TRANSSEXUALISM - GENERAL OUTCOME AND PROGNOSTIC FACTORS - A 5-YEAR FOLLOW-UP-STUDY OF 19 TRANSSEXUALS IN THE PROCESS OF CHANGING SEX

Nineteen transsexuals, approved for sex reassignment, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of soc ial, psychological, and psychiatric functioning. At baseline the patie nts were evaluated according to axis I, II, V (DSM-III-R), SCID screen , SASB (Structural Analysis of Social Behavior), and DMT (Defence Mech anism Test). At follow-up all but 1 were treated with contrary sex hor mones, 12 had completed sex reassignment surgery, and 3 females were w aiting for phalloplasty. One male transsexual regretted the decision t o change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n = 13) had improved in at least two areas of functioning. In 3 cases (16%) o utcome were judged as unsatisfactory and one of those regarded sex cha nge as a failure. Another 3 patients were mainly unchanged after 5 yea rs. Female transsexuals had a slightly better outcome, especially conc erning establishing and maintaining partnerships and improvement in so cioeconomic status compared to male transsexuals. Baseline factors ass ociated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power Negative self-image , according to SASB, predicted a negative outcome, whereas DMT variabl es were not correlated to outcome.