acute suicidality was an exclusion criterion for this study (see section 4.6.4). There were two deaths by suicide in this study, and 11 reports of suicidal ideation, out of 315 participants, and these patients showed no evidence of being suicidal when the study began. This raises the possibility of iatrogenic harm. It would be beneficial to have more data on the suicidality of this cohort, but the next problem is that the authors did not report this data, despite collecting it according to their protocol document.
The 5 reported outcome measures in Chen 2023 are only a small fraction of the original data collected. The authors also assessed suicidality, Gender Dysphoria per se (not merely appearance congruence), body esteem and body image (two separate scales), service utilization, resiliency and other measures. This data is missing from the paper.