are typical of this body of work; none of the patients in these studies regretted having had surgery, and most reported being satisfied with the cosmetic and functional results of the surgery.

[...]

A prospective study conducted in the Netherlands evaluated 325 consecutive adult and adolescent subjects seeking sex reassignment (Smith, Van Goozen, Kuiper, & Cohen-Kettenis, 2005 [only abstract]). Patients who underwent sex reassignment therapy (both hormonal and surgical intervention) showed improvements in their mean gender dysphoria scores, measured by the Utrecht Gender Dysphoria Scale. Scores for body dissatisfaction and psychological function also improved in most categories. Fewer than 2% of patients expressed regret after therapy.

[...]

The vast majority of follow-up studies have shown an undeniable beneficial effect of sex reassignment surgery on postoperative outcomes such as subjective well being, cosmesis, and sexual function (De Cuypere et al., 2005; Garaffa, Christopher, & Ralph, 2010 [only abstract]; Klein & Gorzalka, 2009 [only abstract])

The standard of care then goes on to list some studies showing less beneficial results, but criticizes them for bad methods or comparing post op trans people with cis people to show that their quality of life is lower (instead of comparing them to pre op trans people or measuring increase/decrease in quality of life of individuals).

The swedish study you link to also has a good list of references, here are some quotes from them that I think are relevant:

http://www.ncbi.nlm.nih.gov/pubmed/19473181

80% of individuals with GID reported significant improvement in gender dysphoria [...]; 78% reported significant improvement in psychological symptoms [...]; 80% reported significant improvement in quality of life [...]; and 72% reported significant improvement in sexual function [...].

http://www.ncbi.nlm.nih.gov/pubmed/9570489

The results showed that 3.8% of the patients who were sex reassigned during 1972-1992 regretted the measures taken. [...] The results of logistic regression analysis indicated that two factors predicted regret of sex reassignment, namely lack of support from the patient's family, and the patient belonging to the non-core group of transsexuals

http://www.ncbi.nlm.nih.gov/pubmed/16362252

After SRS, the transsexual person's expectations were met at an emotional and social level, but less so at the physical and sexual level even though a large number of transsexuals (80%) reported improvement of their sexuality.

Your Links

Chris Hydes statements (eg "there's still a large number of people who have the surgery but remain traumatised - often to the point of committing suicide") are not the result of a study (as in published, peer reviewed), but just research he did for The Guardian.

The Guardian also says this: "Research from the US and Holland suggests that up to a fifth of patients regret changing sex. A 1998 review by the Research and Development Directorate of the NHS Executive found attempted suicide rates of up to 18% noted in some medical studies of gender reassignment.", but doesn't link to it, nor cites it correctly. I could not find it. But it seems that they infer from an 18% suicide rate that 18% (up to a fifth) regret sex reassignment surgery, which doesn't seem like a reasonable conclusion to me (and I doubt that the NHS made this conclusion).

As for the swedish study, it is a study comparing post op trans people to cis people, so it doesn't say anything about the success or failure of gender reassignment surgeries (and it doesn't try to do this either).

The linked blog post also mentions a 41% suicide rate for transgender people overall, but I agree with you, I don't see how that is relevant to sex reassignment surgery.

The only actual study showing adverse effects of gender reassignment surgery I could find in your links is the 1979 study by Meyer & Reter.

Conclusion

The sources I could find highly suggest that the quality of life of trans people who want SRS increases after SRS, and the majority of trans people do not regret SRS.

The linked claims to the contrary rely on decade-old studies or purposefully misrepresent the results of more recent studies.

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    All good data, though your last quote concerns me some. I would expect higher then a 2% dissatisfaction reported for any type of surgery; there are always people with regrets or who simply had bad surgery or other issues. A claim as low as 2% makes me question the validity of that particular study, especially with ambiguous 'with therapy' phrase on the end; the rest looks good though. Did these studies make any attempt to control for people who dropped out of studies or did not report? I assume they used multiple criteria, not just self reporting of satisfaction?
    – dsollen
    Commented Jun 17, 2015 at 15:25
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    @dsollen I added a study that puts the rate at ~4%. Personally, I could believe such low numbers (most surgeries are easy to get, while SRS is extremely hard to get, which might lead to lower dissatisfaction rates). The main point for me is that no study exists which supports the 20% claim the OP linked to. Criteria seem to mainly consist of self reported data, but eg the meassure of sexual satisfaction include (self reported, I assume) masturbation rate; other criteria are the need for revision surgery, general health (depression, heart conditions, ...), stability of sexual relationships, etc
    – tim
    Commented Jun 17, 2015 at 15:53
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    If there is a 41% suicide rate, and an 18% suicide rate after sex reassignment surgery, then sex reassignment surgery seems to be highly advisable. On the other hand, I'd want to know where these numbers come from.
    – gnasher729
    Commented Apr 26, 2017 at 19:57
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    Re Sweden: here is an interesting image from Swedish public service svtstatic.se/image/wide/650/21720634/1554212242 that shows the number of boys (blue line) and girls (red line) that are treated for gender dysphoria. There was an update to this statistics in a follow up program sent earlier 2020. I couldn't find an image with a diagram but this 1 minute clip shows it in the background svt.se/nyheter/granskning/ug/… - the number hade gone down 65 % in just a year!!
    – d-b
    Commented Jun 15, 2020 at 6:55
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Regarding http://waltheyer.typepad.com/blog/2013/11/20-regret-changing-genders-over-40attempt-suicide-and-even-after-surgery-a-large-number-remain-traum.html

Walt Heyer was by his own admission in his autobiography given a ". . . a treatment for a disorder [gender identity disorder] I didn't have. I wasn't a man trapped in a woman's body. I was an alcoholic with dissociative disorder." (Trading My Sorrows, p118.)"

Alcoholics with what used to be called "multiple personalities" are perhaps not the most credible of witnesses, and everything they say should be checked.

Regarding "This study [J. K. Meyer & Reter, 1979 [only abstract]] focused on patients’ occupational, educational, marital, and domiciliary stability. The results revealed several significant changes with treatment. These changes were not seen as positive"

From Sex Reassignment. Thirty Years of International Follow-up Studies After Sex Reassignment Surgery: A Comprehensive Review, 1961-1991 Friedemann Pfäfflin, Astrid Junge (Translated from German into American English by Roberta B. Jacobson and Alf B. Meier) re the 1979 Meyer study: ""The tables and figures shared by the authors do not seem serious because after the scoring table a maximum of only eight minus and five plus points can be achieved, but in the results table (p. 1014) a range from -18 to +19 points is given. How these figures came about remains totally in the dark....One asks the question how it came about that a renowned professional publication published such opaque figure material."

I would recommend looking at the chapter on this study, as it's a textbook case of bad science published for political ends. The Pfäfflin text is also worth reading in its own right, as it's quite comprehensive, albeit dated now. A volume II covering 1991-2021 would be useful, and would likely take 5 years to write.

A good review of the evidence for the effectiveness of trans surgery is in the Department of Health and Human Services DEPARTMENTAL APPEALS BOARD Appellate Division NCD 140.3, Transsexual Surgery Docket No. A-13-87 Decision No. 2576 May 30, 2014.

This reviewed the evidence to decide whether such treatment should be covered under the US Medicare and Medicaid programs, based on their effectiveness.

Here is a meta-list of over 100 citations on the effectiveness of various treatment protocols, hormonal and surgical. Basically, there is strong evidence that the triadic therapy including surgery and hormones works.

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    Welcome to Skeptics! Is this intended as answer to the question? I don't see what your answer is.
    – Oddthinking ♦
    Commented May 30, 2016 at 12:58
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    While I appreciate your contribution some of the answer could use some rework to fit the standard format. The first example is not a study and thus owouldn't be qualified. As to the other two links, it could use some clarification as to the point being made. You site a complaint about a study but it's not clear why the complaint is relevant, and the final paragraph does not give an overview of the study results. A little more description on why the links are relevant, and removal of the first quote which doesn't meet our standards for proof, could make this a good & useful post.
    – dsollen
    Commented May 30, 2016 at 16:13
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    Hopefully this clears up some of the flaws. I do think the first quotation from the cited author's autobiography is relevant regarding being able to judge the likely worth of the assertions made in the original citation. They should be checked with a more sceptical eye than is usual.
    – Zoe Brain
    Commented May 30, 2016 at 23:03
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    So we can safely assume that it is not a good idea to have a gender reassignment operation if you are not a trangender person. But I think most of us knew that already.
    – gnasher729
    Commented Apr 28, 2017 at 22:10
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http://transadvocate.com/fact-check-study-shows-transition-makes-trans-people-suicidal_n_15483.htm is an interview with the main author of the Swedish study used by anti-trans critics to cite high suicide rates. She totally disavows their misinterpretations of her work.

"Dhejne: People who misuse the study always omit the fact that the study clearly states that it is not an evaluation of gender dysphoria treatment. If we look at the literature, we find that several recent studies conclude that WPATH Standards of Care compliant treatment decrease gender dysphoria and improves mental health."

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    That study shows that the more time has passed since an operation, the higher suicide rates are. The unjustified conclusion is that people are unhappier with the result as they grow older. More likely is that the quality of these operations has improved over the years, and if a long time has gone by since the operation, the person likely had an operation that was of lower quality with less good results.
    – gnasher729
    Commented Apr 26, 2017 at 20:05

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