title: Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden.
abstract: BACKGROUND
  The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person's body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment.
  
  
  OBJECTIVE
  To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons.
  
  
  METHODS
  A population-based matched cohort study.
  
  
  METHODS
  Sweden, 1973-2003.
  
  
  METHODS
  All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973-2003. Random population controls (10:1) were matched by birth year and birth sex or reassigned (final) sex, respectively.
  
  
  METHODS
  Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]).
  
  
  RESULTS
  The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8-4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8-62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9-8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0-3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls.
  
  
  CONCLUSIONS
  Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
authors.affiliation: Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Dhejne
authors.forename: Paul
authors.initials: P
authors.lastname: Lichtenstein
authors.forename: Marcus
authors.initials: M
authors.lastname: Boman
authors.forename: Anna L V
authors.initials: AL
authors.lastname: Johansson
authors.forename: Niklas
authors.initials: N
authors.lastname: Långström
authors.forename: Mikael
authors.initials: M
authors.lastname: Landén
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012042:Registries; D057830:Gender-Affirming Surgery / Q000401:mortality / Q000534:rehabilitation; D013405:Suicide / Q000706:statistics & numerical data; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014189:Transsexualism / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*