|
|
Editors: Managing Editor: Editorial Assistant: Contents Info Published by |
Volume 2, Number 1, January - March 1998
Empirical Data on Epidemiology and Application of the German Transsexuals' Act During Its First Ten Years
By C. Weitze, M.D., S.
Osburg, M.D.
Citation: Weitze C., M.D., Osburg S., M.D. (1997) Empirical Data on Epidemiology and Application of the German Transsexuals' Act During Its First Ten Years . IJT 2,1, http://www.symposion.com/ijt/ijtc0303.htm
In Europe special legislation for transsexuals was fist passed by Sweden in 1972, followed by Germany in 1981, Italy in 1982, the Netherlands in 1985, and Turkey in 1988.
As far as legislation between different countries with various civil-law systems can be compared, laws relating to transsexuals demonstrate considerable differences. The German Transsexuals´ Act (TSG) provides two options, which may be applied either successively or independently of each other. The first so-called "minor solution" refers to changing the applicant's first name in accordance with Section 1 of the Transsexuals' Act (§1 TSG). The second so called "major solution", legislates gender reassignment according to § 8 TSG. For both proceedings two mutually independent expert opinions are necessary. These expert evaluations have to certify that diagnostic criteria for transsexualism have been in existence for at least three years, and that the condition is of lasting nature. For the "major solution", e.g. the change of legal sex, the applicant has to undergo sex reassignment surgery the extend of which is not precisely defined and adapt his external physical appearance to that of the desired gender. The applicant must furthermore be unmarried and permanently incapable of reproduction. The lower age limit of 25 years, which had originally been required for both proceedings, was eliminated for the legal status change in 1982 according to a decision by the highest German court (Federal Constitutional Court); it continued to be applied for change of first name until 1993. Hormone treatment and surgery do not generally require legal permission; however, a request for castration must be reviewed in advance by two physicians according to the German Castration Act.
We considered the tenth anniversary of the German TSG as an occasion to review the application of this law, and also the epidemiological data arising from its use.
The first goal of this study was the exhaustive examination of all decisions rendered on the basis of the Transsexuals´Act in West Germany during the initial ten years of its existence. To this end, questionnaires were submitted to all German courts of first resort which handle such cases. 36 of these had decided cases according to TSG from 1981 to 1990.
Secondly , all judges who had dealt with TSG cases were asked to fill out questionnaires concerning their decision making rationale. We got answers from 39 judges out of 27 courts.
Thirdly, questionnaires were sent to all transsexuals, who had obtained an expert`s
opinion. They were asked about their experience of undergoing an assessment by two
different experts. Of our 60 transsexual clients, we could reach 49 persons, of whom 37
answered our questionnaire.
Prevalence:
In the Federal Republic of (West) Germany from 1981 to 1990 (i.e. the last decade before
reunification), German courts decided on 1,422 cases of transsexualism. Decrees on first
name changes according to § 1 TSG constituted 683 of this total. There were 733 rulings
on sex change (change of legal status) according to § 8 TSG. In addition, there were six
applications involving retransformation. Since some people had applied for first name
change and sex change successively, these cases represented 1,199 persons.
Based on the adult population, this figure corresponds to a ten year prevalence rate of approximately 2.4 applicants per 100,000 population. If one considers only the legally recognized transsexuals , i.e. those 1,047 applications approved in court, then the adjusted ten year prevalence rate amounts to 2.1 transsexuals per 100,000 population.
The 1,199 applications submitted under the German Transsexuals' Act between 1981 and 1990 represent a number certainly considerably below the total number of transsexuals living in West Germany during the period covered. So far, no empirical studies have been able to estimate the absolute number of cases of gender identity disorder. Gathering epidemiological data on this disorder has proven to be methodologically difficult, as repeatedly demonstrated by reports in the literature.
Table 1: The prevalence of transsexualism - overview on previous studies
| Autor | Land | TS Total | M-zu-F | F-zu-M | Ratio M: F |
| Walinder 1967 | Sweden | 1: 54.000 | 1: 37.000 | 1: 103.000 | 2,8:1 |
| Pauly 1968 | USA | 1: 100.000 | 1: 400.000 | 4:1 | |
| Hoenig & Kenna 1974 | England | 1: 53.000 | 1: 34.000 | 1: 108.000 | 3,2:1 |
| Ross et al 1981 | Australia | 1: 42.000 | 1: 24.000 | 1: 150.000 | 6,1:1 |
| Tsoi 1988 | Singapore | 1: 2.900 | 1: 9.000 | 1: 27.000 | |
| Gooren et al.1992 | Netherlands | 1:11.900 | 1: 30.400 | 70-80%: 20-30% | |
| Osburg & Weitze 1993 | Germany (Former Federal Republic) |
1: 42.000 - 1: 48.000 = 2,1 - 2,4 100.000 |
1:36.000-1:42.000 | 1: 94.000 - 1: 104.000 |
2,3:1- 2,2:1 |
Of all the epidemiological studies of transsexualism, so far only a small number have attempted to systematically incorporate the required data from all available sources of a particular country (e.g., Walinder 1968; Ross et al. 1981; and Tsoi 1988). Most of these populations are from centralized treatment institutions which we can assume are treating the great majority of transsexuals living in a given country (e.g., Benjamin 1966; Pauly 1968; Hoenig & Kenna,1974; Gooren 1993). In all empirical studies transsexualism appears to be a relatively rare phenomenon. However, owing to fundamental differences in data collection, the comparative validity of these studies is limited, as are estimates of the prevalence of transsexualism.
Frequency of claims and court orders during the data collection period:
After an initial peak in the number of claims ( 68 under § 1 TSG and 94 § 8
TSG) in 1981, there were definitely fewer applications in the following four years
1982-1985. From 1986 to 1990, the application frequency rose again and reached a level
(107 applications under § 1 TSG and 98 under § 8 TSG) which has not since been exceeded.
One can furthermore conclude from these numbers that, during the first five years under
the law, the number of sex changes was higher than first name changes.
Figure 1: German Court Orders in Transsexual Cases from 1981 to
1990
An initial peak during the first year had to be expected, because there probably was a back log of applicants eagerly awaiting the new legislation who had long since met requirements for changing their legal status. This interpretation in fact explains the peak of legal status changes during the first two years under the law, as well as the following decrease from 1982 to 1985. However, the continually increasing number of applications from 1986 on is extraordinary. In order to determine whether this increase actually reflects a general trend, more long term studies are necessary. Gooren and al. (1993) noted a steady increase of cases up to 1989, followed by a slight decrease in 1990 and 1991.
Distribution of gender
There was an overall predominance of male-to-female transsexuals of 2.3: 1. For
first name changes, the ratio is roughly 3 : 1 in favor of male-to-female transsexuals,
for determination of sexual identity it is only 2 : 1. A comparison of the various years
of the study period reveals considerable fluctuations in the gender distribution: ranging
from 8.5 : 1 for first-name change in 1982 to 1.6 : 1 in 1985. As far as legal sex change
applications are concerned, however, the distribution of male-to-female and female-to-male
transsexuals approaches equality. Within the period of data collection, we found a
considerable range of variation between the individual years, without a recognizable
trend. As a result, we cannot support Walinder's and Pauly´s assertion of a development
toward an equal number of male-to female and female-to-male transsexuals (1971,1981).
Figure 2a: Distribution of Gender - First Name Changes
Figure 2b: Distribution of Gender - Legal Status Changes
At any rate, it is noteworthy that the predominance of male-to-female transsexuals is considerably lower for legal status changes than for changes of first name. It must also be emphasized that female-to-male transsexuals file their applications, and begin a sex-reassignment treatment at a younger average age. This corresponds to comparative studies, that reveal a higher degree of social integration of female-to-male transsexuals at the time of the diagnosis, or before treatment and legal recognition (Pauly 1974, Kockott &Fahrner, 1988).
Age distribution of applicants
The average age of applicants at the time of their legal decrees was 33 for first
name as well as for legal status change. The core group is formed by those 25 to 34 years
of age. The mean age of the male-to-female transsexuals was 34, which is higher than that
for female-to-male, which was only 30 years for both proceedings. The overall age
distribution of all applicants is comparable with the Dutch study by Gooren et al. (
1993). A considerably younger average age is stated for Singapore (1988); there, 82% of
the male-to-female and 71% of the female-to-male transsexuals, were under 30 years of age.
Figure 3: Age Distribution of German Transsexuals ( 1981 - 1990 )
