title: Transgender Surgery in Denmark From 1994 to 2015: 20-Year Follow-Up Study.
abstract: BACKGROUND
  Gender dysphoria is a mismatch between a person's biological sex and gender identity. The best treatment is believed to be hormonal therapy and gender-confirming surgery that will transition the individual toward the desired gender. Treatment in Denmark is covered by public health care, and gender-confirming surgery in Denmark is centralized at a single-center with few specialized plastic surgeons conducting top surgery (mastectomy or breast augmentation) and bottom surgery (vaginoplasty or phalloplasty and metoidioplasty).
  
  
  OBJECTIVE
  To report the first nationwide single-center review on transsexual patients in Denmark undergoing gender-confirming surgery performed by a single surgical team and to assess whether age at time of gender-confirming surgery decreased during a 20-year period.
  
  
  METHODS
  Electronic patient databases were used to identify patients diagnosed with gender identity disorders from January 1994 through March 2015. Patients were excluded from the study if they were pseudohermaphrodites or if their gender was not reported.
  
  
  METHODS
  Gender distribution, age trends, and surgeries performed for Danish patients who underwent gender-confirming surgery.
  
  
  RESULTS
  One hundred fifty-eight patients referred for gender-confirming surgery were included. Fifty-five cases (35%) were male-to-female (MtF) and 103 (65%) were female-to-male (FtM). In total, 126 gender-confirming surgeries were performed. For FtM cases, top surgery (mastectomy) was conducted in 62 patients and bottom surgery (phalloplasty and metoidioplasty) was conducted in 17 patients. For MtF cases, 45 underwent bottom surgery (vaginoplasty), 2 of whom received breast augmentation. The FtM:MtF ratio of the referred patients was 1.9:1. The median age at the time of surgery decreased from 40 to 27 years during the 20-year period.
  
  
  CONCLUSIONS
  Gender-confirming surgery was performed on 65 FtM and 40 MtF cases at our hospital, and 21 transsexuals underwent surgery abroad. Mastectomy was performed in 62 FtM and bottom surgery in 17 FtM cases. Vaginoplasty was performed in 45 MtF and breast augmentation in 2 MtF cases. There was a significant decrease in age at the time of gender-confirming surgery during the course of the study period.
authors.affiliation: Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: doguay@hotmail.com.
authors.forename: Dogu
authors.initials: D
authors.lastname: Aydin
authors.affiliation: Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Liv Johanne
authors.initials: LJ
authors.lastname: Buk
authors.affiliation: Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Partoft
authors.affiliation: Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Bonde
authors.affiliation: Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Michael Vestergaard
authors.initials: MV
authors.lastname: Thomsen
authors.affiliation: Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Tina
authors.initials: T
authors.lastname: Tos
mesh_terms: D000328:Adult; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005783:Gender Identity; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D012725:Sexual Behavior; D063106:Transgender Persons / Q000523:psychology / Q000706:statistics & numerical data; D014189:Transsexualism / Q000453:epidemiology* / Q000523:psychology / Q000601:surgery*
keywords: Bottom Surgery; Gender Dysphoria; Gender Identity; Gender Variation; Gender-Confirming Surgery; Top Surgery; Transsex