Skip to main content

Long-Term Follow-Up of Adults with Gender Identity Disorder


The aim of this study was to re-examine individuals with gender identity disorder after as long a period of time as possible. To meet the inclusion criterion, the legal recognition of participants’ gender change via a legal name change had to date back at least 10 years. The sample comprised 71 participants (35 MtF and 36 FtM). The follow-up period was 10–24 years with a mean of 13.8 years (SD = 2.78). Instruments included a combination of qualitative and quantitative methods: Clinical interviews were conducted with the participants, and they completed a follow-up questionnaire as well as several standardized questionnaires they had already filled in when they first made contact with the clinic. Positive and desired changes were determined by all of the instruments: Participants reported high degrees of well-being and a good social integration. Very few participants were unemployed, most of them had a steady relationship, and they were also satisfied with their relationships with family and friends. Their overall evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive. Regarding the results of the standardized questionnaires, participants showed significantly fewer psychological problems and interpersonal difficulties as well as a strongly increased life satisfaction at follow-up than at the time of the initial consultation. Despite these positive results, the treatment of transsexualism is far from being perfect.

This is a preview of subscription content, access via your institution.


  1. We are using individuals’ current gender role as a benchmark for labeling their sexual orientation, while other studies use their birth sex to do so.

  2. See Footnote 1.


  • Barrett, J. (1998). Psychological and social function before and after phalloplasty. International Journal of Transgenderism, 2. Retrieved from

  • Bem, S. L. (1974). The measurement of psychological androgyny. Journal of Consulting and Clinical Psychology, 42, 155–162.

    PubMed  Article  Google Scholar 

  • Brauckmann, J. (2002). Die Wirklichkeit transsexueller Männer. Mannwerden und heterosexuelle Partnerschaften von Frau-zu-Mann-Transsexuellen [The reality of transsexual men: Becoming a man and heterosexual relationships of female-to-male transsexuals]. Gießen: Psychosozial.

  • Chivers, M. L., & Bailey, J. M. (2000). Sexual orientation of female-to-male transsexuals: A comparison of homosexual and nonhomosexual types. Archives of Sexual Behavior, 29, 259–278.

    PubMed  Article  Google Scholar 

  • Coleman, E., Bockting, W. O., & Gooren, L. (1993). Homosexual and bisexual identity in sex-reassigned female-to-male transsexuals. Archives of Sexual Behavior, 22, 37–50.

    PubMed  Article  Google Scholar 

  • De Cuypere, G., Elaut, E., Heylens, G., Van Maele, G., Selvaggi, G., T’Sjoen, G., … Monstrey, S. (2006). Long-term follow-up: Psychological outcome of Belgian transsexuals after sex reassignment surgery. Sexologies, 15, 126–133.

    Article  Google Scholar 

  • De Cuypere, G., T’Sjoen, G., Beerten, R., Selvaggi, G., De Sutter, P., Hoebeke, P., … Rubens, R. (2005). Sexual and physical health after sex reassignment surgery. Archives of Sexual Behavior, 34, 679–690.

    PubMed  Article  Google Scholar 

  • Derogatis, L. R. (1977). The SCL-90 manual: Scoring, administration and procedures for the SCL-90. Baltimore: Clinical Psychometric Research.

    Google Scholar 

  • 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, 6(2), e16885. doi:10.1371/journal.pone.0016885.

    PubMed Central  PubMed  Article  Google Scholar 

  • Essers, M., & Diederichs, P. (1996). Katamnestische Untersuchung operierter und nichtoperierter Transsexueller [Follow-up study of operated and not operated transsexuals]. In H. Kentenich & M. Rauchfuss (Eds.), Mythos Geburt. Und weitere Beiträge der Jahrestagung Psychosomatische Gynäkologie und Geburtshilfe 1995/96 (pp. 163–174). Gießen: Psychosozial.

  • Fahrenberg, J., Hampel, R., & Selg, H. (2001). Das Freiburger Persönlichkeitsinventar FPI. Revidierte Fassung FPI-R und teilweise geänderte Fassung FPI-A1. Handanweisung [Freiburg Personality Inventory FPI. [Revised version FPI-R and partly changed version FPI-A1. Manual (7th ed.)]. Göttingen: Hogrefe.

  • Franke G. H. (1995). SCL-90-RDie Symptom-Checkliste von Derogatis [SCL-90-R: The Symptom Checklist by Derogatis (1st ed.)]. Weinheim: Beltz Test.

  • Franke, G. H. (2002). SCL-90-RDie Symptom-Checkliste von Derogatis [SCL-90-R: The Symptom Checklist by Derogatis (2nd ed.]). Weinheim: Beltz Test.

  • 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 

  • Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine.

    Google Scholar 

  • Happich, F. J. (2006). Postoperative Ergebnisse bei Transsexualität unter besonderer Berücksichtigung der Zufriedenheiteine Nachuntersuchung [Postoperative results in transsexualism in due consideration of satisfaction: A a follow-up study]. Dissertation, Medical Faculty, University of Essen-Duisburg.

  • Hepp, U., Klaghofer, R., Burkhard-Kübler, R., & Buddeberg, C. (2002). Behandlungsverläufe transsexueller Patienten [Courses of treatment of transsexual patients]. Nervenarzt, 73, 283–288.

    PubMed  Article  Google Scholar 

  • Horowitz, L. M. (1999). Manual for the inventory of interpersonal problems. San Antonio: Psychological Corporation.

    Google Scholar 

  • Horowitz, L. M., Strauß, B., & Kordy, H. (2000). Inventar zur Erfassung Interpersonaler Probleme (IIP-D)deutsche Version. Manual [Inventory of Interpersonal Problems (IIP-D)-German version. Manual]. Weinheim: Beltz Test.

  • Jarrar, K., Wolff, E., & Weidner, W. (1996). Langzeitergebnisse nach Geschlechtsangleichung bei männlichen Transsexuellen [Long-term results after sex reassignment in male transsexuals]. Urologe, 35, 331–337.

    PubMed  Google Scholar 

  • Junge, A. (1987). Behandlungsverlauf und Katamnese von operierten weiblichen Transsexuellen [Course of treatment and follow-up of operated female transsexuals]. Dissertation, Medical Faculty, University of Hamburg.

  • Kuhn, A., Bodmer, C., Stadlmayr, W., Kuhn, P., Mueller, M. D., & Birkhäuser, M. (2008). Quality of life 15 years after sex reassignment surgery for transsexualism. Fertility and Sterility, 92, 1685–1689.

    PubMed  Article  Google Scholar 

  • Kuiper, B., & Cohen-Kettenis, P. (1988). Sex reassignment surgery: A of 141 Dutch transsexuals. Archives of Sexual Behavior, 17, 439–457.

    PubMed  Article  Google Scholar 

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

    PubMed  Article  Google Scholar 

  • Lawrence, A. A. (2005). Sexuality before and after male-to-female sex reassignment surgery. Archives of Sexual Behavior, 34, 147–166.

    PubMed  Article  Google Scholar 

  • Löwenberg, H., Lax, H., Rossi Neto, R., & Krege, S. (2010). Komplikationen, subjektive Zufriedenheit und sexuelles Erleben nach geschlechtsangleichender Operation bei Mann-zu-Frau-Transsexualität [Complications, subjective satisfaction, and sexual experience after sex reassignment surgery in male-to-female transsexualism]. Zeitschrift für Sexualforschung, 23, 328–347.

    Article  Google Scholar 

  • Olsson, S.-E., Jansson, I., & Möller, A. (1996). Men as women. Experiences from five cases after administrative, hormonal, and surgical treatment. Nordic Journal of Psychiatry, 50, 395–399.

    Article  Google Scholar 

  • Pfäfflin, F. (1993a). Regrets after sex reassignment surgery. Journal of Psychology & Human Sexuality, 5, 69–85.

    Article  Google Scholar 

  • Pfäfflin, F. (1993b). Transsexualität. Beiträge zur Psychopathologie, Psychodynamik und zum Verlauf [Transsexualism. Psychopathology, psychodynamics, and development]. Stuttgart: Enke.

  • Pfäfflin, F. (1997). Klinische Aspekte der Transsexualität [Clinical aspects of transsexualism]. In P. Buchheim, M. Cierpka, & T. Seifert (Eds.), Lindauer Texte: Teil 1 Sexualitätzwischen Phantasie und Realität. Teil 2 Qualitätssicherung (pp. 132–148). Berlin: Springer.

  • Pfäfflin, F., & Junge, A. (1992). Nachuntersuchungen nach Geschlechtsumwandlung. Eine kommentierte Literaturübersicht 1961–1991. In F. Pfäfflin & A. Junge (Eds.), Geschlechtsumwandlung: Abhandlungen zur Transsexualität (pp. 149–457). Stuttgart: Schattauer.

  • Pfäfflin, F., & Junge, A. (1998). Sex reassignment-Thirty years of international follow-up studies after sex reassignment surgery: A comparison review, 19611991. Retrieved from

  • Pimenoff, V., & Pfäfflin, F. (2011). Transsexualism: Treatment outcome of compliant and noncompliant patients. International Journal of Transgenderism, 13, 37–44.

    Article  Google Scholar 

  • Rachlin, K. (1999). Factors which influence individual’s decisions when considering female-to-male genital reconstructive surgery. International Journal of Transgenderism, 3. Retrieved from

  • Rauchfleisch, U., Barth, D., & Battegay, R. (1998). Resultate einer Langzeitkatamnese von Transsexuellen [Results of a long-term follow-up of transsexuals]. Nervenarzt, 69, 799–805.

    PubMed  Article  Google Scholar 

  • Schneider-Düker, M. (1978). Deutsche Neukonstruktion des BEM Sex-Role Inventory [German version of the BEM Sex-Role Inventory]. Arbeiten der Fachrichtung Psychologie Nr. 51, University of Saarbrücken.

  • Udeze, B., Abdelmawla, N., Khoosal, D., & Terry, T. (2008). Psychological functions in male-to-female transsexual people before and after surgery. Sexual and Relationship Therapy, 23, 141–145.

    Article  Google Scholar 

  • Weyers, S., Elaut, E., De Sutter, P., Gerris, J., T’Sjoen, G., Heylens, G., … Verstraelen, H. (2009). Long-term assessment of the physical, mental, and sexual health among transsexual women. Journal of Sexual Medicine, 6, 752–760.

    PubMed  Article  Google Scholar 

  • World Health Organization. (1991). International statistical classification of diseases and related health problems (10th rev.). Geneva: Author.

  • World Professional Association for Transgender Health. (2011). Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. International Journal of Transgenderism, 13, 165–232.

    Google Scholar 

  • Zimmermann, A., Zimmer, R., Kovacs, L., Einödshofer, S., Herschbach, P., Henrich, G., … Papadopoulos, N. (2006). Lebenszufriedenheit transsexueller Patienten nach geschlechtsangleichenden Operationen [Life satisfaction of transsexual patients after sex reassignment surgery]. Chirurg, 77, 432–438.

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ulrike Ruppin.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ruppin, U., Pfäfflin, F. Long-Term Follow-Up of Adults with Gender Identity Disorder. Arch Sex Behav 44, 1321–1329 (2015).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Gender dysphoria
  • Gender identity disorder
  • Transgenderism
  • Transsexualism
  • Follow-up