Surgical gender reassignment for male to female transsexual people
Best L, Stein K.
Surgical gender reassignment for male to female transsexual people.
Southampton: Wessex Institute for Health Research and Development, 1998:25.
Abstract [Full Text] [PDF]
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To provide an overview of the effectiveness and cost-effectiveness of surgical gender reassignment for male to female transsexuals.
Type of intervention
The electronic databases MEDLINE, HealthStar, Embase, the Cochrane Library, Social Science Citation Index, PsycLit, the National Research Register and GEARS were searched.
There is no comparable alternative to gender reassignment surgery in those who are eligible for surgery. Individuals who are refused NHS treatment may approach private clinics, both in the UK and abroad. The prevalence of transsexualism has not been studied in this country in recent years. European studies suggest that there may be 150 male transsexual people in the South and West region, and we may expect five requests for surgical gender reassignment each year. Current evidence consists of one prospective controlled study, numerous case series, and one cross-sectional study. Most studies about the effectiveness of surgical gender reassignment have not collected data prospectively and are hampered by losses to follow up and lack of validated outcome measures. It is evident that a number of male to female transsexual people experience a successful outcome following surgery in terms of subjective well-being, cosmetic appearance and sexual function. Some patients have reported postoperative complications, dissatisfaction and regrets.
Was any cost information reported?
Surgical gender reassignment surgery costs in the region of 9,600 GBP (ECR prices). Following successful surgery the need for psychiatric and hormonal treatment may be reduced, thereby resulting in savings of up to 950 GBP per patient per year.
It is clear that a small number of people may experience important benefits from this technology. However, the potential hazards of treatment are considerable and more rigorous research is required into the long term risks and benefits to support case selection and justify service development. Where surgery is performed it should be restricted to specialist centres with proven technical expertise and which have clear protocols for patient selection and good clinical audit in place. Pending improvements to the evidence base in this area, the Committee noted the value of guidelines such as those promulgated by the Harry BenjaminGender Dsyphoria Association in identifying minimum standards of care for people applying for surgery.
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