In the clamour of the culture wars surrounding transgender issues, it’s easy to forget that at the centre, and maybe also in the shadows, is a small minority of people who, for the most part, would like to live their lives with as much fulfilment as they can.
Their numbers are indeed small, maybe 1 per cent of the population, though estimates vary. Gender transition can improve the lives of this minority quite substantially.
In this regard, I was very struck by a report on a review of 55 studies in English on gender transition and its effect on wellbeing conducted by Cornell University. The study found that, in 93 per cent of cases, gender transition improved the overall wellbeing of transgender people. “We found no studies concluding that gender transition causes overall harm,” the university said.
It’s a remarkable statement and, in itself, constitutes a strong case for efficient and effective gender transition treatment.
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Ireland has not been doing well in the area of transgender healthcare, coming last in a survey of the 27 EU member states by the EU-funded Transgender Europe last year. HSE chief clinical officer Dr Colm Henry announced in February that a new model of care was to be developed.
What may be the positive outcomes of transitioning for people with gender dysphoria (a clash between the gender one identifies with and one’s biological gender)?
According to the Cornell study it’s a long list: improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, reductions in anxiety and depression, in suicidality and in substance abuse. On the other hand, transgender individuals who cannot access treatment or whose social environment is not supportive “are more likely than the general population to experience health challenges such as depression, anxiety, suicidality and minority stress”.
Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques
— Cornell University study
But what if a person who transitions, or is in the course of transitioning, later regrets the decision?
The “regret rate”, according to various studies, ranges from 0.3 per cent of those who transition to 3.8 per cent. Either way, it’s a very small percentage. Interestingly, however, the Cornell study says that “regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques”.
The Italian current affairs magazine Internazionale quotes a 2015 transgender study to the effect that 62 per cent of those who change their minds still think of their gender as the one to which they chose to transition or they go back to living as that chosen gender. So the risk of regretting is low.
Gender dysphoria can result from differing hormonal influences on the genitals and the central nervous system before birth, according to Dr Alexandra Fisher, an endocrinologist working with trans people in Florence, interviewed for Internazionale. The hormonal influence on the genitals may push a person’s development in one direction such as male while the influence on the central nervous system pushes them in the female direction.
It’s important to remember that transgender people perceived as different may suffer bullying at school and may themselves have internalised feelings of inadequacy. So the quality of the emotional support, such as counselling, they get is very important.
A lot needs to be done, especially in Ireland. It will help if we can separate addressing the physical and psychological needs of people with gender dysphoria from wider controversies.
- Padraig O’Morain (Instagram, Twitter: @padraigomorain) is accredited by the Irish Association for Counselling and Psychotherapy. His books include Acceptance – Create change and move forward; his daily mindfulness reminder is available free by email (pomorain@yahoo.com).