Debunked: "The Swedish Study" Doesn't Say What Anti-Trans Activists Claim It Says

In many hearings lately, anti-trans activists have brought up "The Swedish Study" to claim that trans people have 19x higher suicide rates. This is a myth not supported by the study or the author.

In recent months, many anti-trans activists, Republicans and witnesses have cited a "Swedish Study," alleging that transgender individuals face a 19 times higher suicide rate after receiving gender-affirming care. Dr. Jennifer Bauwens mentioned this study in a congressional hearing on gender affirming care recently. Chloe Cole, a political detransitioner, referred to the study in a lawsuit against Kaiser Permenente. Even Elon Musk cited the study, suggesting he would "actively lobby to criminalize gender-affirming care for transgender youth." The issue? The "Swedish Study" doesn't support any of these claims. It uses data from several decades ago, a period when transgender people faced heightened abuse rates, to make a statement about that time period. Moreover, the study doesn't discuss or observe the impact of gender-affirming care on suicidality, contrary to what these opponents suggest.

Typically, when anti-trans activists refer to “The Swedish Study,” they are citing a 2011 study done by a research team led by Dr. Cecilia Dhejne, a medical research doctor specializing in gender identity. The study looked at 324 transgender people who had received sex-reassignment surgery between the years of 1973-2003. The purpose of the study was to analyze all-cause mortality among the patient population, historically, in order to assess transgender health in that time period. Specifically, the study says that it does not “address whether sex reassignment is an effective treatment or not.

Importantly, the study does not compare transgender people who received gender affirming care with transgender people who did not receive gender affirming care. Instead, it compares transgender people who received care with the general population of cisgender people - this is purposeful, as the point of the study was to evaluate the unique health risks of post-op transgender people. Again, the study makes no evaluation of the risks or effectiveness of gender affirming care.

The study recorded high rates of all-cause mortality and elevated suicide rates between 1973 and 2003. Such findings are consistent with the challenges faced by the transgender community during this period. Discrimination against transgender individuals was rampant. The AIDS/HIV epidemic disproportionately affected the community. While the gay rights movement made significant strides, transgender rights often lagged far behind. Past standards of care were extremely restrictive, mandating dozens of very costly therapy sessions. Access to hormone medication was heavily gatekept. Widespread discrimination was prevalent; during this era, many transgender individuals were compelled to present according to their assigned sex at birth in workplaces, schools, and various public spaces. It was a rough period for the transgender community.

Portrait credit: Sylvia Rivera (with Christina Hayworth and Julia Murray) by Luis Carle, gelatin silver print, 2000. National Portrait Gallery, Smithsonian Institution; acquisition made possible through the support of the Latino Initiatives Pool, administered by the Smithsonian Latino Center

Although the study recorded high rates of mortality and suicide, which is understandable given the political climate decades ago, it crucially did not compare the suicide and mortality rates of post-op trans individuals with those who did not receive care or surgery. This distinction is vital, given frequent assertions that the study claims "gender-affirming care leads to higher suicide rates." The study does not substantiate this claim. In reality, the elevated suicide rates in the 1980s likely resulted from widespread sexual violence, abuse, and discrimination faced by the transgender community in that era. It's likely that the suicide rates were even more pronounced among those who did not access care.

The author of the study has specifically come out against those who use the study to claim that “gender affirming care causes suicide” or that “gender affirming care does not lower suicide rates.” Dr. Dhejne, when addressing these misleading interpretations, stated of the study:

“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.”

Despite the study not saying what anti-trans activists claim it says, it is still one of the most commonly cited studies used to justify banning gender affirming care. It has been used in multiple hearings across the United States. The Heritage Foundation has referred to the study to support bans. The Florida AHCA report used to justify banning care in the state likewise leans heavily on the study.

Despite this, some anti-trans activists have noted that misusing the study is akin to willful dishonesty. Dr. Leor Sapir, a political scientist from the anti-trans Manhattan Institute who has advocated against gender affirming care, called out his colleagues over the misuse of the study:

Leor Sapir pointing out that those on his own side are misusing “The Swedish Study.”

Despite this, there are a wealth of studies that show that gender affirming care does save lives. A recent report from the medical journal, The Lancet, dated July 26, indicates that gender-affirming care is a form of preventative healthcare. This care is tied to improved quality of life and is vital for the well-being of transgender youth. Multiple studies have found that it leads to positive psychological outcomes and significantly reduces suicidality—with some research noting an impressive 73% drop. The effectiveness of gender-affirming care is bolstered by a compilation of more than 50 papers assembled by Cornell University, each emphasizing its positive effects.

In the future, anticipate more frequent references to "the Swedish study." Despite the fact that the study draws from data several decades old and doesn't compare the outcomes of those who received gender-affirming care with those who didn't, it has become a predominant source of misinformation. It's vital to be informed about such misinformation, especially as it is employed to support policies that undermine science and potentially transgender individuals globally.