A follow‐up study of operated transsexual females

Not nearly as many female as male transsexuals have been operated on in Denmark, although the incidence of male and female applicants has equalized during recent years. Information from the literature is sparse and mostly casuistic. Since 1956, when the first female transsexual in Denmark was operated on, 30 females ‐ examined by us ‐ have applied for permission to have sex‐change operations and to change their first name. The majority of sex‐change applicants in this country have been assessed at the Rigs‐hospital. Among the applicants eight were recommended for sex‐modifying surgery and have subsequently been followed up. The average for the follow‐up period is 5 years. Postoperatively, most of the patients resumed work and also got female partners. However, they often had considerable problems at work and in their life together with a partner. Likewise, if there are children within the partnership, tensions between the transsexuals and the children are in evidence. All the patients had had sexual relationships postoperatively, but for most of them there had been both psychical and physical problems. Seventy‐five per cent found that sex‐reassignment involved severe practical and social problems; however, only one of the patients regretted the operations. It is emphasized that surgery is a symptomatic treatment and the rational reason for the operation is to strengthen the defence of the female against an insecure gender identity. With relation to an earlier proposed hypothesis by the author to the effect that the most conspicuous trait in female transsexualism is a phallic character, it is concluded that the postoperative result is best, when the phallic character is fairly well‐modulated, whereas the postoperative course is more problematic for patients with an alloplastic character and patients threatened with psychosis. With regard to the last two groups it is recommended to desist from operation.