Lundström, Pauly & Wålinder, 1984
Dept. of Psychiatry, St. Jörgens Hospital, University of Göteborg, Sweden, Dept. of Psychiatry and Behavioral Sciences, University of Nevada, School of Medicine, Reno, NV, USA and Dept. of Psychiatry, University of Linköpig, Sweden

This overview compares and evaluates the reviews about follow-up studies by Lundström (1981), Pauly (1981) and Lothstein (1982) which were published one right after the other. It is most of all against Lothstein's conclusion that most patients who, at that time, desired a sex reassignment, were secondary transsexuals, that is, transvestites or effeminate homosexuals who cannot be helped by surgery.

• Sample
• Results and Indication Recommendations
• Follow-up Studies Mentioned
• Methodological Issues
• Authors' Evaluation

Results and Indication Recommendations
(1) Independent from each other, the reviews from Lundström (1981) and Pauly (1981) came to the conclusion that 10-15% unsatisfactory results were observed. Said in another way, this signifies that the portion of satisfactory and/or good results is 85-90%. Both reviews overlap in 15 follow-up studies; Lundström additionally regards 13 publications that are not included in Pauly.

(2) Even though seen absolutely for males, favorable results are reported about more frequently than females, this difference is not statistically significant.

(3) Surgical results that are satisfactory in the cosmetic and functions aspects contribute, but not exclusively, to a good overall result.

(4) Personal and social instability are prognostically unfavorable factors without being an absolute contra-indication against surgical procedures. Psychotherapy and somatic treatment must not be applied exclusively.

(5) The older the patient is at the time of the first contact to a physician, the more probable an unsatisfactory result is. This is probably because secondary transsexuals see the physician later and that overall the results for secondary transsexuals are less favorable.

(6) When denied surgery, secondary transsexuals cope better than primary transsexuals, who will try, as a rule, to undergo surgery elsewhere.

(7) For certainly diagnosed genuine, resp., primary, transsexuals a surgical sex reassignment is the best treatment. For secondary transsexuals with an early history of instability and patients see the physician for the first time after the 30th birthday, a major reservation regarding a surgical indication is necessary.

Follow-up Studies Mentioned
Benjamin, 1966; Hastings, 1974; Hertz et al., 1961; Hoenig et al., 1970a, b, 1971; Hore et al., 1975; Hunt & Hampson, 1980b; König et al., 1978; Kröhn et al., 1981; Lothstein, 1980, 1982; Lundström, 1981; Meyer & Reter, 1979; Money & Ehrhardt, 1970; Pauly, 1968, 1974, 1981; Randell, 1969; Sörensen, 1981a, b; Stürup, 1976; Wålinder & Thuwe, 1975; Wålinder et al., 1978

Methodological Issues
With Lothstein (1982) the authors complain about the heterogeneity of the diagnosis used in some follow-up studies, about the selection criteria for surgical procedures and the follow-up study instruments, so that it is difficult to make comparisons.

Author's Evaluation
The authors contradict Lothstein's conclusion that the published follow-up studies do not permit evaluation of treatment results surely and especially consider his statement unsubstantiated that at that time mostly secondary transsexuals desired sex reassignment and that they could not be helped by it. For carefully diagnosed genuine transsexuals with a stable early history who see the physician early, the surgical sex reassignment is the best treatment method in their judgment.