Fact Check: Musk Says Trans Study Shows Higher Suicide Rate After Surgery

Since his takeover of Twitter, Elon Musk has not hesitated to engage in sensitive topics on the social media platform.

Having previously courted controversy over gender, the billionaire has entered into multiple conversations about transgender treatment and care.

During one recent exchange on transgender health, Musk quoted a study suggesting that those who had undergone transgender surgery were more likely to die by suicide than the general population.

The Claim

A tweet by Musk, posted on April 25, 2023, viewed 1.2 million times, claimed that a "comprehensive study in Sweden" showed that "sex-reassigned" persons showed increased suicide.

Musk added: "Death for sex-reassigned persons was higher than for controls of same birth sex, particularly death from suicide. They also had increased risk for suicide attempts and psychiatric inpatient care."

The Facts

The association between transgender people and poorer mental health outcomes is documented. Multiple studies have observed association between suicide attempts and people who identify as transgender, with figures ranging from about 20 percent to 40 percent within those populations.

However, the study that Musk cites contains some important details that should be taken into consideration when looking at his claim.

The study, published in 2011, estimated the "mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons" of "324 "sex-reassigned persons" in Sweden for 30 years. Each of these participants was matched with 10 population controls matched by birth year and birth sex or "reassigned (final) sex."

Data, which was taken from health and population registers in Sweden, found that those who had their sex "reassigned" were more likely to have died by suicide, made a suicide attempt or been psychiatrically hospitalized.

The paper stated: "This highlights that post surgical transsexuals are a risk group that need long-term psychiatric and somatic follow-up. Even though surgery and hormonal therapy alleviates gender dysphoria, it is apparently not sufficient to remedy the high rates of morbidity and mortality found among transsexual persons.

"Improved care for the transsexual group after the sex reassignment should therefore be considered."

Although a long-term analysis, the findings might reflect only the attitudes toward and lack of support for transgender people from 1973 to 2003. The paper recognizes modern improvements to sex reassignment surgery, hormonal treatments and psychosocial care that "might have improved the outcome" of the transgender case studies.

In keeping with this, other results in the study appear to show that those who had surgery later in the data set had a lower incidence rate of some of the mortality and morbidity outcomes it measured.

For example, the researchers found that there was not a statistically significant higher risk of suicide attempts among those who had reassignment surgery between 1989 and 2003 compared to those who did so between 1973 and 1988. The overall mortality rate was also only significantly higher in the group that had the surgery before 1989.

While we cannot conclude without further analysis why the 15-year period in which reassignment surgeries were performed led to these statistical differences, the study notes that it might be explained "by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions."

Historical context is important in assessing health risks as serious and sensitive as suicide, particularly in marginalized groups. It was just over 10 years ago that the American Psychiatric Association revised its Diagnostic and Statistical Manual of Mental Disorders to no longer list being transgender as a mental disorder (after the study Musk cited was published).

It is just one example of the types of changes to attitudes and care that might affect access to and willingness to seek health care, support and treatment, and could have influenced the results here.

These attitudes might also have affected the pool of participants that the researchers were able to recruit. As mentioned, the cases in the study were also based on national database records, not cases identified individually or recruited within the population.

Had a greater number of individuals felt compelled or comfortable to seek surgery during the time period from which data was collected, it might have provided more representative results of what the actual risks of mental illness and suicide were among the wider transgender population.

In any case, while Musk is not necessarily wrong to quote the study—which does provide useful insights into the risk outcomes among those who undergo reassignment surgery—it also neglects to mention the historical context of the data it was based on and the evidence in it that suggests that younger generations experienced improved outcomes.

This month, several transgender groups accused Twitter of censoring language associated with the LGBTQ+ community. Certain words, such as "trans," "LGBT" or "BLM" (Black Lives Matter), were said not to appear in the preview pane if sent as a private message, known as a DM, on the platform.

Trans Safety Network, a U.K.-based organization of journalists and data analysts who provide research to decision-makers influencing actions that affect trans people's safety, also looked into the issue.

It found many more words seemed to have been banned from Twitter DMs, including "queer," "sex," "lesbian," "homosexual," "bisexual" and "intersex."

Newsweek reached out to Twitter for comment.

The Ruling

Needs Context.

While Musk did not incorrectly quote the results of the 2011 study, his tweet does not mention that it was based on data from (in some instances) 50 years ago, nor does it mention the improved outcomes among the younger generations in the study.

Although the study Musk mentions provides some interesting insight into transgender-based outcomes, the importance of the historical context from which the data was taken should be carefully considered.

FACT CHECK BY Newsweek's Fact Check team