Sex Reassignment : Predictors and Outcomes Of Treatment for Transsexuals

Abstract

Prospective research supports the therapeutic effect of sex reassignment (SR) for adolescent and adult transsexuals. Data were used from 345 patients who applied for SR. Of these applicants, 232 started hormone treatment, 113 did not. The group who completed SR consisted of 196 transsexuals. Follow-up data were gathered one to five years after SR.

The results of 171 treated adult transsexuals showed improvement in many areas of functioning after SR. The main symptom for which the patients had requested treatment, gender dysphoria, had disappeared after treatment, which is the primary goal of SR. Improvement was also found in satisfaction of the patients with their sex characteristics. In addition, according to observers, the appearance of the transsexuals better matched that of the desired new gender after treatment. Psychological functioning of the group had also improved after SR. Most of the transsexuals also functioned well socially, sexually, and in the new gender role. Above all, the vast majority of the group expressed no feelings of regret about their SR. However, a few individuals expressed reservations about the beneficial effects of treatment at follow-up. In particular, one male-to-female expressed strong regret and another some feelings of regret, during and after treatment. Both assigned these feelings to the adverse reactions from society.

By far the least explored and most controversial domain with respect to SR is early (hormone) treatment with adolescent transsexuals. Results of the present study support the decision to refer well-functioning adolescents for early (between 16 to 18 years) hormone treatment, considering the positive outcomes of SR on several areas of postoperative functioning of this group. Within the treated adolescent group the gender dysphoria was absent after SR. The adolescents also appeared to function quite well socially and psychologically, and they were more satisfied with their sex characteristics as well after SR. Not a single adolescent expressed feelings of regret concerning the decision to undergo SR.

Other findings from this thesis led us to conclude that the distinction between subtypes of transsexuals is theoretically and clinically meaningful. The differences that were found between homosexual and nonhomosexual transsexuals suggest different developmental routes for each of these subtypes. The road along which the nonhomosexual subtype evolves the gender identity conflict is most likely to be accompanied with more obstacles. Taking into account that the nonhomosexuals were found to be psychologically more vulnerable than the homosexuals, especially before treatment, they may require additional guidance during treatment.

Finally, we investigated which factors at assessment could predict the course and outcomes of SR. Eligibility for SR was largely based upon the factors gender dysphoria, psychological stability, and physical appearance. Transsexuals with a nonhomosexual preference, psychological instability, and strong dissatisfaction about their appearance, at assessment, are more at risk for worse postoperative functioning and more dissatisfaction after treatment.

To conclude, the current study substantiates findings from previous, mainly retrospective, studies, that SR is indeed effective. However, alleviation of the gender identity problem is not equivalent with an easy life. Yet, for most of the transsexuals who participated in this study, the strict eligibility criteria and the standard professional guidance as currently provided, appears to be sufficient to help resolve their gender identity conflict.