Quality of life in people with transsexuality after surgery: a systematic review and meta-analysis

Abstract

Background: Several reports have demonstrated varying results on the quality of life (QoL) of the transgender population. Therefore, the aim of this study was to conduct a systematic review and meta-analysis about the quality of life (QoL) of individuals during the post transsexual surgery period. Methods: We searched major biomedical electronic databases, including Scopus, Google Scholar, Psychological Information Database (PsycInfo), Web of Science, PubMed, Excerpta Medica dataBASE (EMBASE), and ProQuest, for all relevant literature published in English up to December 2019. The included papers required to be cross sectional studies that reported quality of life in people with transsexuality post surgery. After selecting eligible studies, 2 authors extracted data of each study independently and resolved any inconsistency by consensus with the third reviewer. The risk of bias was assessed by 2 independent research experts by the Newcastle-Ottawa Scale (NOS). Results: In this study, out of 497 articles extracted from the initial investigation, 8 articles with 1099 patients were ultimately selected for meta-analysis. The pooled mean of quality of life in transsexual individuals was obtained to be 70.45 (95%CI 55.87-85.03) and 59.17 (95%CI 48.59-69.74), based on World Health Organization Quality of Life (WHOQoL-BREF) and The 36-item short form of the Medical Outcomes Study questionnaire (SF36), respectively. Also, the results of the subgroup analysis for the weighted mean quality of life in male to female and female to male showed that the mean quality of life in female to male was 57.54 (95%CI 42.24-72.84) and it was 62.47 (95%CI 45.94-79.00) in male to female, based on SF36 questionnaire. Moreover, the weighted mean quality of life in female to male was 69.99 (95%CI 43.76, 96.23) and it was 70.65 (95%CI 53.11, 88.19) in male to female, based on WHOQoL-BREF questionnaire. Conclusion: The results of this systematic review may support the approaches to transsexuality that facilitates sex reassignment. In this review, the means of quality of life after surgery were not compared to the means of quality of life before surgery or even before hormonal therapy which was due to inadequate number of primary studies.

Quality of Life and Perceived Social Support Before and After Sex Reassignment Surgery

“…The 12-item form developed by the researchers is in line with the pertinent literature, consisting of questions on the participants’ socio-demographic characteristics (age, education, working, income status, mother’s education status, father’s education status, the family’ attitude toward sexuality, religious attitude of the family, size, weight, persons living with at home, the age at which fantasies of being the opposite sex began, and the mean age at which the families of the participants realized the change in their children’s sexual orientation) (Barone et al, 2017; Eftekhar Ardebili et al, 2020; Simbar et al, 2018; Zavlin et al, 2018).…”

“…Gender identity disorder, gender dysphoria, is a condition characterized by a strong and persistent mismatch between the biological sex attributed to individuals at birth and the gender they identify with, and often leads to significant mental distress (Simbar et al, 2018). While the prevalence of transsexuality is 1 in 30,000 men, it is 1 in 100,000 women (Eftekhar Ardebili et al, 2020). In a meta-analysis conducted in Europe, the prevalence of transsexuality among men was 2.6 per 100,000 people, and there has been an increase in the reported prevalence over the past 50 years (Arcelus et al, 2015).…”

“…It is reported that 25% of FtM patients have undergone mastectomies, 14% hysterectomy, 13% genital reconstruction, and 3% phalloplasty (James et al, 2016; Kailas et al, 2017). According to the data reported in the literature, the general prevalence of FtM patients is increasing (Arcelus et al, 2015; Eftekhar Ardebili et al, 2020).…”

“…Transsexual individuals may communicate less successfully with different individuals and social groups than non transsexual people. Therefore, transsexuals’ social capital is lower than that of non transsexual people, meaning that they sometimes face limitations in meeting their basic needs such as education, job seeking, marriage, housing, safety, compassion, and communication with others (Eftekhar Ardebili et al, 2020; Gómez-Gil et al, 2012). Bränström & Pachankis (2020) in their study found that Swedish transsexual individuals experienced mental problems and anxiety disorders six times more often, used antidepressants and anxiolytics three times more often, and attempted to commit suicide six times more frequently than the general population.…”

“…SRS is a complex phenomenon that significantly affects not only an individual’s identity but also his or her health and social performance. What is more, it also changes an individual’s circle of social roles (such as changing profession, changing their place of residence, and changing their circle of friends; Eftekhar Ardebili et al, 2020; Hess et al, 2017). Several studies have revealed that SRS has positive effects on the lives of FtM transsexuals and can improve their social life and the quality of life in many areas (Castellano et al, 2015; Gómez-Gil et al, 2014; Sani et al, 2019; Weinforth et al, 2019).…”