An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960–2010: Prevalence, Incidence, and Regrets

Abstract

Incidence and prevalence of applications in Sweden for legal and surgical sex reassignment were examined over a 50-year period (1960–2010), including the legal and surgical reversal applications. A total of 767 people (289 natal females and 478 natal males) applied for legal and surgical sex reassignment. Out of these, 89 % (252 female-to-males [FM] and 429 male-to-females [MF]) received a new legal gender and underwent sex reassignment surgery (SRS). A total of 25 individuals (7 natal females and 18 natal males), equaling 3.3 %, were denied a new legal gender and SRS. The remaining withdrew their application, were on a waiting list for surgery, or were granted partial treatment. The incidence of applications was calculated and stratified over four periods between 1972 and 2010. The incidence increased significantly from 0.16 to 0.42/100,000/year (FM) and from 0.23 to 0.73/100,000/year (MF). The most pronounced increase occurred after 2000. The proportion of FM individuals 30 years or older at the time of application remained stable around 30 %. In contrast, the proportion of MF individuals 30 years or older increased from 37 % in the first decade to 60 % in the latter three decades. The point prevalence at December 2010 for individuals who applied for a new legal gender was for FM 1:13,120 and for MF 1:7,750. The FM:MF sex ratio fluctuated but was 1:1.66 for the whole study period. There were 15 (5 MF and 10 MF) regret applications corresponding to a 2.2 % regret rate for both sexes. There was a significant decline of regrets over the time period.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. Ålgars, M., Santtila, P., & Sandnabba, N. K. (2010). Conflicted gender identity, body dissatisfaction, and disordered eating in adult men and women. Sex Roles, 63, 118–125. doi:10.1007/s11199-010-9758-6.

    Article  Google Scholar 

  2. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  3. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.

  4. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  5. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

    Google Scholar 

  7. Baba, T., Endo, T., Ikeda, K., Shimizu, A., Honnma, H., Ikeda, H., et al. (2011). Distinctive features of female-to-male transsexualism and prevalence of gender identity disorder in Japan. Journal of Sexual Medicine, 8, 1686–1693. doi:10.1111/j.1743-6109.2011.02252.x.

    Article  PubMed  Google Scholar 

  8. Bakker, A., van Kesteren, P. J., Gooren, L. J., & Bezemer, P. D. (1993). The prevalence of transsexualism in the Netherlands. Acta Psychiatrica Scandinavica, 87, 237–238.

    Article  PubMed  Google Scholar 

  9. Blanchard, R., Clemmensen, L. H., & Steiner, B. W. (1987). Heterosexual and homosexual gender dysphoria. Archive of Sexual Behavior, 16, 139–152.

    Article  Google Scholar 

  10. Blanchard, R., Steiner, B. W., Clemmensen, L., & Dickey, R. (1989). Prediction of regrets in postoperative transsexuals. Canadian Journal of Psychiatry, 34, 43–45.

    Google Scholar 

  11. Conron, K. J., Scott, G., Stowell, G. S., & Landers, S. J. (2012). Transgender health in Massachusetts: Results from a household probability sample of adults. American Journal of Public Health, 102, 118–122. doi:10.2105/AJPH.2011.300315.

    PubMed Central  Article  PubMed  Google Scholar 

  12. De Cuypere, G., Janes, C., & Rubens, R. (1995). Psychosocial functioning of transsexuals in Belgium. Acta Psychiatria Scandinavia, 91, 180–184.

    Article  Google Scholar 

  13. De Cuypere, G., Van Hemelrijck, M., Michel, A., Carael, B., Heylens, G., Rubens, R., et al. (2007). Prevalence and demography of transsexualism in Belgium. European Psychiatry, 22, 137–141. doi:10.1016/j.eurpsy.2006.10.002.

    Article  PubMed  Google Scholar 

  14. de Vries, A. L. C., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality, 59, 301–320. doi:10.1080/00918369.2012.653300.

    Article  PubMed  Google Scholar 

  15. Dixen, J. M., Maddever, M., Van Maasdam, J., & Edwards, P. W. (1984). Psychosocial characteristics of applicants evaluated for surgical gender reassignment. Archive of Sexual Behavior, 13, 269–276.

    Article  Google Scholar 

  16. Dulko, S., & Imielinski, C. (2004). The epidemiology of transsexualism in Poland. Journal of Psychosomatic Research, 56, 637.

    Article  Google Scholar 

  17. Eklund, P. L., Gooren, L. J., & Bezemer, P. D. (1988). Prevalence of transsexualism in the Netherlands. British Journal of Psychiatry, 152, 638–640.

    Article  PubMed  Google Scholar 

  18. Garrels, L., Kockott, G., Michael, N., Preuss, W., Renter, K., Schmidt, G., et al. (2000). Sex ratio of transsexuals in Germany: The development over three decades. Acta Psychiatria Scandinavia, 102, 445–448.

    Article  Google Scholar 

  19. Godlewski, J. (1988). Transsexualism and anatomic sex ratio reversal in Poland. Archives of Sexual Behavior, 17, 547–548.

    Article  PubMed  Google Scholar 

  20. Gómez-Gil, E., Trilla García, A., Godás Sieso, T., Halperin Rabinovich, I., Puig Domingo, M., Vidal Hagemeijer, A., et al. (2006). Estimación de la prevalencia, incidencia y razón de sexos del transexualismo en Cataluña según la demanda asistencial [Estimation of prevalence, incidence and sex ratio of transsexualism in Catalonia according to health care demand]. Actas Españolas de Psiquiatría, 34, 295–302.

    PubMed  Google Scholar 

  21. Gómez-Gil, E., Trilla, A., Salamero, M., Godás, T., & Valdés, M. (2009). Sociodemographic, clinical, and psychiatric characteristics of transsexuals from Spain. Archives of Sexual Behavior, 38, 378–392. doi:10.1007/s10508-007-9307-8.

    Article  PubMed  Google Scholar 

  22. Hoenig, J., & Kenna, J. C. (1974). The prevalence of transsexualism in England and Wales. British Journal of Psychiatry, 124, 181–190.

    Article  PubMed  Google Scholar 

  23. ILGA-Europe, the European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association. (2013). The rainbow map and index. Retrieved from http://www.ilga-europe.org/home/publications/reports_and_other_materials/rainbow_europe_map_and_index_may_2012.

  24. Kreukels, B. P., Haraldsen, I. R., De Cuypere, G., Richter-Appelt, H., Gijs, L., & Cohen-Kettenis, P. T. (2010). A European network for the investigation of gender incongruence: The ENIGI initiative. European Psychiatry, 27, 445–450. doi:10.1016/j.eurpsy.2010.04.009.

    Article  PubMed  Google Scholar 

  25. Kuyper, L., & Wijsen, C. (2014). Gender identities and gender dysphoria in the Netherlands. Archives of Sexual Behavior, 43, 377–385. doi:10.1007/s10508-013-0140-y.

    Article  PubMed  Google Scholar 

  26. Lai, M. C., Chiu, Y. N., Gadow, K. D., Gau, S. S., & Hwu, H. G. (2010). Correlates of gender dysphoria in Taiwanese university students. Archives of Sexual Behavior, 39, 1415–1428. doi:10.1007/s10508-009-9570-y.

    Article  PubMed  Google Scholar 

  27. Landén, M., & Innala, S. (2000). Attitudes toward transsexualism in a Swedish national survey. Archives of Sexual Behavior, 29, 375–388.

    Article  PubMed  Google Scholar 

  28. Landén, M., & Innala, S. (2002). The effect of a biological explanation on attitudes towards homosexual persons. A Swedish national sample study. Nordic Journal of Psychiatry, 56, 181–186. doi:10.1080/080394802317607156.

    Article  PubMed  Google Scholar 

  29. Landén, M., Wålinder, J., Hambert, G., & Lundström, B. (1998). Factors predictive of regret in sex reassignment. Acta Psychiatrica Scandinavica, 97, 284–289.

    Article  PubMed  Google Scholar 

  30. Landén, M., Wålinder, J., & Lundström, B. (1996). Prevalence, incidence and sex ratio of transsexualism. Acta Psychiatrica Scandinavica, 93, 221–223.

    Article  PubMed  Google Scholar 

  31. Lawrence, A. A. (2003). Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Archives of Sexual Behavior, 32, 299–315.

    Article  PubMed  Google Scholar 

  32. Lawrence, A. A. (2010). Societal individualism predicts prevalence of nonhomosexual orientation in male-to-female transsexualism. Archives of Sexual Behavior, 39, 573–583. doi:10.1007/s10508-008-9420-3.

    Article  PubMed  Google Scholar 

  33. Meyer zu Hoberge, S. (2009). Prevalence, incidence and sex ratio of transsexualism in Germany established by counting applications of the German Transsexual Act during the period 1991 until 2000. Unpublished doctoral thesis, Medical Faculty Christian-Albrechts-Universität zu Kiel, Kiel, Germany.

  34. Nieder, T. O., Herff, M., Cerwenka, S., Preuss, W. F., Cohen-Kettenis, P. T., De Cuypere, G., et al. (2011). Age of onset and sexual orientation in transsexual males and females. Journal of Sexual Medicine, 8, 783–791.

    Article  PubMed  Google Scholar 

  35. O’Gorman, E. C. (1982). A retrospective study of epidemiological and clinical aspects of 28 transsexual patients. Archives of Sexual Behavior, 11, 231–236.

    Article  PubMed  Google Scholar 

  36. Okabe, N., Sato, T., Matsumoto, Y., Ido, Y., Terada, S., & Kuroda, S. (2008). Clinical characteristics of patients with gender identity disorder at a Japanese gender identity disorder clinic. Psychiatry Research, 157, 315–318. doi:10.1016/j.psychres.2007.07.022.

    Article  PubMed  Google Scholar 

  37. Olsson, S. E., & Möller, A. R. (2003). On the incidence and sex ratio of transsexualism in Sweden, 1972–2002. Archives of Sexual Behavior, 32, 381–386.

    Article  PubMed  Google Scholar 

  38. Pauly, I. (1968). The current status of change of sex operation. Journal of Nervous and Mental Disease, 147, 460–471.

    Article  PubMed  Google Scholar 

  39. Pfäfflin, F. (1992). Regrets after sex reassignment surgery. Journal of Psychology and Human Sexuality, 5, 69–85.

    Article  Google Scholar 

  40. Pimenoff, V. (2006). On the care of transsexuals in Finland. International Journal of Transgenderism, 9, 23–33.

    Article  Google Scholar 

  41. R Foundation for Statistical Computing. (2013). R: A Language and Environment for Statistical Computing, Vienna, Austria. Retrieved from http://www.r-project.org/.

  42. Ross, M. W., Wålinder, J., Lundström, B., & Thuwe, I. (1981). Cross-cultural approaches to transsexualism. A comparison between Sweden and Australia. Acta Psychiatrica Scandinavica, 63, 75–82.

    Article  PubMed  Google Scholar 

  43. Smith, Y. L., van Goozen, S. H., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Transsexual subtypes: Clinical and theoretical significance. Psychiatry Research, 137, 151–160.

    Article  PubMed  Google Scholar 

  44. Sørensen, T., & Hertoft, P. (1980). Sexmodifying operations on transsexuals in Denmark in the period 1950–1977. Acta Psychiatrica Scandinavica, 61, 56–66.

    Article  PubMed  Google Scholar 

  45. Sørensen, T., & Hertoft, P. (1982). Male and female transsexualism: The Danish experience with 37 patients. Archives of Sexual Behavior, 11, 133–155.

    Article  PubMed  Google Scholar 

  46. Sweden Statistics. (2012). Befolkningsstatistik. Retrieved from http://www.scb.se/Pages/SSD/SSD_SelectVariables_340507.aspx?px_tableid=ssd_extern%3aBefolkningNy&rxid=0b3f5d00-ca4f-4813-9c77-5803f5fff6da.

  47. Sweden Statistics. (2013). Tillgång till it-utrustning och internet i hemmet för personer i åldern 16-74 år. År 2003–2012. Retrieved from http://www.scb.se/Pages/SSD/SSD_TablePresentation_340486.aspx?layout=tableViewLayout1&rxid=f3be8994-75f3-4f4c-b0d6-e17cf3d08019.

  48. Tsoi, W. F. (1988). The prevalence of transsexualism in Singapore. Acta Psychiatrica Scandinavica, 78, 501–504.

    Article  PubMed  Google Scholar 

  49. van Kesteren, P. J., Gooren, L. J., & Megens, J. A. (1996). An epidemiological and demographic study of transsexuals in the Netherlands. Archives of Sexual Behavior, 25, 589–600.

    Article  PubMed  Google Scholar 

  50. Veale, J. F. (2008). Prevalence of transsexualism among New Zealand passport holders. Australian and New Zealand Journal of Psychiatry, 42, 887–889.

    Article  PubMed  Google Scholar 

  51. Vujovic, S., Popovic, S., Sbutega-Milosevic, G., Djordjevic, M., & Gooren, L. (2008). Transsexualism in Serbia: A twenty-year follow-up study. Journal of Sexual Medicine, 6, 1018–1023. doi:10.1111/j.1743-6109.2008.00799.x.

    Article  PubMed  Google Scholar 

  52. Wålinder, J. (1968). Transsexualism: definition, prevalence, and sex distribution. Acta Psychiatrica Scandinavica, 203(Suppl.), 255–258.

  53. Wålinder, J. (1971). Incidence and sex ratio of transsexualism in Sweden. British Journal of Psychiatry, 119, 195–196.

    Article  PubMed  Google Scholar 

  54. Weitze, C., & Osburg, S. (1996). Transsexualism in Germany: Empirical data on epidemiology and application of the German Transsexuals’ Act during its first ten years. Archives of Sexual Behavior, 25, 409–425.

    Article  PubMed  Google Scholar 

  55. Wilson, P., Sharp, C., & Carr, S. (1999). The prevalence of gender dysphoria in Scotland: A primary care study. British Journal of General Practice, 49, 991–992.

    PubMed Central  PubMed  Google Scholar 

  56. Wood, H., Sasaki, S., Bradley, S. J., Singh, D., Fantus, S., Owen-Anderson, A., … Zucker, K. J. (2013). Patterns of referral to a gender identity service for children and adolescents (1976–2011): Age, sex ratio, and sexual orientation [Letter to the Editor]. Journal of Sex and Marital Therapy, 39, 1–6. doi:10.1080/0092623X.2012.675022.

  57. World Health Organization. (1992). The international statistical classification of diseases, and related health problems (10th ed.). Geneva: Author.

    Google Scholar 

  58. Zucker, K. J., & Lawrence, A. A. (2009). Epidemiology of Gender Identity Disorder: Recommendations for the Standards of Care of the World Professional Association for Transgender Health. International Journal of Transgenderism, 11, 8–18.

    Article  Google Scholar 

Download references

Acknowledgments

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Financial support was provided through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and the Karolinska Institutet, through grants from the Royal Swedish Academy of Sciences (Torsten Amundson’s Foundation) and from the Clinical Department of Psychiatry Stockholm Health Care Services. We thank Linda Almqvist, at the time for data collection legal adviser at The National Board of Health and Welfare, Stockholm, Sweden for valuable assistance with data collection and administrative support. We also thank Dr. Gail Knudson, who generously commented on the article.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Cecilia Dhejne.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dhejne, C., Öberg, K., Arver, S. et al. An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960–2010: Prevalence, Incidence, and Regrets. Arch Sex Behav 43, 1535–1545 (2014). https://doi.org/10.1007/s10508-014-0300-8

Download citation

Keywords

  • Transsexualism
  • Gender identity disorder
  • Gender dysphoria
  • Incidence
  • Prevalence
  • Sex ratio