Journal of Happiness Studies

, Volume 18, Issue 5, pp 1305–1317 | Cite as

Eudaimonic Well-Being in Transsexual People, Before and After Gender Confirming Surgery

  • Antonio PrunasEmail author
  • Alessandra D. Fisher
  • Elisa Bandini
  • Mario Maggi
  • Valeria Pace
  • Orlando Todarello
  • Chiara De Bella
  • Maurizio Bini
Research Paper


Gender confirming surgery (GCS) and cross-sex hormones (CSH) are crucial steps in the self-realization of a transsexual individual. However, no study has analyzed the outcome of GCS in a eudaimonic perspective, nor explored eudaimonic well-being before GCS. The study compares the eudaimonic well-being of trans men (N = 56) and women (N = 89) before and after GCS; in the MtF sample, a further comparison was carried out between those who never started any medical intervention and those who were already taking CSH. Finally, the impact of experiences of harassment, discrimination and violence on eudaimonic well-being in the post-surgery sample was explored. All participants completed the Psychological Well-being Scales (Ryff in J Pers Soc Psychol 57:1069–1081, 1989) and, only the post-surgery sample, a questionnaire to assess previous experiences of harassment, discrimination and violence. Both in MtF and FtM participants, those who already received GCS showed higher scores on self-acceptance; in the MtF sample, higher scores were also found on environmental mastery and lower scores on personal growth. The association between experiences of discrimination on well-being was limited and positive, with higher scores in personal growth only in FtM participants who reported being victims of such experiences. Our results suggest that both MtF and FtM transsexuals show higher levels of eudaimonic well-being after GCS.


Transsexualism Eudaimonic well-being Gender confirming surgery Gender transition Transphobic violence 



The authors are heartily grateful to Patrizia Steca, PhD, and Dario Monzani, PhD, for precious comments on a previous draft of this paper.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.CrossRefGoogle Scholar
  2. Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943–951. doi: 10.2105/AJPH.2013.301241.CrossRefGoogle Scholar
  3. Browne, K., & Lim, J. (2008). Count me in too: LGBT lives in brighton and hove. Brighton, UK: University of Brighton. Retrieved from
  4. Caldarera, A., & Pfäfflin, F. (2011). Transsexualism and sex reassignment surgery in Italy. International Journal of Transgenderism, 13(1), 26–36.CrossRefGoogle Scholar
  5. Cass, V. C. (1979). Homosexual identity formation: A theoretical model. Journal of Homosexuality, 4, 219–235.CrossRefGoogle Scholar
  6. Cass, V. C. (1984). Homosexual identity formation: Testing a theoretical model. Journal of Sex Research, 20, 143–167.CrossRefGoogle Scholar
  7. Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., et al. (2011). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13, 165–232.CrossRefGoogle Scholar
  8. De Cuypere, G., T’Sjoen, G., Beerten, R., Selvaggi, G., De Sutter, P., Hoebeke, P., et al. (2005). Sexual and physical health after sex reassignment surgery. Archives of Sexual Behavior, 34(6), 679–690. doi: 10.1007/s10508-005-7926-5.CrossRefGoogle Scholar
  9. Devor, A. H. (2004). Witnessing and mirroring: A fourteen stage model of transsexual identity formation. Journal of Gay & Lesbian Psychotherapy, 8(1/2), 41–67.Google Scholar
  10. Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PloS One,. doi: 10.1371/journal.pone.0016885.Google Scholar
  11. European Union Agency for Fundamental Rights. (2014). Being trans in the European Union: comparative analysis of EU LGBT survey data. Retrieved from
  12. Giami, A., & Beaubatie, E. (2014). Gender identification and sex reassignment surgery in the trans population: A survey study in France. Archives of Sexual Behavior, 43(8), 1491–1501. doi: 10.1007/s10508-014-0382-3.CrossRefGoogle Scholar
  13. Gijs, L., & Brewaeys, A. (2007). Surgical treatment of gender dysphoria in adults and adolescents: Recent developments, effectiveness, and challenges. Annual Review of Sex Research, 18, 178–224.Google Scholar
  14. Harper, W., & Schneider, M. (2003). Oppression and discrimination among lesbian, gay, bisexual, and transgendered people and communities: a challenge for community psychology. American Journal of Community Psychology, 31(3/4), 243–252.CrossRefGoogle Scholar
  15. Keyes, C. L., Shmotkin, D., & Ryff, C. D. (2002). Optimizing well-being: The empirical encounter of two traditions. Journal of Personality and Social Psychology, 82(6), 1007–1022. doi: 10.1037/0022-3514.82.6.1007.CrossRefGoogle Scholar
  16. Klein, C., & Gorzalka, B. B. (2009). Sexual functioning in transsexuals following hormone therapy and genital surgery: A review. Journal of Sexual Medicine, 6, 2922–2939. doi: 10.1111/j.1743-6109.2009.01370.x.CrossRefGoogle Scholar
  17. Lawrence, A. A. (2003). Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Archives of Sexual Behavior, 32, 299–315.CrossRefGoogle Scholar
  18. Lawrence, A. A. (2005). Sexuality before and after male-to-female sex reassignment surgery. Archives of Sexual Behavior, 34(2), 147–166.CrossRefGoogle Scholar
  19. Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. New York, NY: Haworth Clinical Practice Press.Google Scholar
  20. Mullen, G., & Moane, G. (2013). A qualitative exploration of transgender identity affirmation at the personal, interpersonal, and sociocultural levels. International Journal of Transgenderism, 14(3), 140–154.CrossRefGoogle Scholar
  21. Pinto, N., & Moleiro, C. (2015). Gender trajectories: Transsexual people coming to terms with their gender identities. Professional Psychology: Research and Practice, 46(1), 12–20.CrossRefGoogle Scholar
  22. Pollock, L., & Eyre, S. L. (2012). Growth into manhood: Identity development among female-to-male transgender youth. Culture, Health & Sexuality, 14, 209–222. doi: 10.1080/13691058.2011.636072.CrossRefGoogle Scholar
  23. Prunas, A., Bandini, E., Fisher, A. D., Maggi, M., Pace, V., Quagliarella, L., Todarello, O., & Bini, M. (2016). Experiences of discrimination, harassment, and violence in a sample of italian transsexuals who have undergone sex-reassignment surgery. Journal of Interpersonal Violence. doi: 10.1177/0886260515624233.
  24. Prunas, A., Clerici, C. A., Veneroni, L., Muccino, E., Gentile, G., & Zoja, R. (2015). Transphobic murders in Italy: An overview of homicides in Milan (Italy) in the last two decades (1993–2012). Journal of Interpersonal Violence, 30(16), 2872–2885. doi: 10.1177/0886260514554293.CrossRefGoogle Scholar
  25. Riggle, E. D. B., Rostosky, S. S., & Danner, F. (2009). LGB identity and eudaimonic well-being in midlife. Journal of Homosexuality, 56(6), 786–798. doi: 10.1080/00918360903054277.CrossRefGoogle Scholar
  26. Riggle, E. D. B., Whitman, J. S., Olson, A., Rostosky, S. S., & Strong, S. (2008). The positive aspects of being a lesbian or gay man. Professional Psychology: Research and Practice, 39(2), 210–217.CrossRefGoogle Scholar
  27. Ruini, C., Ottolini, F., Rafanelli, C., Ryff, C., & Fava, G. A. (2003). La validazione italiana delle Psychological Well-being Scales (PWB). [Italian validation of Psychological Well-being Scales (PWB)]. Rivista di psichiatria, 38(3), 117–130.Google Scholar
  28. Ryan, R. M., & Deci, E. L. (2001). On happiness and human potential: A review of research on hedonic and eudaimonic well-being. Annual Review of Psychology, 52, 141–166. doi: 10.1146/annurev.psych.52.1.141.CrossRefGoogle Scholar
  29. Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57, 1069–1081.CrossRefGoogle Scholar
  30. Ryff, C. D. (1995). Psychological well-being in adult life. Current Directions in Psychological Science, 4, 99–104.CrossRefGoogle Scholar
  31. Ryff, C. D. (2014). Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and Psychosomatics, 83, 10–28. doi: 10.1159/000353263.CrossRefGoogle Scholar
  32. Ryff, C. D., Keyes, C. L. M., & Hughes, D. L. (2003). Status inequalities, perceived discrimination, and eudaimonic well-being: Do the challenges of minority life hone purpose and growth? Journal of Health and Social Behavior, 44, 275–291.CrossRefGoogle Scholar
  33. Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9, 1–28.CrossRefGoogle Scholar
  34. Ryff, C. D., & Singer, B. (2000). Interpersonal flourishing: a positive health agenda for the new millennium. Personality and Social Psychology Review, 4, 30–44.CrossRefGoogle Scholar
  35. Selvaggi, G., & Bellringer, J. (2011). Gender reassignment surgery: An overview. Nature Reviews Urology, 8, 274–282. doi: 10.1038/nrurol.2011.46.CrossRefGoogle Scholar
  36. Transgender Europe. (2013). Constant rise in murder rates. Retrieved from
  37. Turner, L., Whittle, S., & Combs, R. (2009). Transphobic hate crime in the European Union. Retrieved from
  38. Waterman, A. S. (1993). Two conceptions of happiness: contrasts of personal expressiveness (eudaimonia) and hedonic enjoyment. Journal of Personality and Social Psychology, 64, 678–691.CrossRefGoogle Scholar
  39. Weyers, S., Elaut, E., De Sutter, P., Gerris, J., T’Sjoen, G., Heylens, G., et al. (2009). Long-term assessment of the physical, mental, and sexual health among transsexual women. Journal of Sexual Medicine, 6, 752–760. doi: 10.1111/j.1743-6109.2008.01082.x.CrossRefGoogle Scholar
  40. Wierckx, K., Van Caenegem, E., Elaut, E., Dedecker, D., Van de Peer, F., Toye, K., et al. (2011). Quality of life and sexual health after sex reassignment surgery in transsexual men. Journal of Sexual Medicine, 8(12), 3379–3388. doi: 10.1111/j.1743-6109.2011.02348.x.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Antonio Prunas
    • 1
    Email author
  • Alessandra D. Fisher
    • 2
  • Elisa Bandini
    • 2
  • Mario Maggi
    • 2
  • Valeria Pace
    • 3
  • Orlando Todarello
    • 3
  • Chiara De Bella
    • 1
  • Maurizio Bini
    • 4
  1. 1.Dipartimento di PsicologiaUniversità degli Studi di Milano-BicoccaMilanItaly
  2. 2.Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical SciencesCareggi University HospitalFlorenceItaly
  3. 3.Dipartimento di Scienze mediche e di base, neuroscienze e organi di sensoUniversity of BariBariItaly
  4. 4.Gender Dysphoria UnitOspedale Niguarda-Ca’ GrandaMilanItaly

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