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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Fourth ed., text rev.). Washington, DC: Author.
Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias. Archives of Sexual Behavior, 18, 315–334.
Blanchard, R., Steiner, B. W., Clemmensen, L. H., & Dickey, R. (1989). Prediction of regrets in postoperative transsexuals. Canadian Journal of Psychiatry, 34, 43–45.
Bodlund, O., & Kullgren, G. (1996). Transsexualism: General outcome and prognostic factors. Archives of Sexual Behavior, 25, 303–316.
Cohen-Kettenis, P. T., & Pfäfflin, F. (2003). Transgenderism and intersexuality in childhood and adolescence: Making choices. Thousands Oaks, CA: Sage.
Docter, R. F. (1988). Transvestites and transsexuals: Toward a theory of cross-gender behavior. New York: Plenum Press.
Doorn, C. D., Poortinga, J., & Verschoor, A. M. (1994). Cross-gender identity in transvestites and male transsexuals. Archives of Sexual Behavior, 23, 185–201.
Eldh, J., Berg, A., & Gustafsson, M. (1997). Long term follow up after sex reassignment surgery. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 31, 39–45.
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.
Hunt, D., & Hampson, J. L. (1980). Transsexualism: A standardized psychosocial rating format for the evaluation of results of sex reassignment surgery. Archives of Sexual Behavior, 9, 255–263.
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.
Landén, M., Wålinder, J., Hambert, G., & Lundström, B. (1998). Factors predictive of regret in sex reassignment. Acta Psychiatrica Scandinavia, 97, 284–289.
Lawrence, A. A. (2003). Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Archives of Sexual Behavior, 32, 299–315.
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.
Lundström, B., Pauly, I. B., & Wålinder, J. (1984). Outcome of sex reassignment surgery. Acta Psychiatrica Scandinavica, 70, 289–294.
Olsson, S., & Möller, R. (2003). On the incidence of transsexualism in Sweden, 1972–2002. Archives of Sexual Behavior, 32, 381–386.
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.
Smith, Y. L. S., van Goozen, S. H. M., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Sex reassignment: Outcomes and predictors for adolescents and adult transsexuals. Psychological Medicine, 35, 89–99.
World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: Author.
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.
Wålinder, J., & Thuwe, I. (1975). A social follow-up study of 24 sex-reassigned transsexuals. Gothenburg, Sweden: Scandinavian University Books.
This study was supported by grants from the Sjöbring Foundation and the Lindhaga Foundation, the University Hospital of Lund, and the Department of Psychiatry at the University Hospital of Umeå, Sweden.
About this article
Cite this article
Johansson, A., Sundbom, E., Höjerback, T. et al. A Five-Year Follow-Up Study of Swedish Adults with Gender Identity Disorder. Arch Sex Behav 39, 1429–1437 (2010). https://doi.org/10.1007/s10508-009-9551-1
- Gender identity disorder
- Sex reassignment