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      Quality of life improves early after gender reassignment surgery in transgender women

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          Abstract

          Background

          Few studies have examined the long-term quality of life (QoL) of individuals with gender dysphoria, or how it is affected by treatment. Our aim was to examine the QoL of transgender women undergoing gender reassignment surgery (GRS).

          Methods

          We performed a prospective cohort study on 190 patients undergoing male-to-female GRS at Karolinska University Hospital between 2003 and 2015. We used the Swedish version of the Short Form-36 Health Survey (SF-36), which measures QoL across eight domains. The questionnaire was distributed to patients pre-operatively, as well as 1, 3, and 5 years post-operatively. The results were compared between the different measure points, as well as between the study group and the general population.

          Results

          On most dimensions of the SF-36 questionnaire, transgender women reported a lower QoL than the general population. The scores of SF-36 showed a non-significant trend to be lower 5 years post-GRS compared to pre-operatively, a decline consistent with that of the general population. Self-perceived health compared to 1 year previously rose in the first post-operative year, after which it declined.

          Conclusions

          To our knowledge, this is the largest prospective study to follow a group of transgender patients with regards to QoL over continuous temporal measure points. Our results show that transgender women generally have a lower QoL compared to the general population. GRS leads to an improvement in general well-being as a trend but over the long-term, QoL decreases slightly in line with that of the comparison group.

          Level of evidence: Level III, therapeutic study.

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          Most cited references15

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          Mental health and gender dysphoria: A review of the literature.

          Studies investigating the prevalence of psychiatric disorders among trans individuals have identified elevated rates of psychopathology. Research has also provided conflicting psychiatric outcomes following gender-confirming medical interventions. This review identifies 38 cross-sectional and longitudinal studies describing prevalence rates of psychiatric disorders and psychiatric outcomes, pre- and post-gender-confirming medical interventions, for people with gender dysphoria. It indicates that, although the levels of psychopathology and psychiatric disorders in trans people attending services at the time of assessment are higher than in the cis population, they do improve following gender-confirming medical intervention, in many cases reaching normative values. The main Axis I psychiatric disorders were found to be depression and anxiety disorder. Other major psychiatric disorders, such as schizophrenia and bipolar disorder, were rare and were no more prevalent than in the general population. There was conflicting evidence regarding gender differences: some studies found higher psychopathology in trans women, while others found no differences between gender groups. Although many studies were methodologically weak, and included people at different stages of transition within the same cohort of patients, overall this review indicates that trans people attending transgender health-care services appear to have a higher risk of psychiatric morbidity (that improves following treatment), and thus confirms the vulnerability of this population.
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            Female-to-male transgender quality of life.

            We evaluated health-related quality of life in female-to-male (FTM) transgender individuals, using the Short-Form 36-Question Health Survey version 2 (SF-36v2). Using email, Internet bulletin boards, and postcards, we recruited individuals to an Internet site (http://www.transurvey.org), which contained a demographic survey and the SF36v2. We enrolled 446 FTM transgender and FTM transsexual participants, of which 384 were from the US. Analysis of quality of life health concepts demonstrated statistically significant (p<0.01) diminished quality of life among the FTM transgender participants as compared to the US male and female population, particularly in regard to mental health. FTM transgender participants who received testosterone (67%) reported statistically significant higher quality of life scores (p<0.01) than those who had not received hormone therapy. FTM transgender participants reported significantly reduced mental health-related quality of life and require additional focus to determine the cause of this distress. Providing this community with the hormonal care they request is associated with improved quality of life.
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              • Abstract: found
              • Article: not found

              Psychiatric characteristics in transsexual individuals: multicentre study in four European countries.

              Research into the relationship between gender identity disorder and psychiatric problems has shown contradictory results.
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                Author and article information

                Contributors
                0046 73 982 43 49 , kalle.lundgren@ki.se
                Journal
                Eur J Plast Surg
                Eur J Plast Surg
                European Journal of Plastic Surgery
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0930-343X
                1435-0130
                29 October 2016
                29 October 2016
                2017
                : 40
                : 3
                : 223-226
                Affiliations
                [1 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Clinic for Reconstructive Plastic Surgery, , Karolinska University Hospital, ; 171 76 Stockholm, Sweden
                [2 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Dept. of Molecular Medicine and Surgery, , Karolinska Institute, ; 171 77 Stockholm, Sweden
                [3 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Stockholm Craniofacial Center, Clinic for Reconstructive Plastic Surgery, A2:04, , Karolinska University Hospital, ; 171 76 Stockholm, Sweden
                Article
                1252
                10.1007/s00238-016-1252-0
                5440516
                28603386
                373a07b4-5cd4-47ff-a0cc-027cbc4e2f9b
                © The Author(s) 2016

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 12 July 2016
                : 10 October 2016
                Funding
                Funded by: Karolinska Institute
                Categories
                Original Paper
                Custom metadata
                © Springer-Verlag Berlin Heidelberg 2017

                Surgery
                gender reassignment surgery,gender dysphoria,quality of life,sf-36
                Surgery
                gender reassignment surgery, gender dysphoria, quality of life, sf-36

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