A follow-up study of operated transsexual males.

The opportuneness of operating on transsexuals has often been discussed but it has obviously been the only form of treatment they wish themselves. Most transsexuals in Denmark have been assessed at the Rigshospital prior to surgery. Since 1951, when the first operation on a transsexual took place, we have had a thorough preoperative knowledge of a total of 29 transsexual males who have all obtained official status as females and who have subsequently been followed up. A phenomenologically based clinical theory of the dynamic coherence of the symptomatology of transsexuals has been advanced. A special core group of transsexual males has been described as characterized by a stable defence in the form of a pseudofeminine narcissism, a stable ego strength, an intact reality testing and a poor genital interest. These patients are expected to have a relatively stable life postoperatively. Of the 29 operated transsexual males six were not interviewed, three had committed suicide and two refused to take part in the follow-up. These last five did not belong to the core group, whereas one patient, who emigrated to Canada after sex-reassignment, belonged to the core group. The remaining 23 have all been interviewed, of the 14 belonged to the core group. The average for the follow-up period is 6 years. The operations turned out not to be resocializing, rather the contrary. The majority had no occupation at follow-up and the number of persons with disablement pension had increased considerably. About 66% lived alone and the majority of those with sexual relationships had had problems. Both before and after operation the majority felt socially isolated. About 66% were satisfied with the surgical outcome, nevertheless 50% wished for supplementary plastic surgery. None of the patients showed signs of more severe psychic sufferings or psychoses postoperatively. Psychically, 83% felt better after than before sex-reassignment. The majority have had complications and subjective trouble in connection with plastic surgery leading to reoperations of the vagina in most of them. Almost 75% have had sexual relationships postoperatively but not without difficulties. Characteristic of the persons in the core group is a better economy, a better adjustment to the environment and less problems with neighbours, they are more satisfied with the surgical outcome and have had fewer surgical corrections and also have a better psychic condition than the rest. It is the general impression at follow-up that the advantages of sex-reassignment outweigh the disadvantages where the core group is concerned. But among the persons who do not belong to the core group subjective and objective problems seem so pronounced that operation must be advised against in spite of the often extremely, subjectively unsatisfactory condition of these patients preoperatively.