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

• 767 mensen (289 als vrouw geboren, 478 als man geboren) vroegen tussen 1960 en 2010 in Zweden een wettelijke genderwijziging plus operatie aan, en 681 (89%) kregen beide.
• 25 aanvragers (3,3%) werden geweigerd; de rest trok zich terug, wachtte op een operatie, of kreeg slechts een deel van de behandeling.
• Per jaar stegen aanvragen van ongeveer 1,6 naar 4,2 per miljoen als vrouw geboren mensen en van 2,3 naar 7,3 per miljoen als man geboren mensen, met de sterkste stijging na 2000.
• 15 mensen (5 als vrouw geboren, 10 als man geboren) vroegen om hun wettelijke gender terug te veranderen, een spijtpercentage van 2,2% (2,0% voor wie als vrouw geboren was en 2,3% voor wie als man geboren was).
• Per aanvraagdecennium was het percentage terugveranderen 5,8% (1972–1980), 1,3% (1981–1990), 2,4% (1991–2000) en 0,3% (2001–2010).
• Mensen vroegen gewoonlijk 7,5 jaar na hun nieuwe wettelijke gender om terug te veranderen als ze als vrouw geboren waren en 8,5 jaar als ze als man geboren waren, dus het cijfer voor 2001–2010 is onvolledig.
• Als vrouw geboren mensen die later om terugveranderen vroegen, waren jonger toen ze voor het eerst aanvroegen (gewoonlijk 22) dan als vrouw geboren mensen in het algemeen (gewoonlijk 27).

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.