- There is no conclusive evidence that sex change operations
improve the lives of transsexuals, with many people remaining severely
distressed and even suicidal after the operation, according to a medical
review conducted exclusively for Guardian Weekend tomorrow.
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- The review of more than 100 international medical studies
of post-operative transsexuals by the University of Birmingham's aggressive
research intelligence facility (Arif) found no robust scientific evidence
that gender reassignment surgery is clinically effective.
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- The Guardian asked Arif to conduct the review after speaking
to several people who regret changing gender or believe that the medical
care they received failed to prepare them for their new lives. They explain
why they are unhappy with their sex change and how they cope with the consequences
in the Weekend magazine tomorrow (July 31).
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- Chris Hyde, the director of Arif, said: "There is
a huge uncertainty over whether changing someone's sex is a good or a bad
thing. While no doubt great care is taken to ensure that appropriate patients
undergo gender reassignment, there's still a large number of people who
have the surgery but remain traumatised - often to the point of committing
suicide."
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- Arif, which advises the NHS in the West Midlands about
the evidence base of healthcare treatments, found that most of the medical
research on gender reassignment was poorly designed, which skewed the results
to suggest that sex change operations are beneficial.
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- Its review warns that the results of many gender reassignment
studies are unsound because researchers lost track of more than half of
the participants. For example, in a five-year study of 727 post-operative
transsexuals published last year, 495 people dropped out for unknown reasons.
Dr Hyde said the high drop out rate could reflect high levels of dissatisfaction
or even suicide among post-operative transsexuals. He called for the causes
of their deaths to be tracked to provide more evidence.
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- Dr Hyde said: "The bottom line is that although
it's clear that some people do well with gender reassignment surgery, the
available research does little to reassure about how many patients do badly
and, if so, how badly."
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- There are around 5,000 post-operative transsexuals in
the UK, according to the transgender pressure group Press for Change (PFC).
It is estimated that up to 400 sex changes will be performed this year
on the NHS and privately. Each operation costs the NHS around £3,000,
while private patients pay upwards of £8,000 for surgery.
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- Christine Burns, of PFC, said the campaign group's research
suggested that the vast majority of transsexual people enjoyed much happier
lives following surgery.
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- Ms Burns added that the greatest flaws in medical literature
about gender reassignment were in those studies unsympathetic to transsexual
people. For example, one study was based on a survey of seven transsexual
prostitutes interviewed in one gay bar in Chicago.
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- She said: "The fact that research is badly constructed
isn't a poor reflection on transpeople, but on the people we should be
able to trust for our care. If they "lose" half the patients
they ought to be able to track the question is why? As we've repeatedly
pointed out ourselves there is really no difficulty in getting transpeople
to come forward and cooperate in research that is properly constructed
and conceived with people's true well-being in mind."
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- 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.
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- Andrew McCulloch, chief executive of the Mental Health
Foundation, has written to the mental health minister, Rosie Winterton,
requesting a "thorough assessment" of the long-term effects of
sex change operations. He wants the National Institute for Clinical Excellence,
which decides what treatments should be available on the NHS, to draw up
guidelines on gender reassignment.
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- Transgender psychiatrists, who assess whether patients
should change sex, agree that more scientific research is needed. But Kevan
Wylie, chairman of the Royal College of Psychiatrists' working party on
gender identity disorders, said that all of his patients' lives have drastically
improved following gender reassignment surgery.
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- Dr Wylie added that it was difficult to conduct research
on the outcome of gender reassignment, or to compare its effects with alternative
treatments, because transsexualism was such a "rare experience".
Urological surgeon James Bellringer, who has performed more than 200 sex
changes over the past four years, claimed that trying to carry out research
that involves studying a control group of transsexual patients who were
denied hormones and surgery would be unethical.
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- Mr Bellringer, who works at the main NHS gender identity
clinic at Charing Cross hospital in west London, said: "I don't think
that any research that denied transsexual patients treatment would get
past an ethics committee. There's no other treatment that works. You either
have an operation or suffer a miserable life. A fifth of those who don't
get treatment commit suicide."
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- SocietyGuardian.co.uk © Guardian Newspapers Limited
2004
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- http://society.guardian.co.uk/mentalhealth/story/0,8150,1272093,00.html
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