(CP) Trans-identifying adults who undergo body-mutilating surgeries as part of an effort to look like the opposite sex have an elevated suicide attempt risk, according to a recent study.

The study, titled "Risk of Suicide and Self-Harm Following Gender-Affirmation Surgery," was published in April in the medical science journal Cureus. Researchers conducted the study by assessing over 90 million adults aged 18 to 60.

According to the study, individuals who underwent "gender-affirming surgery" had a 12-fold higher suicide attempt risk than those who did not. The researchers found that 3.5% of people who had an elective trans surgery were treated for attempting suicide. As the study reported, 0.3% of patients who did not undergo a surgical procedure did not attempt suicide.

One critic of the study, trans-identified journalist Erin Reed, published an analysis on his Substack page, Erin in The Morning, refuting its findings. The analysis claims that the authors' methodology raises questions about the study's accuracy.

Reed questioned the study's results, taking issue with the research because, he claimed, it compared people who had trans surgeries to non-trans-identifying individuals to determine if said surgeries increased the risk of suicide.

"To accurately assess whether transgender surgeries increase suicide risk, the correct control group would be transgender people who did not have surgery or, even more accurately, those who were denied surgery," Reed wrote. "It would be like judging the effectiveness of a new teaching method by comparing college students using the new method to those who never went to college, rather than to college students using the old method."

Dietrich Jehle, one of the study's authors, said in a statement to The Christian Post that they "looked at associations with outcomes rather than causation in a large propensity matched retrospective study." Jehle serves as professor and chair of the Sealy Department of Emergency Medicine at the University of Texas Medical Branch in Galveston, Texas.

"We did not look at the effect of surgery — just the outcomes of the population that had gender affirmation surgery," Jehle told CP, adding that trans-identifying individuals typically have higher rates of depression.

"[I should emphasize] that we did not use individuals that wanted gender affirmation surgery and were not granted the surgery as a control as patients are required to undergo at least two psychiatric evaluations in order to qualify for surgery (i.e., patients who qualify for surgery are at lower suicide risk than the group who wants surgery but does not qualify regardless of whether the group that qualifies undergoes surgery)," Jehle added.

According to the researcher, the "key point" of the study is that individuals who have undergone a trans surgery "need comprehensive psychiatric care in the years following the surgery."

"Our conclusion might be better worded: Patients who undergo gender-affirming surgery are associated with significantly elevated suicide attempt risks, underlining the necessity for comprehensive post-procedure psychiatric support," Jehle said.

He further told CP that researchers used "Z87.890" for the study, which is a code used in medical records to indicate whether someone has a history of undergoing trans procedures.

Regarding the methodology, the study consisted of four separate cohorts. The first Cohort, A, consisted of 1,501 adults aged 18 to 60, who underwent a trans surgery and later sought emergency care for suicidal ideation. Cohort B was intended to serve as the study's control group, and it consisted of adults aged 18 to 60 who had gone to an emergency room for mental health concerns but had no history of having undergone a sex-change operation.

Another group, Cohort C, served as the study's second control group, and it consisted of adults aged 18 to 60, who went to the ER and had tubal litigation (surgery performed on women to prevent pregnancy) or a vasectomy but they did not undergo "gender-affirmation surgery."

"A secondary analysis involving a control group with pharyngitis, referred to as cohort D, was conducted to validate the results from cohort C," the study stated.

The study concluded, "Gender-affirming surgery is significantly associated with elevated suicide attempt risks, underlining the necessity for comprehensive post-procedure psychiatric support."

Brandon Showalter, a social commentator for The Christian Post, who has done extensive research on the topic of gender dysphoria and so-called gender-affirming surgeries, noted that there can be a variety of factors that cause a person to feel compelled to end his or her life.

"While I'm not surprised to see these higher numbers in this latest research, the prevailing challenge for critics of these procedures is to make visible the harms of this experimental medicalization and irreversible surgeries, which are numerous aside from any consideration about how those medical practices might contribute to suicide," Showalter stated.

Discussions about the effectiveness of so-called "gender-affirming care" and the potentially negative impact on an individual's mental health are ongoing.

In October 2019, a study published in the American Journal of Psychiatry initially highlighted the mental health benefits associated with "gender-affirming" surgeries. Researchers analyzed the records of 9.7 million Swedes in the national population registry. Between 2005 and 2015, 1018 of the 2,679 individuals diagnosed with "gender incongruence" underwent surgery to remove their genitals or permanently alter their bodies.

The study authors highlighted a supposed 8% decrease in mood and anxiety disorders for postoperative patients each year after the surgery. The authors later posted a correction after several media outlets reported on the finding, stating their data "demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts."

A separate extensive long-term study conducted in Sweden by scholars at the Karolinska Institute and Gothenburg University concluded that "after sex reassignment, [trans-identified individuals] have considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population."

The study analyzed 324 individuals (191 male-to-female, 133 female-to-male) for over 30 years after a sex-change surgery from a period of 1973 to 2003.

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