Long-term concerns of Endocrine Therapy
        (information from Futterweit, 1998)

• Female-->Male:  at risk for cardiovascular disease, obesity, insulin resistance.
• Male-->Female:  Estrogens may induce glucose intolerance, hyperinsulinemia, an insulin resistance.  May be beneficial,  as estrogen reduces risk of coronary heart disease.

    All 28 patients expressed that they felt better than prior to surgery. In these cases, a satisfactory harmony was achieved between their feelings of affinity and physical appearance. 27 patients reported that changing their gender role through surgery affected the overall quality of their life in a very satisfactory manner. 22 patients believed that achieving good cosmetic result from acquiring attractive and appropriate female genitalia holds great importance for their personal feelings. None of the patients regretted or had doubts about having undergone sex-reassignment surgery.  Most patients were able to maintain their standard of living and to continue working, usually at the same jobs. Very little difficulty in maintaining close friendships was reported, and most patients experienced strong support from family and/or friends. A tendency toward longer and more stable relationships with lovers was evident.  A marked decrease of suicide attempts, criminal activity and drug use in our postoperative population was noted. This might indicate that there is a marked improvement in antisocial an self-destructive behavior, that was evident prior to sex reassignment surgery.

    (In a different study of 19 GID patients by Bodlund, et al., 1996)

• 70% improved in social psychoanalytic, and psychiatric aspects.
• 16% reported unsatisfactory outcomes.
• 1 patient regretted the surgery.

        Rehaman, et al (1999) also found that some patients expressed some disappointment in how their lives were going. They realized that the surgery did not solve all their problems and had not shown them automatically how to live their lives as females, having had no preparation in doing so many things in the female role.  In their new gender identity as females, generally, the patient's ability to form interpersonal and intimate sexual relationships with a male is difficult. Their lack of experience in living as females in a stereotypical sexual role with behavior, such as passive sexuality during courtship and the simultaneous desire to be attractive and desirable to another, complicates the picture. They feel shame, embarrassment, and frustration ,which sometimes causes them to avoid intimate relationships with a male. Also, there is fear that the new vaginal entrance wished for so long will break or be damaged during intercourse.
 

  Other Findings

• It appeared that the most appropriate age for sex reassignment surgery was the early 30's. This age enabled patients to live successfully and to adjust socially and sexually. Moreover, it increased the possibility for developing their attractiveness and for allowing them to mature in dealing with new life stressors (Rehman, et al, 1999).
• The outcome of sex reassignment is consistently better in F-M compared to M-F transsexuals, despite the fact that surgical results are more beneficial for M-F. Social functioning, psychological adjustments, and the quality of relationships with partners and siblings are slightly better for sex reassigned biological women than for biological men. Male transsexuals, in general, have difficulties in social integration, but after sex reassignment they also become more sexually satisfied (Bodlund, et al, 1996).
• Approximately 20-30% of transsexuals are content to change their names and live as the opposite sex without surgery.  Very few wish to reverse their changes, whether just name change or surgery (Weitze & Osburg, 1996).
• Factors predicting positive outcome after sex reassignment are not fully known, but there are indications that female sex, early debut, high level of social functioning before surgery, personal stability, restricted inclusion criteria, and supportive programs are essential for a favorable outcome. The quality of partnerships and ability to achieve a satisfactory sex life without functional genitalia also seem to be of importance.

  emily_jeffers@houghton.edu or anne_warner@houghton.edu