Sex Reassignment : Predictors and Outcomes Of Treatment

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 Yolanda Louise Susanne Smith Р[S.l.] : [s.n.], 2002 РTekst. РProefschrift Universiteit Utrecht

 

From Abstract:
Prospective research supports the therapeutic effect of sex reassignment (SR) for adolescent and adult transsexuals. Data were used from 345 patients who applied for SR…Follow-up data were gathered one to five years after SR…By far the least explored and most controversial domain with respect to SR is early (hormone) treatment with adolescent transsexuals. Results of the present study support the decision to refer well-functioning adolescents for early (between 16 to 18 years) hormone treatment, considering the positive outcomes of SR on several areas of postoperative functioning of this group…The adolescents also appeared to function quite well socially and psychologically… Eligibility for SR was largely based upon the factors gender dysphoria, psychological stability, and physical appearance.

Transsexuals with a nonhomosexual preference, psychological instability, and strong dissatisfaction about their appearance, at assessment, are more at risk for worse postoperative functioning and more dissatisfaction after treatment.
Other findings from this thesis led us to conclude that the distinction between subtypes of transsexuals is theoretically and clinically meaningful. The differences that were found between homosexual and nonhomosexual transsexuals suggest different developmental routes for each of these subtypes. The road along which the nonhomosexual subtype evolves the gender identity conflict is most likely to be accompanied with more obstacles.

Taking into account that the nonhomosexuals were found to be psychologically more vulnerable than the homosexuals, especially before treatment, they may require additional guidance during treatment…Finally, we investigated which factors at assessment could predict the course and outcomes of SR. Eligibility for SR was largely based upon the factors gender dysphoria, psychological stability, and physical appearance. Transsexuals with a nonhomosexual preference, psychological instability, and strong dissatisfaction about their appearance, at assessment, are more at risk for worse postoperative functioning and more dissatisfaction after treatment.

From the Text:
“Later, several other authors (Bentler, 1976; Buhrich and McConaghy, 1978; Freund et al., 1982; Hamburger, 1953; Money and Gaskin, 1970-1971; Person and different types of transsexuals and arrived at a similar distinction. Although these authors may have differed in the names and the number of subtypes or in the percentages each of their subtypes consisted of they identified and labeled a homosexual type more consistently than any other category of transsexual (see also Blanchard, 1989a)… .. Taking all the findings into account, we conclude that homosexual and nonhomosexual transsexuals differ from each other in many ways, but that the pattern of differences is not entirely similar for MFs and FMs.

An important characteristic the sexes do have in common is that nonhomosexuals function psychologically less favorable. The different manifestations of homosexual and nonhomosexual subtypes of transsexualism found in this study might be reflecting different etiologies knowing that the nonhomosexuals are psychologically more vulnerable than the homosexuals, especially before treatment, they need special attention during the diagnostic procedure.”

Comments:

This is a really excellent and significant set of studies in the Netherlands. Yolanda Smith with well known Dutch researchers Stephanie van Goozen and Peggy Cohen-Kettenis, were able to replicate nearly every study Blanchard did at the CAMH demonstrating significant differences between homosexual and non-homosexual transsexuals with a large population. That they were able to replicate Blanchard’s findings reinforces the already well established typology differentiating the two types of transsexuals.

Yolanda Smith was able to find additional significant differences in homosexual and non-homosexual transsexuals, finding differences in psychological functioning and physical appearance that had not been examined as directly in earlier studies. She suggests that the difference isn’t just interesting from an academic standpoint but relevant to treatment. Smith also found really positive and consistent results for starting treatment in adolescence.
One thing to note though is that the homosexual and non-homosexual groups were not sorted so well because Smith included mtfs currently self reporting an attraction to men regardless of sexual history in the homosexual group. This ended up including mtfs who had been married to females in the homosexual group based on current sexual orientation, though they certainly would not have been considered homosexual transsexuals in any etiological sense. Given this poor sorting there were probably at least 20% and up to nearly 40% of the “homosexual group” who were in fact not originally homosexual. (assuming that pseudo-androphile non-hsts marry at a similar rate as the other non-hsts mtfs in her study).

Despite this, her sample sizes were large enough that they still found the same statistical differences that Blanchard did and confirmed his studies; since even if the homosexual group was only 60% hsts and 40% non-hsts there would still be significant differences with a group that was 100% non-hsts…but I would think if Smith had sorted into groups based on sexual experience (such as asking “have you been sexually active with men, women, both, neither” instead of current sexual orientation she would have found even more striking results.
In any case I think Sex Reassignment: Predictors and Outcomes Of Treatment for Transsexuals is an excellent piece of work. Anyone who is interested in (or wants to dispute) Blanchard’s research but doesn’t have access to a university library with his publications, should read it since some of the experiments done are very similar.

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