title: Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with a gender identity disorder.
abstract: BACKGROUND
  At the start of gender reassignment therapy, persons with a gender identity disorder (GID) may deal with various forms of psychopathology. Until now, a limited number of publications focus on the effect of the different phases of treatment on this comorbidity and other psychosocial factors.
  
  
  OBJECTIVE
  The aim of this study was to investigate how gender reassignment therapy affects psychopathology and other psychosocial factors.
  
  
  METHODS
  This is a prospective study that assessed 57 individuals with GID by using the Symptom Checklist-90 (SCL-90) at three different points of time: at presentation, after the start of hormonal treatment, and after sex reassignment surgery (SRS). Questionnaires on psychosocial variables were used to evaluate the evolution between the presentation and the postoperative period. The data were statistically analyzed by using SPSS 19.0, with significance levels set at P < 0.05.
  
  
  METHODS
  The psychopathological parameters include overall psychoneurotic distress, anxiety, agoraphobia, depression, somatization, paranoid ideation/psychoticism, interpersonal sensitivity, hostility, and sleeping problems. The psychosocial parameters consist of relationship, living situation, employment, sexual contacts, social contacts, substance abuse, and suicide attempt.
  
  
  RESULTS
  A difference in SCL-90 overall psychoneurotic distress was observed at the different points of assessments (P = 0.003), with the most prominent decrease occurring after the initiation of hormone therapy (P < 0.001). Significant decreases were found in the subscales such as anxiety, depression, interpersonal sensitivity, and hostility. Furthermore, the SCL-90 scores resembled those of a general population after hormone therapy was initiated. Analysis of the psychosocial variables showed no significant differences between pre- and postoperative assessments.
  
  
  CONCLUSIONS
  A marked reduction in psychopathology occurs during the process of sex reassignment therapy, especially after the initiation of hormone therapy.
authors.affiliation: Department of Sexology and Gender Problems, Ghent University Hospital, Ghent, Belgium.
authors.forename: Gunter
authors.initials: G
authors.lastname: Heylens
authors.forename: Charlotte
authors.initials: C
authors.lastname: Verroken
authors.forename: Sanne
authors.initials: S
authors.lastname: De Cock
authors.forename: Guy
authors.initials: G
authors.lastname: T'Sjoen
authors.forename: Griet
authors.initials: G
authors.lastname: De Cuypere
mesh_terms: D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000601:surgery; D005260:Female; D005783:Gender Identity; D012739:Gonadal Steroid Hormones / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D057829:Gender-Affirming Procedures; D012725:Sexual Behavior / Q000523:psychology; D011795:Surveys and Questionnaires; D014189:Transsexualism / Q000188:drug therapy* / Q000523:psychology*
chemical_list: D012739:Gonadal Steroid Hormones
keywords: Gender Dysphoria; Gender Identity Disorder; Gender Reassignment Therapy; Psychopathology