title: Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality.
abstract: BACKGROUND
  There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which comprised 98% (n = 104) of all individuals in Denmark.
  
  
  OBJECTIVE
  (1) To investigate psychiatric morbidity before and after sex reassignment surgery (SRS) among Danish individuals who underwent SRS during the period of 1978-2010. (2) To investigate mortality among Danish individuals who underwent SRS during the period of 1978-2010.
  
  
  METHODS
  Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals.
  
  
  RESULTS
  Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant). A total of 6.7% of the sample were registered with psychiatric morbidity both before and after SRS. Significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth. Ten individuals were registered as deceased post-SRS with an average age of death of 53.5 years.
  
  
  CONCLUSIONS
  No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.
authors.affiliation: a Psychiatric Centre Sexological Clinic , GIUUC, Copenhagen, Denmark.|b Department of Clinical Medicine , University of Copenhagen , Denmark.
authors.forename: Rikke Kildevæld
authors.initials: RK
authors.lastname: Simonsen
authors.affiliation: a Psychiatric Centre Sexological Clinic , GIUUC, Copenhagen, Denmark.|b Department of Clinical Medicine , University of Copenhagen , Denmark.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Giraldi
authors.affiliation: a Psychiatric Centre Sexological Clinic , GIUUC, Copenhagen, Denmark.|b Department of Clinical Medicine , University of Copenhagen , Denmark.
authors.forename: Ellids
authors.initials: E
authors.lastname: Kristensen
authors.affiliation: c Department of Public Health , University of Copenhagen , Denmark.
authors.forename: Gert Martin
authors.initials: GM
authors.lastname: Hald
mesh_terms: D000293:Adolescent; D000328:Adult; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D005783:Gender Identity; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology; D008875:Middle Aged; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000523:psychology*; D014189:Transsexualism / Q000150:complications / Q000523:psychology / Q000601:surgery*; D055815:Young Adult
keywords: Follow-up; gender identity disorder; mortality; psychiatric morbidity; sex reassignment surgery (SRS); transsexualism