Svenska register: 2,2 % ansökte om att häva könskorrigering, med ansökningar i median 8 år senare

En analys av alla ansökningar om könskorrigerande kirurgi i Sverige, 1960–2010: förekomst, incidens och ånger

Kohort- & registerstudier Av-transition & ånger Kirurgi

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

767 personer (289 födda som kvinnor, 478 födda som män) ansökte om juridiskt könsbyte plus kirurgi i Sverige mellan 1960 och 2010, och 681 (89 %) fick båda.
25 sökande (3,3 %) nekades. De övriga drog tillbaka sin ansökan, väntade på kirurgi eller fick bara en del av behandlingen.
Varje år ökade ansökningarna från cirka 1,6 till 4,2 per miljon födda som kvinnor och från 2,3 till 7,3 per miljon födda som män, med den kraftigaste ökningen efter 2000.
15 personer (5 födda som kvinnor, 10 födda som män) ansökte om att ändra sitt juridiska kön tillbaka, en andel ånger på 2,2 % (2,0 % för dem födda som kvinnor och 2,3 % för dem födda som män).
Per årtionde för ansökan var andelen som ändrade tillbaka 5,8 % (1972–1980), 1,3 % (1981–1990), 2,4 % (1991–2000) och 0,3 % (2001–2010).
Människor ansökte typiskt om att ändra tillbaka 7,5 år efter sitt nya juridiska kön om de var födda som kvinnor och 8,5 år om de var födda som män, så siffran för 2001–2010 är ofullständig.
Personer födda som kvinnor som senare ansökte om att ändra tillbaka var yngre när de först ansökte (typiskt 22) än personer födda som kvinnor överlag (typiskt 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.

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