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Assertions by Australian Christian Lobby that were made on Q&A refuted
The Australian and New Zealand Professional Association for Transgender Health (ANZPATH) have released a statement regarding the Australian Christian Lobby’s misrepresentation of stats on the ABC program Q&A.
Quote:Australian and New Zealand
Professional Association for Transgender Health
6th March 2016To: Mr Peter McEvoy
Executive Producer Q&A
Australian Broadcasting Corporation Melbourne VICTORIADear Mr McEvoy,
ANZPATH (Australian and New Zealand Professional Association for Transgender Health) wishes to express deep concern in relation to misleading “facts” presented by Mr Lyle Shelton, managing director of the Australian Christian Lobby on the ABC’s Q&A program on Monday, 29 February 2016.
On the program, Mr Shelton stated that the suicide rate in people who had undergone sex reassignment surgery was 20 times higher than the general population 10 years after having had the surgery. The implication was that sex reassignment surgery was not an effective treatment for gender dysphoria. The facts quoted were from a study titled “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden” which was published by Cecilia Dhejne et al. in PLoS ONE, February 2011/ Volume 6 / Issue 2.
What Mr Shelton failed to state was the authors in their paper quoted several other studies “that suggest that sex reassignment of transsexual persons improves quality of life and gender dysphoria”. The authors went on to state “it is therefore important to note that the current study is only informative with respect to transsexual persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment.”
A study by G. De Cuypere et al. Titled “Long-term follow-up: psychosocial outcome of Belgian transsexuals after sex reassignment surgery” published in Sexologies 15 (2006) 126- 133, the authors stated “although the suicide attempt rate dropped significantly from 29.3% to 5.1%, it was definitely higher than in the average population”.
The mental health problems associated with being transgender, including the higher risk of suicide, is not inherently due to being transgender itself but due to the stigma, discrimination, exclusion and disadvantage inflicted by society. Society’s views of transgender individuals is unchanged by an individual’s decision to undergo sex reassignment surgery, hence the high suicide rate in the Swedish study even post operatively. However, society’s negative views of transsexualism can be reinforced when misinformation and trans-phobic comments are broadcast on national television.
In support of his argument that sex reassignment surgery was not an effective treatment for transsexualism, Mr Shelton went on to cite the closure of the Johns Hopkins Gender Identity Clinic in 1979 by Dr Paul McHugh as support for his argument. Mr Shelton describes McHugh and his colleagues as “pioneers” in the field.
Sex reassignment surgery was being carried out in Melbourne, at the Royal Melbourne Hospital, in the 1960s. McHugh’s decision to close the Johns Hopkins clinic was based on research carried out in 1979 by Dr Jon Meyer, one of McHugh’s staff psychiatrists. The research is outdated and methodologically flawed. Despite the research showing that patients who had undergone sex reassignment surgery reported subjective satisfaction post operatively and a low regret rate, McHugh (a Conservative Catholic) decided to close the clinic on the basis that patients did not show “sufficient” improvement on socio-economic and other parameters.
McHugh’s views have been widely criticised as outdated. He ignores extensive research over the past 30 years which clearly shows the efficacy of medical and surgical interventions for gender dysphoria in children, adolescents and adults. McHugh’s view that transsexualism is inherently psychopathological is no longer held by mental health professionals working in the field. Many take the view that transgenderism is simply a reflection of nature’s diversity. Diversity is how we have evolved as a species but while nature loves diversity, society does not. McHugh’s support for “reparative” psychological treatment has been rejected outright by WPATH (World Professional Association for Transgender Health) and ANZPATH. In some countries such as Canada, this therapy has been made illegal.
Mr Shelton went on to criticise Minus18, a support group for LGBT youth, and described the “sexualised content” of their publications as “horrific”. We feel his language is emotive and he fails to understand the intense gender dysphoria that drives young birth assigned females (who identify as male) to bind their breasts and young birth assigned males (who identify as female) to tuck their penises. Minus18 does not encourage these behaviours but gives accurate advice to young people who feel compelled to follow these procedures to alleviate their intense gender dysphoria.
Mr Shelton argues that treatment for transgender children remains “contested”. Within the medical and scientific community this statement is untrue. Without treatment during childhood and adolescence, 50% of adolescents self-harm and 28% attempt suicide (Hillier 2010). In contrast, young people with access to puberty blockers and hormones during adolescence had significantly reduced depression and anxiety with their quality of life, educational and vocational outcomes being equivalent to that of the general population (De Vries 2014).
He cites research claiming that 80% of transgender children, if left untreated, reconcile with their birth assigned gender. This statement is also not a true reflection of the research as these studies looked at children showing “gender non-conforming behaviour” but whom did not necessarily meet the full criteria for gender dysphoria. These children were not necessarily living in supportive environments and sufficient follow-up studies have not been conducted. This figure, therefore, is likely to significantly under-estimate the number of young children who persist with their transgender identification into adolescence.
Once a child reaches puberty (usually at the age of between 9-12 years) studies show the persistence rate is as high as 99.5%. The experience at the Royal Children’s Hospital in Melbourne is that the majority of young children who satisfy the diagnostic criteria for gender dysphoria in childhood and who have the benefit of supportive home and school environments, persist with gender dysphoria into adolescence and adulthood.
http://www.anzpath.org

Australian and New Zealand
Professional Association for Transgender Health
ANZPATH sincerely hopes that any further ABC television debates on this subject will be informed by accurate current scientific data presented by professionals who are expert in the field. It is regrettable that no gender health specialist or trans-identified person was represented on the Q&A panel discussion on Monday, 29 February 2016.Yours sincerely,
ANZPATH Executive:
Dr Fintan Harte MA MB BCh Dobs DCH FRCPsych FRANZCP Consultant Psychiatrist
President, ANZPATHDr Rob Lyons MB BS (Hons) FRANZCP Dip (Psych) Consultant Psychiatrist
Vice President, ANZPATHDr Jaco Erasmus MB ChB MRCPsych FRANZCP Consultant Psychiatrist
Treasurer, ANZPATHA/Prof Cindy Macardle PhD FFSc (RCPA) Consultant Pathologist (Science) Secretary, ANZPATH
Dr Michelle Telfer MB BS (Hons) FRACP Consultant Paediatrician
Executive Member, ANZPATHMs Kaete Walker RN BA (Social Welfare) Cert.Psych.Nursing Clinical Nurse Specialist
Executive Member, ANZPATH -
6 Replies
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Let’s hope that just for once a good set of facts can spoil a ridiculous transphobic rant.
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FactCheck Q&A: was Lyle Shelton right about transgender people and a higher suicide risk after surgery?
Kairi Kõlves
Griffith UniversityThe Conversation has fact-checked claims made on Q&A, broadcast Mondays on the ABC at 9:35pm.
Quote:Studies that have been done of transgendered people who have had sex reassignment surgery, people who have been followed for 20 or so years have found that after 10 years from the surgery, that their suicide mortality rate was actually 20 times higher than the non-transgendered population. So I’m very concerned that here we are encouraging young people to do things to their bodies … like chest binding for young girls … [and] penis tucking … Now this is taking kids on a trajectory that may well cause them to want to take radical action, such as gender reassignment surgery…– Lyle Shelton, managing director of the Australian Christian Lobby, speaking on Q&A on February 29, 2016.
Australia’s Safe Schools Coalition program has been accused of promoting a radical view of gender and sexuality in schools.
The program’s architects say it aims to boost acceptance of same sex attracted, intersex and gender diverse students, staff and families.
Critics have said that the program directs children to groups such as Minus18, a youth-led network for lesbian, gay, bisexual, transgender and intersex people. Among the resources on Minus18’s website is information about appearance modification for transgender people such as:
Quote:Changing your appearance is another way you can express your gender. Things like makeup, the clothes or school uniform you wear, binding your chest, tucking/packing your pants, or the way you do your hair can all help you better express yourself.Speaking on Q&A, the Australian Christian Lobby’s Lyle Shelton stressed that respect is essential and that no one should be bullied at school. However, Shelton said he would prefer anti-bullying programs didn’t include “contested gender ideology” that may lead to gender reassignment surgery.
He also said research showed that people who had undergone sex reassignment surgery were 20 times more likely to suicide than the general population a decade after their surgery.
Let’s take a closer look at what the research says.
Checking the research
Shelton did not respond to The Conversation’s request for comment and clarification. However, later in the program he referred to a Swedish study of over 300 people over about 30 years between 1973 and about 2003 that found that the suicide mortality rate was 20 times higher than the non transgendered population – so it seems likely he is referring to a 2011 study published in the journal PLOS ONE
That study, led by researcher Cecilia Dhejne, tracked 324 sex-reassigned people in Sweden between 1973 and 2003 to estimate their mortality, morbidity, and criminal rate after surgery. The researchers also included a comparison group. In that group, for every transgender person studied, the researchers included a non-transgendered person the same age and the same sex as the transgender person was before surgery.
The researchers found that:
Quote:Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population.The authors did not find that surgery was the cause of increased suicide risk, writing in their paper that:
Quote:the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment.Why are post-surgery transgender people at higher risk of suicide than the general population?
It is possible that Shelton was not implying any causal relationship between sex reassignment surgery and a higher suicide risk. The Conversation asked him to clarify what he wanted to convey by mentioning the study, but he did not reply.
It is also possible some viewers may have been left with the impression that the study showed sex reassignment surgery causes a higher risk of suicide later in life. That is not the case.
The Conversation asked the authors of that study how they felt about the way Shelton had represented their findings. One of the authors, Mikael Landén from the Department of Clinical Neuroscience at Stockholm’s Karolinska Institutet medical university, told The Conversation that:
Quote:As Mr Shelton phrases it, it may sound as if sex reassignment increased suicide risk 20 times. That is not the case. The risk of suicide was increased 19 times compared to the general population, but that is because gender dysphoria is a distressing condition in itself. Our study does not inform us whether sex reassignment decreases (which is likely) or increases (which is unlikely) that risk.When asked why people who have had sex reassignment surgery may be more prone than the general population to suicide later in life, Landén said:
Quote:Gender dysphoria is a distressing condition. We have known for a long time that it is associated with other psychiatric disorders (such as depression) and increased rate of suicide attempts. Sex reassignment is the preferred treatment and outcome studies suggest that gender dysphoria (the main symptom) decreases. But it goes without saying that the procedure is a stressful life event. And that the surgery and medical treatment is not perfect. It is thus not surprising that this group of patients will continue to suffer from stress-related psychiatric disorders. There might be lingering professional and relational problems. It is also possible (but unproven) that gender dysphoria is somehow etiologically related to depression. In that case, fixing the first with a cure would not automatically fix the latter.In November 2015, Cecilia Dhejne told the website The TransAdvocate that, “Medical transition alone won’t resolve the effects of crushing social oppression: social anxiety, depression and post-traumatic stress.
(Dhejne also confirmed to The Conversation that the transcript of her interview on The TransAdvocate website is accurate).
What does other research say?
Recent literature reviews, including a literature review colleagues and I conducted reviewing Australian literature until the end of 2012, found a greater prevalence of suicidal behaviours among sexual minorities in general.
Risk factors for suicidal behaviours specific to LGBTI people include “coming out” in adolescence and early adulthood, prejudice, discrimination, shame, hostility, and self-hatred.
A recent review of literature focused on suicidal behaviours – including suicidal thought, suicide attempts and suicide rates – among trans people (the term used by the authors of that review) between 1966 and April 2015. The authors concluded that the prevalence of suicidal behaviours differs depending on the different stages of transition, but they are still overall greater than the general population.
A 2011 Dutch study found that male-to-female transsexuals had a risk of suicide 5.7 times higher than the general population.
However, suicide risk was found not to be significantly higher in female-to-male transsexuals compared to the general population in an 18 year follow-up of 996 male-to-female and 365 female-to-male transexuals.
Again, those studies do not indicate the cause of increased suicide risk.
It’s possible that a number of other lifestyle factors, combined with lack of social support, discrimination and stigmatisation increase the risk of suicidal behaviour in the trans population.
Verdict
Shelton was correct to say that research shows that transgendered people who have had sex reassignment surgery had a suicide mortality rate later in life that was roughly 20 times higher than the non-transgendered population.
However, it is also possible some viewers may have been left with the impression that the study showed sex reassignment surgery causes a higher risk of suicide later in life. That is not what the Swedish study showed. In fact, the researchers wrote that things might have been even worse without sex reassignment.
Nevertheless, there is lack of research on the topic and his comment appears to be based on one study from Sweden.
This article was originally published on The Conversation. Read the original article
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Thanks Adrian. You are a great source of information!
It is interesting to reflect on the amount of attention currently on transgendered people. Even more disturbing than the Australian scene is the focus in the US on legislation to make it illegal for transgender people to use the facilities of their presentation.
Is being a focus a good thing or bad?
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Michelle_1 wrote:Is being a focus a good thing or bad?
I have previously argued that “being in the spotlight” (awareness) doesn’t necessarily lead to acceptance. What the ACL is demonstrating at the moment is the sad fact that awareness of transgender issues can be highjacked with deliberate misinformation to achieve very negative outcomes (for us).
Those who subscribe to the view that “All publicity is good publicity” would do well to observe how the ACL operates. They appear organised but we are often splintered and disorganised. We all need to spread postive information about being transgender to counter this, and if we can’t or won’t then perhaps it would be better to go a bit slower with less publicity and public focus.
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In my limited personal sphere, some publicity has been good with several folk mentioning Caitlin Jenner and wanting to know more. Some interesting discussions and the chance to educate. Separately though I’m pleased that the ‘I am Cait’ show may be cancelled. Her support of an anti-TG republican candidate is deeply disturbing.
I am yet to feel the effects of negative publicity but we in Australia enjoy some very positive legislation supporting difference. My fear is that might ultimately be threatened.
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Thankyou Adrian. I have been in email correspondence this week with the Queensland ACL leadership and this kind of research is precisely the kind of thing they are currently using to push their interests. Such clear and helpful rebuttals are most welcome – and exactly what I have been looking for this week to help others in whom this ACL approach has sown doubts.
I have to say that the exchange I have had with ACL has been surprisingly cordial, intelligent, and not without some small sign of concession in where ACL has been in the past. It has been a welcome change from the more vitriolic and hysterical comments and communications I have recently received from ACL fellow travellers locally. However I think it is this slightly more ‘sweetened’ and definitely more intelligent approach that is the real and substantial challenge at present. Whilst the visceral homophobia and transphobia is of course more directly offensive – and physically a potential personal threat – it is the apparent ‘reason’ of others on the right wing which sows seeds of doubt in those who would otherwise be clearly supportive.
In my view, we should not be fearful of the ACL, rightwing MPs, or their ilk. Frustrated yes! – I think they know the game is largely up for them (not least among the majority of Christians in this country) but current political mathematics (and the blinkered resistance of such as Catholic bishops, though not Catholics as such) still allow them sway. I feel therefore that we should increasingly be calling their bluff and showing up the shrinking foundations of their real support in the wider community. That the ACL is shifting towards transgender concerns is,in my view, also a sign that they recognise they have lost the argument over homosexuality with most people (including most Christians). It is also probably a recognition that transgender concerns even more radically undermine the rigid paradigms they have sought to construct – paradigms which run contrary both to contemporary reason and experience and to the variety of history and the considerable ambiguity of Christian tradition. Sadly we have to put up with these continued frenzied twitches for the time being!
