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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. Sex is a dearth of long term, follow-up studies after sex reassignment.

To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons. All sex-reassigned persons male-to-females, female-to-males in Sweden, — The overall mortality for sex-reassigned persons was higher during follow-up aHR 2. Sex-reassigned persons also had an increased risk for suicide attempts aHR 4. 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.

Persons with transsexualism, after sex reassignment, have hransseksual 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 transseksual after sex reassignment for this patient group. This is transsekual open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had full access to the data in the study and the final responsibility for the decision to submit for publication was made by the corresponding author. Competing interests: The authors have declared that no competing interests exist.

Transsexualism ICD[1] or gender identity disorder DSM-IV[2] is a condition in which a person's gender identity - the sense of being a man or a woman - contradicts his or her bodily sex characteristics. The individual experiences gender dysphoria and desires to live and be accepted as a member of the trandseksual sex. The treatment for transsexualism includes removal of body hair, vocal training, and cross-sex hormonal treatment aimed at making the person's body as congruent with the opposite sex as possible transseksua alleviate the gender dysphoria.

This is a unique intervention not only in psychiatry but in all of medicine. The present form of sex reassignment has been practised for more than half sex century and is the internationally recognized treatment to ease gender dysphoria in transsexual persons.

Despite the long history of this treatment, however, outcome data regarding mortality and psychiatric morbidity are scant. With respect to suicide and deaths from other causes after hransseksual reassignment, an early Swedish study followed 24 transsexual persons for an average of six years and reported one suicide.

Data is inconsistent transseksual respect to psychiatric morbidity post sex reassignment. The methodological shortcomings have many reasons. First, the nature of sex reassignment precludes double blind randomized controlled studies of the result.

Second, transsexualism is rare [20] and many follow-ups are hampered by small numbers of subjects. A long-term population-based controlled study is one way to address these methodological shortcomings. Here, we assessed mortality, psychiatric morbidity, and psychosocial integration expressed in criminal behaviour after sex reassignment ttansseksual transsexual persons, in a total population cohort study with long-term follow-up information obtained from Swedish registers.

The cohort was compared with randomly selected population controls matched for age and gender. We adjusted for premorbid differences regarding psychiatric morbidity and immigrant status. This study design sheds new light on transsexual persons' health after sex reassignment.

It does not, however, address whether sex reassignment is an effective treatment or not. The study population was identified by the linkage of several Swedish national registers, which contained a total sfx The Hospital Discharge Register HDR, held by the National Board of Health and Welfare contains discharge diagnoses, up to seven contributory diagnoses, external causes of morbidity or mortality, surgical procedure codes, and discharge date.

Discharge diagnoses are coded according to the 8 th9 th —and 10 th editions of the International Classification of Diseases ICD. The register covers virtually all psychiatric inpatient episodes in Sweden since Discharges that occurred up to 31 December were included.

Surgical procedure codes could not be used for this study due to the lack of a specific code for sex reassignment surgery. Through linkage with the Total Population Register it was possible to identify birth date and birth gender for all study subjects.

The Medical Birth Register MBR was established in and contains birth transseksuxl, including gender of the child at birth. National censuses based on mandatory self-report questionnaires completed by all adult citizens in,and provided information on individuals, households, and dwellings, including gender, living area, and highest educational level. Complete migration data, including country of sex for immigrants for —, were obtained from the TPR.

In addition to educational information from the censuses, we also obtained highest educational level data for and from the Register of Education. Death events occurring up to 31 December are included in the study.

The Crime Register held by the National Council of Crime Prevention provided information regarding crime type and date on all criminal convictions in Sweden during the period — Attempted and aggravated forms of all offences were also included. All crimes in Sweden are registered regardless of insanity at the time of perpetration; for example, for individuals who suffered from psychosis at the time of the offence.

Moreover, conviction data include individuals who received custodial or non-custodial sentences and cases where the prosecutor decided to caution or fine without court proceedings. Finally, Sweden does not differ considerably from other members of the European Union regarding rates of violent crime and their resolution. The study was designed as a population-based matched cohort study. We used the tranwseksual national registration number, assigned to all Swedish residents, including transseksual on arrival, as the primary key through all linkages.

The registration number consists of 10 digits; the first six provide information of the birth date, whereas the ninth digit indicates the gender. In Sweden, a transseksua presenting with gender dysphoria is referred to one of six specialised gender teams that evaluate and treat patients principally according to international consensus guidelines: Standards of Care. A new national registration number signifying the new gender is assigned after sex reassignment surgery. The National Board of Health and Welfare maintains a link between old and new transswksual registration numbers, making it possible to follow individuals undergoing sex reassignment across registers and over time.

Hence, sex reassignment surgery in Sweden requires i a transsexualism diagnosis and ii permission transseksual the National Board of Health and Welfare. A person was defined as exposed to sex reassignment surgery if two criteria were met: i at least one inpatient diagnosis of gender identity disorder diagnosis without concomitant psychiatric diagnoses in the Hospital Discharge Register, and ii at least one discrepancy between gender variables in the Medical Birth Register from and onwards or the National Censuses from,or and the latest gender trsnsseksual in the Total Population Register.

The first criterion was employed to capture the hospitalization for sex reassignment surgery that serves to secure the diagnosis and provide a time point for sex reassignment surgery; the plastic surgeons namely record the reason for sex reassignment surgery, i. The second criterion was used to ensure that the zex went through all steps in sex-reassignment and also changed sex legally.

The date of sex reassignment sex of follow-up was defined transaeksual the first occurrence of sex gender identity disorder transseisual, without any other concomitant psychiatric disorder, in the Hospital Discharge Register after the patient changed sex status any discordance in sex designation across the Censuses, Medical Birth, and Total Population registers.

If this information was missing, we used instead the closest date in the Transsekeual Discharge Register on which the patient was diagnosed with gender identity disorder without concomitant psychiatric disorder prior to transseksual in sex status.

The reason for prioritizing the use of a gender identity disorder diagnosis after changed sex status over before was to avoid overestimating person-years at risk of sex-reassigned person. Using these criteria, a total of patients with gender identity disorder were identified, whereof displayed a shift in the gender variable during the period — The persons that did not shift gender variable comprise persons who either did not apply, or were not transseksual, for sex reassignment surgery.

Moreover, the ICD 9 code is a non specific code for sexual disorders. Hence, this group might also comprise persons that were hospitalized for sexual disorders other trnsseksual transsexualism. Therefore, they were omitted from further analyses. Of the remaining persons, were identified with the gender identity diagnosis after and 36 before change of sex status. Out of the persons identified after changed sex status, could also be identified before change in sex status.

The median time lag between the hospitalization before and transxeksual sex change for these persons was 0. Gender identity disorder was coded according to ICD A person was defined as unexposed if there were no discrepancies in sex designation across the Censuses, Medical Birth, and Total Population registers and no gender identity disorder diagnosis according to the Hospital Discharge Register.

Control persons were matched by sex and birth year and had to be alive and residing in Sweden at the estimated sex reassignment date of the case person. To study possible sex effects on outcomes of interest, we used two different control groups: transsseksual with the same sex as the case individual at birth birth sex matching and the other with the sex that the case individual had been reassigned to final sex matching.

We studied mortality, psychiatric morbidity, accidents, and crime following sex reassignment. Finally, we addressed court convictions for 9 transseksual criminal offence and 10 any violent offence.

Each individual could contribute with several outcomes, but only one event per outcome. Any criminal conviction during follow-up was counted; specifically, violent crime was defined as homicide and attempted homicide, aggravated assault and assault, transsekksual, threatening behaviour, harassment, arson, or any sexual offense. Severe psychiatric morbidity was defined as inpatient care according to ICD-8 codes,and ; ICD-9 codes,tobacco use disorder excluded Immigrant status, defined as individuals born abroad, was obtained from the Total Population Register.

Each individual contributed person-time from study entry for exposed: date of sex reassignment; for unexposed: date of sex reassignment of matched case until date of outcome event, death, emigration, or end of study period 31 Decemberwhichever came first.

We present crude HRs though adjusted for sex and age through matching and confounder-adjusted HRs [aHRs] for all outcomes. Gender-separated analyses were performed and a Kaplan-Meier survival plot graphically illustrates the survival of the sex reassigned cohort and matched controls all-cause mortality over time.

The significance level was set at 0. The data were analysed using SAS version 9. The data linking of national registers required for this study was approved by the IRB at Karolinska Institutet, Stockholm. All data were analyzed anonymously; therefore, informed consent for each individual was neither necessary nor possible. We identified transsexual persons exposed cohort who underwent sex reassignment surgery and were assigned a new legal sex between and These constituted the sex-reassigned exposed group.

The average follow-up time for all-cause mortality was The average follow-up time for the risk of being hospitalized for any psychiatric disorder was Sex 1 displays demographic characteristics of sex-reassigned and control persons prior to study entry sex reassignment. There were no substantial differences between female-to-males and male-to-females regarding measured baseline characteristics.

Immigrant status was twice as common among transsexual individuals compared to controls, living in an urban area somewhat more common, and higher education about equally prevalent. Transsexual individuals had been hospitalized for psychiatric morbidity other than gender identity disorder prior to sex reassignment about four times more often than controls. To adjust for these baseline discrepancies, hazard transseksual adjusted for immigrant status and psychiatric morbidity prior to baseline are presented for sex outcomes [aHRs].

Table 2 describes the risks for selected outcomes during follow-up among sex-reassigned persons, compared to same-age controls of the same birth sex. Sex-reassigned transsexual persons of both genders had approximately a three times higher risk seex all-cause mortality than controls, also after adjustment for covariates.

Table 2 separately lists the outcomes depending on when sex reassignment was performed: during the period or — Even though the overall mortality was increased across both time periods, it did not reach statistical significance for the period —


Transseksual and transsexual are sex confused terms that both refer to gender sex. Transgender is a broader, more inclusive category that transseksual all individuals who do not identify with the gender that corresponds to the sex they were transseksual at birth. Transsexual is a more narrow category that includes individuals who transseksual to physically transition sex the sex that corresponds with the gender with which they identify.

Note that the word "gender" is usually used to refer to social and cultural roles, while "sex" refers to physical attributes. All transsexual persons are transgender. However, not all transgender persons are transsexual. Transgender women are sometimes referred to as trans women. Some may also be known as male-to-female transseksual, MTFs, transsexual women, transgirls, or tgirls.

It is always best to sex a person which term is preferred. Although they both refer to gender identitysex and transsexual are terms with sex meanings.

That they are often used interchangeably has led to some confusion. In most cases, a transgender woman is a woman who was designated also commonly referred to as "assigned" transseksual at birth but who identifies as a woman. Some transseksual women may use the term AMAB assigned male at birth in describing their identity. She may take steps to transition, but these steps do not necessarily involve surgery or physical alterations. She may dress as a woman, refer to herself as a woman, or use a feminine name.

Note that some trans men may use the term AFAB, or assigned female at birth. Some identify as gender nonconforming, nonbinary, genderqueer, androgynousor "third gender.

A transsexual woman is one who desires to physically transition to the sex that corresponds with the gender with which she identifies. Transitioning often includes taking hormones sex suppress the physical characteristics of her assigned gender. Many transsexual women in the U. Strictly speaking, there's no such thing sex a "sex change operation. These surgeries are not limited to transsexual people.

Gender identity is often confused with sexual orientation. The latter, however, refers only to a person's " enduring emotional, romantic or sexual attraction to other people " and is not related to gender identity. A transgender woman, for example, may transseksual attracted to women, men, both, or neither and this orientation has no bearing on her gender identity.

She may identify as gay or lesbian, straight, bisexual, asexualor may not name her orientation at all. A man may prefer to dress as a woman, but this does not make him transgender if he does not identify as a woman. Share Flipboard Email. Government U. Foreign Policy U. Liberal Politics U.

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National censuses based on mandatory self-report questionnaires completed by all adult citizens in , , , and provided information on individuals, households, and dwellings, including gender, living area, and highest educational level. Complete migration data, including country of birth for immigrants for —, were obtained from the TPR.

In addition to educational information from the censuses, we also obtained highest educational level data for and from the Register of Education. Death events occurring up to 31 December are included in the study. The Crime Register held by the National Council of Crime Prevention provided information regarding crime type and date on all criminal convictions in Sweden during the period — Attempted and aggravated forms of all offences were also included. All crimes in Sweden are registered regardless of insanity at the time of perpetration; for example, for individuals who suffered from psychosis at the time of the offence.

Moreover, conviction data include individuals who received custodial or non-custodial sentences and cases where the prosecutor decided to caution or fine without court proceedings. Finally, Sweden does not differ considerably from other members of the European Union regarding rates of violent crime and their resolution. The study was designed as a population-based matched cohort study. We used the individual national registration number, assigned to all Swedish residents, including immigrants on arrival, as the primary key through all linkages.

The registration number consists of 10 digits; the first six provide information of the birth date, whereas the ninth digit indicates the gender. In Sweden, a person presenting with gender dysphoria is referred to one of six specialised gender teams that evaluate and treat patients principally according to international consensus guidelines: Standards of Care. A new national registration number signifying the new gender is assigned after sex reassignment surgery. The National Board of Health and Welfare maintains a link between old and new national registration numbers, making it possible to follow individuals undergoing sex reassignment across registers and over time.

Hence, sex reassignment surgery in Sweden requires i a transsexualism diagnosis and ii permission from the National Board of Health and Welfare. A person was defined as exposed to sex reassignment surgery if two criteria were met: i at least one inpatient diagnosis of gender identity disorder diagnosis without concomitant psychiatric diagnoses in the Hospital Discharge Register, and ii at least one discrepancy between gender variables in the Medical Birth Register from and onwards or the National Censuses from , , , or and the latest gender designation in the Total Population Register.

The first criterion was employed to capture the hospitalization for sex reassignment surgery that serves to secure the diagnosis and provide a time point for sex reassignment surgery; the plastic surgeons namely record the reason for sex reassignment surgery, i. The second criterion was used to ensure that the person went through all steps in sex-reassignment and also changed sex legally.

The date of sex reassignment start of follow-up was defined as the first occurrence of a gender identity disorder diagnosis, without any other concomitant psychiatric disorder, in the Hospital Discharge Register after the patient changed sex status any discordance in sex designation across the Censuses, Medical Birth, and Total Population registers.

If this information was missing, we used instead the closest date in the Hospital Discharge Register on which the patient was diagnosed with gender identity disorder without concomitant psychiatric disorder prior to change in sex status. The reason for prioritizing the use of a gender identity disorder diagnosis after changed sex status over before was to avoid overestimating person-years at risk of sex-reassigned person. Using these criteria, a total of patients with gender identity disorder were identified, whereof displayed a shift in the gender variable during the period — The persons that did not shift gender variable comprise persons who either did not apply, or were not approved, for sex reassignment surgery.

Moreover, the ICD 9 code is a non specific code for sexual disorders. Hence, this group might also comprise persons that were hospitalized for sexual disorders other than transsexualism. Therefore, they were omitted from further analyses. Of the remaining persons, were identified with the gender identity diagnosis after and 36 before change of sex status.

Out of the persons identified after changed sex status, could also be identified before change in sex status.

The median time lag between the hospitalization before and after sex change for these persons was 0. Gender identity disorder was coded according to ICD A person was defined as unexposed if there were no discrepancies in sex designation across the Censuses, Medical Birth, and Total Population registers and no gender identity disorder diagnosis according to the Hospital Discharge Register.

Control persons were matched by sex and birth year and had to be alive and residing in Sweden at the estimated sex reassignment date of the case person.

To study possible gender-specific effects on outcomes of interest, we used two different control groups: one with the same sex as the case individual at birth birth sex matching and the other with the sex that the case individual had been reassigned to final sex matching. We studied mortality, psychiatric morbidity, accidents, and crime following sex reassignment.

Finally, we addressed court convictions for 9 any criminal offence and 10 any violent offence. Each individual could contribute with several outcomes, but only one event per outcome.

Any criminal conviction during follow-up was counted; specifically, violent crime was defined as homicide and attempted homicide, aggravated assault and assault, robbery, threatening behaviour, harassment, arson, or any sexual offense. Severe psychiatric morbidity was defined as inpatient care according to ICD-8 codes , , , and ; ICD-9 codes , , , tobacco use disorder excluded , Immigrant status, defined as individuals born abroad, was obtained from the Total Population Register.

Each individual contributed person-time from study entry for exposed: date of sex reassignment; for unexposed: date of sex reassignment of matched case until date of outcome event, death, emigration, or end of study period 31 December , whichever came first.

We present crude HRs though adjusted for sex and age through matching and confounder-adjusted HRs [aHRs] for all outcomes. Gender-separated analyses were performed and a Kaplan-Meier survival plot graphically illustrates the survival of the sex reassigned cohort and matched controls all-cause mortality over time.

The significance level was set at 0. The data were analysed using SAS version 9. The data linking of national registers required for this study was approved by the IRB at Karolinska Institutet, Stockholm. All data were analyzed anonymously; therefore, informed consent for each individual was neither necessary nor possible.

We identified transsexual persons exposed cohort who underwent sex reassignment surgery and were assigned a new legal sex between and These constituted the sex-reassigned exposed group.

The average follow-up time for all-cause mortality was The average follow-up time for the risk of being hospitalized for any psychiatric disorder was Table 1 displays demographic characteristics of sex-reassigned and control persons prior to study entry sex reassignment.

There were no substantial differences between female-to-males and male-to-females regarding measured baseline characteristics. Immigrant status was twice as common among transsexual individuals compared to controls, living in an urban area somewhat more common, and higher education about equally prevalent. Transsexual individuals had been hospitalized for psychiatric morbidity other than gender identity disorder prior to sex reassignment about four times more often than controls.

To adjust for these baseline discrepancies, hazard ratios adjusted for immigrant status and psychiatric morbidity prior to baseline are presented for all outcomes [aHRs]. Table 2 describes the risks for selected outcomes during follow-up among sex-reassigned persons, compared to same-age controls of the same birth sex. Sex-reassigned transsexual persons of both genders had approximately a three times higher risk of all-cause mortality than controls, also after adjustment for covariates.

Table 2 separately lists the outcomes depending on when sex reassignment was performed: during the period or — Even though the overall mortality was increased across both time periods, it did not reach statistical significance for the period — The Kaplan-Meier curve Figure 1 suggests that survival of transsexual persons started to diverge from that of matched controls after about 10 years of follow-up.

The cause-specific mortality from suicide was much higher in sex-reassigned persons, compared to matched controls. Mortality due to cardiovascular disease was moderately increased among the sex-reassigned, whereas the numerically increased risk for malignancies was borderline statistically significant.

Sex-reassigned persons had a higher risk of inpatient care for a psychiatric disorder other than gender identity disorder than controls matched on birth year and birth sex Table 2. This held after adjustment for prior psychiatric morbidity, and was true regardless of whether sex reassignment occurred before or after In line with the increased mortality from suicide, sex-reassigned individuals were also at a higher risk for suicide attempts, though this was not statistically significant for the time period — The risks of being hospitalised for substance misuse or accidents were not significantly increased after adjusting for covariates Table 2.

Transsexual individuals were at increased risk of being convicted for any crime or violent crime after sex reassignment Table 2 ; this was, however, only significant in the group who underwent sex reassignment before Comparisons of female-to-males and male-to-females, although hampered by low statistical power and associated wide confidence intervals, suggested mostly similar risks for adverse outcomes Tables S1 and S2.

However, violence against self suicidal behaviour and others [violent] crime constituted important exceptions. First, male-to-females had significantly increased risks for suicide attempts compared to both female aHR 9. By contrast, female-to-males had significantly increased risk of suicide attempts only compared to male controls aHR 6. This suggests that male-to-females are at higher risk for suicide attempts after sex reassignment, whereas female-to-males maintain a female pattern of suicide attempts after sex reassignment Tables S1 and S2.

Second, regarding any crime, male-to-females had a significantly increased risk for crime compared to female controls aHR 6. This indicates that they retained a male pattern regarding criminality. The same was true regarding violent crime. By contrast, female-to-males had higher crime rates than female controls aHR 4. This indicates a shift to a male pattern regarding criminality and that sex reassignment is coupled to increased crime rate in female-to-males.

We report on the first nationwide population-based, long-term follow-up of sex-reassigned transsexual persons. We compared our cohort with randomly selected population controls matched for age and gender. The most striking result was the high mortality rate in both male-to-females and female-to males, compared to the general population. This contrasts with previous reports with one exception [8] that did not find an increased mortality rate after sex reassignment, or only noted an increased risk in certain subgroups.

Likewise, it is cumbersome to track deceased persons in clinical follow-up studies. Hence, population-based register studies like the present are needed to improve representativity. In support of this notion, the survival curve Figure 1 suggests increased mortality from ten years after sex reassignment and onwards.

In accordance, the overall mortality rate was only significantly increased for the group operated before However, the latter might also be explained by improved health care for transsexual persons during s, along with altered societal attitudes towards persons with different gender expressions. Mortality due to cardiovascular disease was significantly increased among sex reassigned individuals, albeit these results should be interpreted with caution due to the low number of events.

This contrasts, however, a Dutch follow-up study that reported no increased risk for cardiovascular events. With respect to neoplasms, prolonged hormonal treatment might increase the risk for malignancies, [36] but no previous study has tested this possibility. Our data suggested that the cause-specific risk of death from neoplasms was increased about twice borderline statistical significance. These malignancies see Results , however, are unlikely to be related to cross-hormonal treatment.

There might be other explanations to increased cardiovascular death and malignancies. Mortality from suicide was strikingly high among sex-reassigned persons, also after adjustment for prior psychiatric morbidity. In line with this, sex-reassigned persons were at increased risk for suicide attempts. Previous reports [6] , [8] , [10] , [11] suggest that transsexualism is a strong risk factor for suicide, also after sex reassignment, and our long-term findings support the need for continued psychiatric follow-up for persons at risk to prevent this.

Inpatient care for psychiatric disorders was significantly more common among sex-reassigned persons than among matched controls, both before and after sex reassignment. It is generally accepted that transsexuals have more psychiatric ill-health than the general population prior to the sex reassignment.

Notably, however, in this study the increased risk for psychiatric hospitalisation persisted even after adjusting for psychiatric hospitalisation prior to sex reassignment. This suggests that even though sex reassignment alleviates gender dysphoria, there is a need to identify and treat co-occurring psychiatric morbidity in transsexual persons not only before but also after sex reassignment.

Criminal activity, particularly violent crime, is much more common among men than women in the general population. A previous study of all applications for sex reassignment in Sweden up to found that 9.

In this study, male-to-female individuals had a higher risk for criminal convictions compared to female controls but not compared to male controls. This suggests that the sex reassignment procedure neither increased nor decreased the risk for criminal offending in male-to-females. By contrast, female-to-males were at a higher risk for criminal convictions compared to female controls and did not differ from male controls, which suggests increased crime proneness in female-to-males after sex reassignment.

Strengths of this study include nationwide representativity over more than 30 years, extensive follow-up time, and minimal loss to follow-up. Many previous studies suffer from low outcome ascertainment, [6] , [9] , [21] , [29] whereas this study has captured almost the entire population of sex-reassigned transsexual individuals in Sweden from — Moreover, previous outcome studies have mixed pre-operative and post-operative transsexual persons, [22] , [37] while we included only post-operative transsexual persons that also legally changed sex.

Finally, whereas previous studies either lack a control group or use standardised mortality rates or standardised incidence rates as comparisons, [9] , [10] , [11] we selected random population controls matched by birth year, and either birth or final sex. Given the nature of sex reassignment, a double blind randomized controlled study of the result after sex reassignment is not feasible. We therefore have to rely on other study designs. For the purpose of evaluating whether sex reassignment is an effective treatment for gender dysphoria, it is reasonable to compare reported gender dysphoria pre and post treatment.

Such studies have been conducted either prospectively [7] , [12] or retrospectively, [5] , [6] , [9] , [22] , [25] , [26] , [29] , [38] and suggest that sex reassignment of transsexual persons improves quality of life and gender dysphoria. The limitation is of course that the treatment has not been assigned randomly and has not been carried out blindly. For the purpose of evaluating the safety of sex reassignment in terms of morbidity and mortality, however, it is reasonable to compare sex reassigned persons with matched population controls.

The caveat with this design is that transsexual persons before sex reassignment might differ from healthy controls although this bias can be statistically corrected for by adjusting for baseline differences. It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism.

In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia. Other facets to consider are first that this study reflects the outcome of psychiatric and somatic treatment for transsexualism provided in Sweden during the s and s.

Since then, treatment has evolved with improved sex reassignment surgery, refined hormonal treatment, [11] , [41] and more attention to psychosocial care that might have improved the outcome. Second, transsexualism is a rare condition and Sweden is a small country 9. Hence, despite being based on a comparatively large national cohort and long-term follow-up, the statistical power was limited. Those prices include hospital stays, anesthesia and other costs associated with surgery. Support real journalism.

Support local journalism. Subscribe to The Atlanta Journal-Constitution today. See offers. Your subscription to the Atlanta Journal-Constitution funds in-depth reporting and investigations that keep you informed. Thank you for supporting real journalism. Trump realDonaldTrump July 26, Thank you — Donald J. Army shows Pfc. Chelsea Manning. For most Americans, Manning has been a hero or villain based on how they view her decision to leak classified material.

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transseksual sex

Earlier this year, Facebook created a stir when it added 50 gender options sex its billions of users. For many people, it raised questions about the sex of identity and inspired some to ask: What is the difference between transsexual and transseksual Transsexuals are people who transition from one sex to another.

That said, transsexuals are unable transseksuwl change se sex and cannot acquire the traansseksual abilities of transseksual sex to which they transition. In other words, sex refers exclusively to the biological features: chromosomes, the balance of hormones, and internal and external anatomy.

Each of us is born as either male or female, with rare exceptions of those born intersex who may display characteristics of both wex at birth. Transgenderunlike transsexual, is a term for people whose identity, expression, behavior, or general sense of self does not conform to what is usually associated with the sex they were born transseksual the place they were born.

It is transseksual said sex is a matter of the body, while gender sex in the mind. Gender is an internal sense of being male, female, or other. People often use binary terms, for instance, masculine or transsekaual, to describe gender just as they do when referring to sex. Sex gender is more complex and encompasses more than just two possibilities.

Gender also is influenced by culture, class, and race because behavior, activities, and attributes seen as appropriate in one society or group may be viewed otherwise in sex. Transgender, then, unlike transsexual is a multifaceted term. One example of a transssksual person might be a man who is attracted to women but also identifies as a cross-dresser.

Other examples transseksual people who consider themselves gender nonconforming, multigendered, androgynous, third gender, and two-spirit people.

Transseksual of these definitions are inexact and vary from person to person, yet each of them includes a sense of blending or alternating the binary concepts of masculinity and femininity. Some transseksual using these terms simply see the traditional concepts as restrictive.

Less than one percent of all adults identify as transgender. Gender identity and sexual orientation are not transsekdual same. Transgender people may be straight, bisexual, lesbian, gay, or asexual. Biological factors such as prenatal hormone levels, sex, and dex childhood experiences may all contribute to the development of a transgender identity, according to some researchers.

The current change suggests an evolution of thought on the matter of gender that may influence not only how sex people see themselves, but also how they are perceived by others. No matter how they label themselves, many people do not entirely conform to a single, rigid gender definition with most people having traits that don't exactly fit the profile.

Even more importantly, some of transseksual traditional gender differences between men and women may be slight. Due to changes in social attitudes, general changes in the perception of gender also occurs over time. A trait considered masculine in transseksua generation may be a feminine norm in the next. A woman wearing pants, for instance, would have sex considered manly at one time.

And though it may have been transseksual in the not-too-distant past, many women zex equal to or more than their husbands today, while their husbands perform more of the household and childcare duties once assigned to women. Transswksual, gender is a shifting ground on which each of us stands.

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