Authors' objectives: Background: Gender dysphoria (or transsexualism) denotes individuals with a persistent cross-gender identification and discomfort with their anatomical sex manifested by a preoccupation with removing one’s sex characteristics, or the perception of being born in the wrong sex. Gender affirmation surgery (GAS), affirming the patient’s self-perceived gender, refers to genital, facial and body procedures. The prevalence of gender dysphoria in Sweden is estimated to 0.2-0.5 percent and referrals for evaluation increased threefold between 2013 and 2017 in Region Västra Götaland. In trans women (Male-toFemale, MtF), genital surgery aims at creating feminine genitalia. In trans men (Female-to-Male, FtM), genital surgical techniques include metoidioplasty using the clitoris to produce a small sensate phallus or phalloplasty using, e.g., a radial forearm flap to create a cosmetically satisfactory penis. Objective: To study if GAS compared with no surgery or less extensive reconstruction in adults affects quality of life (QoL), improves patient satisfaction, is associated with regret and cause complications.

Authors' results and conclusions: The number of patients diagnosed with gender dysphoria increases rapidly as does gender affirmation surgery. The available literature includes only observational studies of mostly poor quality, comparative studies are few and data from long-term follow up are lacking. The certainty of evidence for the benefits of genital, facial and body gender affirmation surgery is generally very low (GRADE ⊕) while major surgical complications probably are frequent after genital gender affirmation surgery (GRADE ⊕⊕⊕). Nevertheless, the patients usually value the effects of the interventions highly. Gender affirmation surgery needs to be performed within research projects in order to improve the knowledge about benefits and risks.

Project Status: Completed

Year Published: 2018

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-373/native/2018_102%20Rapport%20K%c3%b6nsdysfori.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se