A Five-Year Follow-Up Study of Swedish Adults with Gender Identity Disorder
This follow-up study evaluated the outcome of sex reassignment as viewed by both clinicians and patients, with an additional focus on the outcome based on sex and subgroups. Of a total of 60 patients approved for sex reassignment, 42 (25 male-to-female [MF] and 17 female-to-male [FM]) transsexuals completed a follow-up assessment after 5 or more years in the process or 2 or more years after completed sex reassignment surgery. Twenty-six (62%) patients had an early onset and 16 (38%) patients had a late onset; 29 (69%) patients had a homosexual sexual orientation and 13 (31%) patients had a non-homosexual sexual orientation (relative to biological sex). At index and follow-up, a semi-structured interview was conducted. At follow-up, 32 patients had completed sex reassignment surgery, five were still in process, and five—following their own decision—had abstained from genital surgery. No one regretted their reassignment. The clinicians rated the global outcome as favorable in 62% of the cases, compared to 95% according to the patients themselves, with no differences between the subgroups. Based on the follow-up interview, more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5–15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health. Most outcome measures were rated positive and substantially equal for MF and FM. Late-onset transsexuals differed from those with early onset in some respects: these were mainly MF (88 vs. 42%), older when applying for sex reassignment (42 vs. 28 years), and non-homosexually oriented (56 vs. 15%). In conclusion, almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning.
KeywordsTranssexualism Gender identity disorder Sex reassignment Outcome
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Fourth ed., text rev.). Washington, DC: Author.Google Scholar
- Blanchard, R., Steiner, B. W., Clemmensen, L. H., & Dickey, R. (1989). Prediction of regrets in postoperative transsexuals. Canadian Journal of Psychiatry, 34, 43–45.Google Scholar
- Cohen-Kettenis, P. T., & Pfäfflin, F. (2003). Transgenderism and intersexuality in childhood and adolescence: Making choices. Thousands Oaks, CA: Sage.Google Scholar
- Docter, R. F. (1988). Transvestites and transsexuals: Toward a theory of cross-gender behavior. New York: Plenum Press.Google Scholar
- 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
- Kuiper, A. J., & Cohen-Kettenis, P. T. (1998). Gender role reversal among postoperative transsexuals. International Journal of Transgenderism, 2. Available at http://www.symposion.com/itj/itjc0502.htm.
- Landén, M., Bodlund, O., Ekselius, L., Hambert, G., & Lundström, B. (2001). Bytt är bytt, kommer aldrig igen. Könsbyte för närvarande bästa metoden för transsexuella [Done is done and gone is gone; sex change presently the best remedy for transsexuals]. Läkartidningen, 30–31(98), 3322–3326.Google Scholar
- Lundström, B. (1981). Gender dysphoria: A social-psychiatric follow-up study of 31 cases not accepted for sex reassignment. Doctoral dissertation, Department of Psychiatry, University of Gothenburg, Gothenburg, Sweden.Google Scholar
- Pfäfflin, F., & Junge, A. (1998). Sex reassignment: Thirty years of international follow-up studies. A comprehensive review, 1961–1991. International Journal of Transgenderism. http://www.symposion.com/ijt/books/index.htm.
- World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: Author.Google Scholar
- Wålinder, J., Lundström, B., & Thuwe, I. (1978). Prognostic factors in the assessment of male transsexuals for sex reassignment. British Journal of Psychiatry, 132, 16–20.Google Scholar
- Wålinder, J., & Thuwe, I. (1975). A social follow-up study of 24 sex-reassigned transsexuals. Gothenburg, Sweden: Scandinavian University Books.Google Scholar