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Nur 21 von 2.467 Schweden machten die rechtliche Geschlechtsänderung rückgängig – ein kleiner Teil der Detransition

Stabilität nach rechtlicher Geschlechtsänderung bei Erwachsenen mit Geschlechtsdysphorie

Kohorten- & RegisterstudienDetransition & Reue
Authors
Kristen D. Clark, Richard A. White, Georgios Karamanis, Malin Indremo, Fatih Özel, Alkistis Skalkidou, Thomas Frisell, Fotios C. Papadopoulos
Journal
JAMA Network Open
Year
2025
Source
https://doi.org/10.1001/jamanetworkopen.2025.27780

Summary

Researchers in Uppsala used Swedish national records to follow everyone first diagnosed with gender dysphoria between 2013 and 2023, 7,293 people. They checked who changed legal gender and who changed back. About a third (2,467) made a legal change. Only 21 changed back, so the estimated chance of keeping the new legal gender for 10 years was about 98%. The records are complete, but narrow. In Sweden, changing back needs a new application and a psychological assessment, so it is only a small, formal part of detransition. People who stop hormones, regret surgery or re-identify with their birth sex without changing their papers are not counted. Most people were followed for only a few years after their legal change, while detransition often happens 5 to 10 years after transition. The study shows that changing legal gender back is rare; it does not show that detransition is rare.

Key findings

  • Die Studie umfasste alle 7.293 Personen in Schweden, bei denen zwischen 2013 und 2023 erstmals Geschlechtsdysphorie diagnostiziert wurde (4.083 weiblich und 3.210 männlich geboren), die im Durchschnitt jeweils etwa 5 Jahre nachverfolgt wurden.
  • 2.467 Personen (34 %) änderten ihr rechtliches Geschlecht, im Durchschnitt 3,2 Jahre nach der Erstdiagnose; die geschätzte Wahrscheinlichkeit, dies innerhalb von 10 Jahren zu tun, lag bei 58 %.
  • Nur 21 Personen änderten ihr rechtliches Geschlecht zurück auf ihr Geburtsgeschlecht: 0,9 % derer, die geändert hatten, und 0,3 % der gesamten Gruppe.
  • Die geschätzte Wahrscheinlichkeit, das neue rechtliche Geschlecht 10 Jahre lang zu behalten, lag bei etwa 98 % (wahrscheinlich zwischen 96 % und 99 %), ohne Unterschied zwischen weiblich und männlich Geborenen.
  • Die 21, die zurückänderten, glichen allen anderen; nur 2 waren vor dem 18. Lebensjahr diagnostiziert worden, und sie waren im Durchschnitt etwa 30, als sie zurückänderten.
  • Die Autoren betonen, dass die Rückänderung des rechtlichen Geschlechts nicht dasselbe ist wie Detransition, nichts über Gründe oder Identität aussagt und als Mindestwert behandelt werden sollte.
  • Die Diskussion der Arbeit nennt die Rückänderungsrate mit 0,09 % derer mit rechtlicher Änderung, was zehnmal niedriger ist als die 0,9 % (21 von 2.467) in den eigenen Ergebnissen.

Abstract

IMPORTANCE: The number of people seeking treatment for gender dysphoria (GD) has risen in recent decades, yet data remain limited for understanding cases of detransition (ie, the reversal of social, medical, or legal transition). Legal gender change in national registers poses an opportunity to examine legal gender reversals, which may reflect an aspect of the detransition process, while also informing an understanding of the stability after a legal gender change. OBJECTIVE: To determine the probability of obtaining a legal gender change and its stability over time among people diagnosed with GD in Sweden during a 10-year study period. DESIGN, SETTING, AND PARTICIPANTS: In this population cohort study using data from Swedish national registers from January 1, 2013, to December 31, 2023, individuals who received their first International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), diagnosis code for GD during the study period were included. While participants may have received a GD ICD-10 code as youths, legal gender changes only occurred for adults (aged ≥18 years) based on legal requirements during the time of data collection. EXPOSURE: Gender dysphoria. MAIN OUTCOMES AND MEASURES: Legal gender change and its stability, that is, absence of legal gender reversal, as reported in the registry. Kaplan-Meier survival analysis was used to determine the probability of legal gender change and its stability during a 10-year study period. RESULTS: A total of 7293 people with a GD diagnosis were included (36 025 person-years). Approximately one-third of the sample (n = 2467) obtained a legal gender change during the study period. The probability of legal gender change at 10 years following diagnosis was 58.3% (95% CI, 56.2%-60.4%). Twenty-one cases of legal gender reversal were identified. The probability of legal gender stability at 10 years following the initial change was 97.7% (95% CI, 96.3%-99.2%), with no differences by sex assigned at birth for either outcome. CONCLUSIONS AND RELEVANCE: In this cohort study using national population registry data, a significant proportion of participants with GD in Sweden obtained legal gender change within 10 years of follow-up. Despite significant growth of the population with GD, the probability of legal gender stability during the 10-year study period was high, at almost 98%. These results highlight that legal gender reversal was an infrequent occurrence in a national sample.

Conclusion

In this cohort study using national population registry data, a significant proportion of participants with gender dysphoria in Sweden obtained legal gender change within 10 years of follow-up. Despite significant growth of the population with gender dysphoria, the probability of legal gender stability during the 10-year study period was high, at almost 98%, and legal gender reversal was an infrequent occurrence in a national sample. No differences by sex assigned at birth were observed, and most individuals who legally reverted were in their twenties at first diagnosis. The authors note that legal gender reversal is not synonymous with detransition, should be considered a lower-bound approximation, and cannot be generalized to social or medical detransition.