Increasing normality–persisting barriers: Current socio‐demographic characteristics of 350 individuals diagnosed with gender dysphoria

Abstract

Introduction The number of individuals requesting medical treatment for gender dysphoria has increased significantly within the past years. Our purpose was to examine current biographic and socio‐demographic characteristics and aspects of legal gender reassignment. Design Medical files from n = 350 individuals of a German Endocrine outpatient clinic were collected from 2009 to 2017 and analysed retrospectively. Results Ratio of transwomen to transmen equates to 1:1.89 with a remarkable increase of transmen by the year 2013, showing a reversal of gender distribution compared with previous studies for the first time. Use of illegal substances or self‐initiated hormone therapy was rare (4.6 and 2.1%). Satisfaction with gender‐affirming hormone therapy was significantly higher in transmen than in transwomen (100% vs 96.2%, P = .005). Use of antidepressants declined significantly after onset of hormone treatment in transmen (13% vs 7%; P = .007). The number of individuals with a graduation diploma was only about half as high as in the general population (14.3% vs 27.3%), whereas unemployment rate was more than twice as high (14% vs 6.9%). Median latency between application for legal gender reassignment and definitive court decision was 9 months. Conclusions Our data provide possible indications for a decline of psychosocial burden in individuals diagnosed with gender dysphoria over the last years. However, affected individuals are still limited in their occupational and financial opportunities as well as by a complex and expensive procedure of legal gender reassignment in Germany.

Return to work of transgender people: A systematic review through the blender of occupational health

“…The QualSyst score ranged from 0.68 to 0.91 (M = 0.71) for quantitative studies [ 28 , 34 , 46 , 50 , 53 , 54 , 58 , 59 ] (see “ Table 3 ”) with an average summary score of 0.77 (SD = 0.08); overall, a score closer to 1 indicates a better quality. For the qualitative studies [ 26 , 35 , 48 , 52 , 56 , 57 ] (see “ Table 4 ”), the overall summary score (QualSyst tool) ranged from 0.19 to 1.0 (M = 0.85, x = 0.70, SD = 0.27): only two studies, with a very distinct study design (report of HR organization, single interview) were of very low (0.19) [ 52 ] to low quality (0.50) [ 57 ], while the remainder were of good to very good quality.…”

“…Less than half of the selected articles reported on employment status (9/20) [ 16 , 46 , 47 , 50 , 53 – 55 , 58 , 59 ] and employment type (6/20) [ 16 , 26 , 35 , 47 , 55 , 59 ] of transgender people. Data on RTW was even more scarce to nonexistent in the case of RTW rates at several time measurements or as a dichotomous variable during transition.…”

“…The other participants were either students, on sickness benefits, or retired. In general, transgender men (TM) had a higher employment rate than transgender women (TW) [ 16 , 26 , 46 , 47 , 50 , 55 , 58 ] (see “ Table 2 ” for more details).…”

“…At the time of transition, TW were on average 5 to 10 years older than TM, but TP who stayed at the same workplace waited up to an additional 7 years to transition than those who had changed jobs [ 16 , 28 , 34 , 46 , 50 , 58 ]. In three studies [ 26 , 35 , 56 ], the majority of TP openly transitioned at work and about half at their current job [ 26 ].…”

“…This was even more true for trans women (TW) than for trans men (TM) [ 28 , 50 , 51 ], but unemployment rates should also be mirrored in the transition phase and chosen steps in GAC. More transgender people (TP) were also either students, on disability, on welfare pensions, or retired, although the proportion of TW versus TM therein was mixed [ 16 , 54 , 58 ]. Countries with a strong social security system, such as Denmark, Sweden, or Belgium [ 46 , 50 , 53 , 54 ], included more TP on social welfare or sickness funds.…”