Published online Mar 2. Published by Elsevier Inc. Abstract Introduction Studies of mortality and somatic well-being after sex-reassignment surgery SRS of transsexual individuals are equivocal. Methods Somatic morbidity and mortality in sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register.
Main Outcome Measures Somatic morbidity and cause of death. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS.
Ten individuals died after SRS at an average age of No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.
Follow-Up, Gender Identity Disorder, Somatic Morbidity, Sex-Reassignment Surgery, Transsexualism Introduction Transsexualism refers to a condition in which the core characteristic is an individual's experience of profound incongruence between assigned sex at birth and the experienced gender.
To develop characteristics of the opposite sex, treatment with cross-sex hormones HT , castration, and genital reconstructive surgery sex-reassignment surgery [SRS] might be conducted. Assessment, in accordance with Danish Health Authority guidelines, 4 includes blood sample analyses for chromosomal and hormonal abnormalities, screening for psychiatric and somatic morbidities, psychological testing, and sessions with a psychologist or psychiatrist.
If SRS is desired by the individual diagnosed with transsexualism, an observational period of at least 1 year 6 months in the study period, 2 years , including 1 year of HT and living in the gender role as the opposite sex, is obligatory before applying for SRS to the Danish Health Authority. Treatment with cross-sex hormones and genital reconstructive surgery has existed for more than 60 years, but findings on mortality and somatic well-being after SRS in long-term follow-up studies are equivocal.
The conclusions emerging from these studies suggest that for MtF individuals 20 , 21 , 22 , 23 the risk of breast cancer is lower than the expected risk of breast cancer in assigned women but similar to that expected in assigned men. For FtM individuals, male sex hormones might have an antiproliferative effect on breast cancer cell lines. Concerning cancer malignancies, a Belgian study, in which the average time of HT was 6 years FtM or 7 years MtF , found no increase in cancer malignancies among included transsexuals compared with controls randomly selected from the population.
When studying increased and decreased risks of cancer in transsexuals receiving HT, it is important to note that HT has been used for 60 years in some transsexual individuals. Accordingly, the duration of exposure to HT might not be long enough for tumors to manifest and the number of individuals exposed is small. Studies of mortality in transsexuals have suggested an increased mortality risk compared with controls.
A Dutch study of 1, individuals receiving HT found no increased mortality overall, but in MtF subjects 25 to 39 years old, mortality was significantly increased because of suicide, acquired immune deficiency syndrome, CVD, drug abuse, and unknown causes. For many of the studies that have focused on somatic morbidity and mortality, including those reviewed earlier, the following methodologic shortcomings apply: Aims The specific aims of the study were to investigate i somatic morbidity before and after SRS and ii cause of death and its relation to somatic morbidity.
The LPR contains diagnoses and dates of onset and end of treatment of all somatic episodes at hospitals from inpatients and from outpatients. The Cause of Death Register has recorded all deaths and causes of death in Denmark since Death events occurring up to April were included in the study.
All participants underwent castration with permission from the Danish Health Authority from through Verification that an individual had undergone SRS was accomplished using social security numbers ie, Danish Cause of Death Register numbers ; numbers ending in even numbers indicate female-assigned sex and those ending with odd numbers indicate male-assigned sex.
Accordingly, changes in this number from even to odd or vice versa indicate the official change of assigned sex ie, successful completion of SRS.