Long-term follow-up of "sex change" in 13 male-to-female transsexuals.

Thirteen male-to-female transsexuals were investigated in an intensive interview study. The follow-up period varied between 6 and 25 years, with an average of 12 years. Surgical outcome was disappointing, and only one-third of the patients where a vaginal construction was carried out had a functioning vagina. The importance of patient cooperation postoperatively is pointed out and reasons for noncooperation are discussed. The generally held view of transsexuals as hypo- or asexual is questioned. In this study, one-third of the patients were very active sexually both before and after radical genital surgery. More than half of these castrated and estrogen-treated former males experienced orgasm, but only one-third were judged as having a fair or good sexual adjustment after sex reassignment. The possibility of unsuccessful surgical results must continue to be an important part of presurgery reality orientation both in doctors and patients. One striking finding is that overall sexual adjustment is often unchanged by genital surgery. Psychosocial adjustment showed a slight improvement after surgery. However, the majority of patients (eight) were judged to be unchanged. Repentance was chosen as the most crucial single outcome variable. One patient had officially requested reversal of sex change and another three were judged as repenting surgery in more indirect ways. Thus for a total of four individuals (30%), sex reassignment was considered retrospectively to be a mistake. Despite their returning to a male social role after surgery, however, two of the repenting patients were judged as fairly well adjusted from a psychosocial point of view.