스웨덴 기록: 2.2%가 성전환을 되돌리는 신청, 신청은 중앙값 8년 뒤에 이루어짐

1960~2010년 스웨덴 성전환 수술 신청 전체 분석: 유병률, 발생률, 후회

Authors: Cecilia Dhejne, Katarina Öberg, Stefan Arver, Mikael Landén
Journal: Archives of Sexual Behavior
Year: 2014
Source: https://doi.org/10.1007/s10508-014-0300-8

Summary

Using Swedish government files, this study looked at every application for a legal gender change plus surgery from 1960 to 2010. Of 681 people who got a new legal gender and surgery, 15 (2.2%) later formally applied to change their legal gender back. Applications rose sharply after 2000. The rate of changing back seemed to fall over time, from 5.8% for those who applied in 1972–1980 to 0.3% for 2001–2010. But people typically applied to change back about 8 years after transition, so the recent figure mostly reflects too little follow-up. The study only counted formal legal reversals. People who regretted it without applying, or who detransitioned only medically or socially, are not included. It covers adults in a strict, tightly controlled system before 2010, unlike many settings today.

Key findings

1960년부터 2010년 사이 스웨덴에서 767명(출생 시 여성 289명, 남성 478명)이 법적 성별 변경과 수술을 신청했고, 681명(89%)이 둘 다 받았습니다.
25명의 신청자(3.3%)는 거절당했고, 나머지는 철회했거나 수술을 기다리고 있었거나 치료의 일부만 받았습니다.
신청은 매년 출생 시 여성 100만 명당 약 1.6건에서 4.2건으로, 출생 시 남성 100만 명당 2.3건에서 7.3건으로 늘었으며 2000년 이후 가장 가파르게 늘었습니다.
15명(출생 시 여성 5명, 남성 10명)이 법적 성별을 되돌려 달라고 신청했으며, 후회율은 2.2%(출생 시 여성 2.0%, 출생 시 남성 2.3%)였습니다.
신청 연대별로 되돌린 비율은 5.8%(1972~1980년), 1.3%(1981~1990년), 2.4%(1991~2000년), 0.3%(2001~2010년)였습니다.
사람들은 통상 새 법적 성별을 얻은 지 출생 시 여성은 7.5년, 출생 시 남성은 8.5년 후에 되돌리기를 신청했으므로, 2001~2010년 수치는 불완전합니다.
나중에 되돌리기를 신청한 출생 시 여성은 처음 신청할 때 나이(통상 22세)가 출생 시 여성 전체(통상 27세)보다 어렸습니다.

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.

Conclusion

The authors conclude that applications for sex reassignment in Sweden increased significantly over the 50 years, especially after 2000; the sex ratio fluctuated without a significant trend; the proportion of natal males applying at 30 or older rose; and the regret rate, defined as application for reversal of legal gender, was 2.2% overall with a significant decline over time. They caution that the last period (2001–2010) is "still undecided" because the median time lag before applying for reversal was 8 years, and that the small number of regret cases means characteristics of those who regretted must be interpreted cautiously. They suggest improved assessment, surgery and support to next-of-kin since 1990 may have contributed to the decline.

Methodological limitations

Narrow meaning of regret: Regret only counted as a formal application to the national health authority to change legal gender back. It misses people who regretted it but did not apply, who detransitioned only medically or socially, or who got help elsewhere.
Recent groups not followed long enough: People typically applied to change back about 8 years after their new legal gender, but data ended in 2010. So the apparent fall to 0.3% for 2001–2010 is mostly because there was not enough time to see regret; the authors call this period "still undecided".
Very few cases: There were only 15 applications to change back, so comparisons by age or sex, and the test showing a decline over time, are shaky; the authors warn against reading much into them.
People treated abroad not fully counted: 41 people who had surgery abroad were only included if they later asked for legal recognition in Sweden, and none had applied to change back by 2010.
Paperwork only: There is no information on mental health, sexual orientation, satisfaction, reasons for regret, or what happened to people who regretted it.
Strict old system: People went through a long, tightly controlled Swedish assessment (typically over 7 years from first visit to new legal gender in early decades), which required sterilisation until 2013. Results may not apply to faster systems, or to teens.
Ends before the big change in patients: Data stop in 2010, before the large rise from about 2012 in teenagers and young adults born female being referred in Sweden.
Often over-stated: The 2.2% (and especially the 0.3%) figure is widely quoted as "the" regret rate for transition, although it only measures legal reversal after surgery in adults.

detrans.ai

Summary

Key findings

Abstract

Conclusion