Summary

Swedish researchers used national records to follow everyone who had sex reassignment surgery and changed legal sex between 1973 and 2003. They compared each person with ten random people of the same age and sex. Over about 11 years, the reassigned group died about three times as often and died by suicide about 19 times as often. They were about five times as likely to attempt suicide and three times as likely to be admitted for psychiatric care, even after allowing for earlier psychiatric admissions. The gaps in deaths and suicide attempts were mainly among people treated before 1989. The authors concluded that surgery, while easing gender distress, is not enough on its own, and better long-term care is needed. Because the comparison was with the general public, not trans people who did not transition, the study cannot say whether surgery made things better or worse.

Key findings

• स्वीडन में 1973 से 2003 के बीच लिंग-परिवर्तन सर्जरी कराने और कानूनी लिंग बदलने वाले सभी 324 लोगों (191 पुरुष से महिला, 133 महिला से पुरुष) की तुलना उसी जन्म वर्ष और लिंग के आम जनता के 3,240 लोगों से की गई।
• सभी कारणों से मृत्यु उसी जन्म-लिंग के लोगों की तुलना में लगभग 3 गुना अधिक थी, और यह अंतर लगभग 10 साल बाद उभरा।
• आत्महत्या से मृत्यु लगभग 19 गुना अधिक थी, जो 324 में 10 आत्महत्याओं बनाम तुलना समूह में 5 पर आधारित है। वास्तविक आँकड़ा बहुत अनिश्चित है (लगभग 6 से 63 गुना तक कुछ भी)।
• आत्महत्या के प्रयास लगभग 5 गुना और मनोरोग अस्पताल प्रवेश लगभग 3 गुना अधिक थे, सर्जरी से पहले के मनोरोग प्रवेशों को ध्यान में रखने के बाद भी, जो लिंग-परिवर्तन कराने वाले समूह में लगभग 4 गुना आम थे।
• हृदय और रक्त वाहिका रोग से मौतें कुछ बढ़ी थीं (लगभग 2.5 गुना; 9 मौतें), और कैंसर से मौतें संभवतः बढ़ी थीं (लगभग 2 गुना)। लेखक चेतावनी देते हैं कि संख्याएँ कम थीं और उन्होंने हार्मोन को दोष नहीं दिया।
• 1989 से 2003 तक इलाज पाने वालों में अतिरिक्त मौतें और आत्महत्या के प्रयास संयोग हो सकते थे, हालाँकि मनोरोग अस्पताल प्रवेश अब भी लगभग 2.5 गुना अधिक थे।
• महिला से पुरुष बने लोगों में अन्य महिलाओं की तुलना में आपराधिक दोषसिद्धि अधिक थी, लगभग पुरुषों जितनी; पुरुष से महिला बने लोग अन्य पुरुषों से भिन्न नहीं थे।
• लेखक कहते हैं कि अध्ययन यह नहीं दिखा सकता कि लिंग-परिवर्तन एक उपचार के रूप में काम करता है या नहीं, और इसके बिना परिणाम और भी बुरे हो सकते थे।

Abstract

Context: The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person's body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment.

Objective: To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons.

Design: A population-based matched cohort study.

Setting: Sweden, 1973-2003.

Participants: All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973-2003. Random population controls (10:1) were matched by birth year and birth sex or reassigned (final) sex, respectively.

Main Outcome Measures: Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]).

Results: The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8-4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8-62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9-8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0-3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls.

Conclusions: Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.

Conclusion

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.