The number of people seeking help with gender dysphoria has increased “exponentially” over the past several decades, experts say. And most who ultimately undergo gonadectomy do not regret their decision.
In general terms, people with gender dysphoria identify with a gender other than their birth gender. Many transgender individuals decide to pursue medical treatment to transition from one gender to another. Such treatment may include puberty suppression (in children), gender-affirming hormonal treatment, or gender-affirming surgery.
With greater acceptance of gender dysphoria in many parts of the world, it has been difficult to determine how many people have actually sought gender-affirming treatment. In many countries, treatment for gender dysphoria is handled by different types of providers. However, in the Netherlands, most treatment of gender dysphoria is centralized.
To learn more about trends in transgender treatment, scientists from the VU University Medical Center in Amsterdam conducted a retrospective study of patients seen from 1972 (when the center began treating adults) to 2015.
During that time, 6,793 people sought help at the center. About 65% were transwomen, and 35% were transmen. The researchers noted a 20-fold increase over time, with 34 gender dysphoria assessments in 1980 and 686 in 2015.
As of the end of 2015, 3,838 people age 16 and over and received treatment for gender dysphoria at the center. Using the over-16 population of the Netherlands as a guide, the researchers estimated that 1 in 3,600 people in that country were transgender, with 1 in 2,800 identified as transwomen and 1 in 5,200 identified as transmen.
Over the study period, the number of people starting hormonal therapy within five years of their first visit declined, but those who underwent gonadectomy within five years of starting hormone treatment stayed steady. [Note: Gonadectomy refers to either oophorectomy (removal of the ovaries) or orchiectomy (removal of the testes). At this center, patients underwent gonadectomy only if they were age 18 or older and on hormone therapy for at least 1.5 years.]
Seventy-six percent of transwomen who met gonadectomy requirements went ahead with surgery. For transmen, the rate was 82%.
Patients who regretted their gonadectomy – 0.6% of transwomen and 0.3% of transmen – started reversal hormonal therapy to approximate their birth gender. Some patients felt “social regret.” For example, their new identities might not have been accepted by family members. Others experienced “true regret,” indicating that gender-affirming surgery was not the “solution” they had hoped for.
The study authors noted that the rates of regret might be underestimated, as people may seek reversal therapy elsewhere or might not seek it at all. “Regret might not always result in a desire for reversal therapy, as it may be hidden from others,” they wrote.
They also recommended that healthcare providers become more familiar with gender dysphoria and its treatment, especially since hormonal therapy can affect other medical conditions and interact with medications.
The study was published online in February in the Journal of Sexual Medicine.
The Journal of Sexual Medicine
Wiepjes, Chantal M., et al.
“The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets”
(Full-text. Published online: February 17, 2018)