This follow-up study evaluated the outcome of sex reassignment as viewed by both clinicians and patients, with an additional focus on the outcome based on sex and subgroups. Of a total of 60 patients approved for sex reassignment, 42 (25 male-to-female [MF] and 17 female-to-male [FM]) transsexuals completed a follow-up assessment after 5 or more years in the process or 2 or more years after completed sex reassignment surgery. Twenty-six (62%) patients had an early onset and 16 (38%) patients had a late onset; 29 (69%) patients had a homosexual sexual orientation and 13 (31%) patients had a non-homosexual sexual orientation (relative to biological sex). At index and follow-up, a semi-structured interview was conducted. At follow-up, 32 patients had completed sex reassignment surgery, five were still in process, and five-following their own decision-had abstained from genital surgery. No one regretted their reassignment. The clinicians rated the global outcome as favorable in 62% of the cases, compared to 95% according to the patients themselves, with no differences between the subgroups. Based on the follow-up interview, more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5-15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health. Most outcome measures were rated positive and substantially equal for MF and FM. Late-onset transsexuals differed from those with early onset in some respects: these were mainly MF (88 vs. 42%), older when applying for sex reassignment (42 vs. 28 years), and non-homosexually oriented (56 vs. 15%). In conclusion, almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning.

A group of transsexuals, 9 biological men and 10 women, was assessed according to clinical DSM-III-R diagnosis and a self-report instrument for Axis II diagnoses based on the Structured Clinical Interview for DSM-III-R (SCID screen). A control group of 133 individuals was assessed by the same instrument. Combined with a functional criterion according to the Global Assessment of Functioning, the SCID screen showed good agreement with clinical Axis II diagnoses. The overall proportion of Axis II criteria fulfilled, proportion of criteria fulfilled for every single personality disorder and number of personality disorders were calculated from the modified version of the SCID screen. Personality disorders, mainly within cluster B, were identified among 5 of 19 transsexuals, and a majority had multiple personality disorders. Among controls, no personality disorder was identified. Personality traits as measured by the SCID screen revealed significantly more subthreshold pathology among transsexuals than controls in 8 of 12 personality categories. The proportion of overall Axis II criteria fulfilled was 29% among transsexuals versus 17% among controls. Sex differences among transsexuals, the usefulness of the SCID screen and diagnostic problems in DSM-III-R with respect to gender identity disorders are discussed.

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One hundred men complaining of poor or absent erectile capacity were investigated with a multidisciplinary approach. Their median age was 47 years. Mainly organic causes of the erectile failure were found in 27 and mainly psychologic in 40 cases, while factors of both types contributed in 33 cases. Vascular disorder was present in 20 men, including (functional) vasoconstriction in eight. Among 24 men with serum testosterone below 15 nmol/l the incidence of arterial disease, alcoholism and partner-related problems was significantly higher than in those with higher testosterone levels. Most psychologic factors were in general intrapsychic (affecting only the patient himself), while a minority were dyadic (related to the partner).

The parental contact reported by 12 biologically male and 12 biologically female transsexuals was compared with that reported by control subjects (109 conscripts in the Swedish Army; 101 pregnant nulliparous women). Parental contact was estimated for three different periods: 1) childhood, 2) adolescence, 3) the year before investigation. Transsexual patients generally reported less satisfactory relations to both parents than same-sexed control subjects. A pattern characterized by warm and intense contact with the cross-sexed parent and poor contact with the same-sexed one was observed in about half of the male transsexuals, but not in the female ones. Our findings suggest that disturbed emotional relations to the parents may be one contributory cause in the development of transsexualism and are in accordance with the hypothesis that gender identity grows out of an interaction of biological and environmental factors.