Archives of Sexual Behavior

, Volume 25, Issue 3, pp 303–316 | Cite as

Transsexualism—General outcome and prognostic factors: A five-year follow-up study of nineteen transsexuals in the process of changing sex

  • Owe Bodlund
  • Gunnar Kullgren


Ninetten transsexuals, approved for sex reassignment, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behavior), and DMT (Defense Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n=13) had improved in at least two areas of functioning. In 3 cases (16%) outcome were judged as unsatisfactory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socioeconomic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome.

Key Words

transsexualism sex reassignment outcome prognostic factors 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association. (1987).Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev., APA, Washington, DC.Google Scholar
  2. American Psychiatric Association. (1994).Diagnostic and Statistical Manual of Mental Disorders, 4th ed., APA, Washington, DC.Google Scholar
  3. Bakker, A., van Kesterer, P. J., Gooren, L. J., and Bezemer, P. D. (1993). The prevalence of transsexualism in The Netherlands.Acta Psychiat. Scand. 87:237–238.PubMedGoogle Scholar
  4. Benjamin, L. (1993).Interpersonal Diagnosis and Treatment of Personality Disorder, Guiford, New York.Google Scholar
  5. Blanchard, R., Steiner, B., Clemmensen H., and Dickey, R. (1989). Prediction of regrets in postoperative transsexuals.Can. J. Psychiat. 34:43–45.Google Scholar
  6. Bodlund, O., and Armelius, K. (1994). Self-image and personality traits in gender identity disorders—An empirical study.J. Sex. Marital Ther. 20(4): 301–314.Google Scholar
  7. Bodlund, O., Kullgren, G. Sundbom, E., and Hojerback, T (1993). Personality traits and disorders among transsexuals.Acta Psychiat. Scand. 88: 322–327.PubMedGoogle Scholar
  8. Burns, A., Farrell, M., and Brown, J. C. (1990). Clinical features of patients attending a gender-identity clinic.Br. J. Psychiat. 157: 265–268.Google Scholar
  9. Ekselius, L., Lindstrom, E., von Knorring, L., Bodlund, O., and Kullgren, G. (1994). SCID interviews and the SCID screen questionnaire as diagnostic tools for personality disorders in DSM-III-R.Acta Psychiat. Scand. 90: 120–123.PubMedGoogle Scholar
  10. Fisk, N. (1974). Gender dysphoria syndrome. Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome, Stanford University Medical Center, Stanford, CA, pp. 7–14.Google Scholar
  11. Green, R., and Fleming D. (1990). Sex reassignment surgery.Ann. Rev. Sex Res. 1.Google Scholar
  12. Hunt, D., and Hampson, J. L. (1980). Follow-up of 17 biologic male transsexuals after sex-reassignment surgery.Am J. Psychiat. 137: 4: 432–438.PubMedGoogle Scholar
  13. Kockott, G., and Fahrner, E.-M. (1988). Male-to-female and female-to-male transsexuals: A comparison.Arch. Sex. Behav. 6: 539–546.CrossRefGoogle Scholar
  14. Kragh, U. (1955).The actual-genetic model of perception-personality, Gleerup, Lund, SwedenGoogle Scholar
  15. Kullgren, G., and Armelius, B. A. (1990). The concept of personality organization: A long-term comparative follow-up study with special reference to borderline personality organization.J. Pers. Dis. 4(2): 203–212.Google Scholar
  16. Lundstrom, B., Pauly, I., and Walinder, J. (1984). Outcome of sex reassignment surgery.Acta Psychiat. Scand. 70: 289–294.PubMedGoogle Scholar
  17. Mate-Kole, C., Fresci, M., and Robin, A. (1990). A controlled study of psychological and social change after surgical gender reassignment in selected male transsexuals.Br. J. Psychiat. 157: 261–264.CrossRefGoogle Scholar
  18. Ohman, K., and Armelius, K. (1990). Schizophrenic and borderline patients: introjection, relationship to mother and symptoms,Acta Psychiat., Scand. 81: 488–496.Google Scholar
  19. Pauly, I. B. (1981) Outcome of sex reassignment surgery for transsexuals.Aust. N. Z. J. Psychiat. 15: 45–51.CrossRefGoogle Scholar
  20. Reich, J. H., and Vasile, G. V. (1993). Effect of personality disorders on treatment outcome of axis I conditions: An update.J. Nerv. Ment. Dis. 181: 475–484.PubMedGoogle Scholar
  21. Ross, M. W., Walinder, J., Lundstrom, B., and Thuve, I. (1981). Cross cultural approaches of transsexualism. A comparison between Sweden and Australia.Acta Psychiat. Scand. 63: 75–82.PubMedGoogle Scholar
  22. Smith, G., and Danielsson, A. (1982). Anxiety and defensive strategies in childhood and adolescence.Psychol. Issues: Monogr. 52.Google Scholar
  23. Sorensen, T. (1981). A follow-up study of operated transsexual females.Acta Psychiat. Scand. 64: 50–64.PubMedGoogle Scholar
  24. Spitzer, R. L., Williams, J. B. W., Gibbon, M., and First, M. B. (1992).The Structured Clinical Interview for DSM-III-R (SCID). 49: 624–629.Google Scholar
  25. Standards of Care (1985). The hormonal and surgical sex reassignment of gender dysphoric persons. The Harry Benjamin International Gender Dysphoria Association.Arch. Sex. Behav. 14: 79–90.CrossRefGoogle Scholar
  26. Sundbom, E., and Kullgren, G. (1992). Multivariate modelling and the Defence Mechanism Test: A comparative study of defensive structures in borderline, other personality disorders and schizophrenic disorder.Acta Psychiat. Scand. 86: 379–385.PubMedGoogle Scholar
  27. Sundbom, E., Bodlund, O., and Hojerback, T. (1995). Object relations and defensive operations in transsexuals and borderline patients as measured by the Defense Mechanism Test.Nordic J. Psychiat. 49: 379–388.Google Scholar
  28. Sundbom, E., Kullgren, G., and Armelius, B. A. (1989). Psychodynamic features in borderline personality disorder identified by a subliminal test, the Defense Mechanism Test.Acta Psychiat. Scand. 80: 101–105.PubMedGoogle Scholar
  29. Walinder, J. (1971). Incidence and sex ratio of transsexualism in Sweden.Br. J. Psychiat. 118: 16–20.Google Scholar
  30. Walinder, J., and Thuwe, J. (1975). Socialpsychiatric follow-up study of 23 sex-reassigned transsexuals.Am. J. Psychiat. 144: 748–752.Google Scholar
  31. Walinder, J., Lundström, B., and Thuwe, I. (1978). Prognostic factors in the assessments of male transsexuals for sex reassignment.Br. J. Psychiat. 132: 16–20.Google Scholar

Copyright information

© Plenum Publishing Corporation 1996

Authors and Affiliations

  • Owe Bodlund
    • 1
  • Gunnar Kullgren
    • 1
  1. 1.Department of PsychiatryUniversity of UmeåUmeåSweden

Personalised recommendations