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. 2017 Sep;79(7):815-823.
doi: 10.1097/PSY.0000000000000465.

Effects of Medical Interventions on Gender Dysphoria and Body Image: A Follow-Up Study

Tim C van de Grift  1 , Els Elaut, Susanne C Cerwenka, Peggy T Cohen-Kettenis, Griet De Cuypere, Hertha Richter-Appelt, Baudewijntje P C Kreukels
Affiliations

Effects of Medical Interventions on Gender Dysphoria and Body Image: A Follow-Up Study

Tim C van de Grift et al. Psychosom Med. 2017 Sep.

Abstract

Objective: The aim of this study from the European Network for the Investigation of Gender Incongruence is to investigate the status of all individuals who had applied for gender confirming interventions from 2007 to 2009, irrespective of whether they received treatment. The current article describes the study protocol, the effect of medical treatment on gender dysphoria and body image, and the predictive value of (pre)treatment factors on posttreatment outcomes.

Methods: Data were collected on medical interventions, transition status, gender dysphoria (Utrecht Gender Dysphoria Scale), and body image (Body Image Scale for transsexuals). In total, 201 people participated in the study (37% of the original cohort).

Results: At follow-up, 29 participants (14%) did not receive medical interventions, 36 hormones only (18%), and 136 hormones and surgery (68%). Most transwomen had undergone genital surgery, and most transmen chest surgery. Overall, the levels of gender dysphoria and body dissatisfaction were significantly lower at follow-up compared with clinical entry. Satisfaction with therapy responsive and unresponsive body characteristics both improved. High dissatisfaction at admission and lower psychological functioning at follow-up were associated with persistent body dissatisfaction.

Conclusions: Hormone-based interventions and surgery were followed by improvements in body satisfaction. The level of psychological symptoms and the degree of body satisfaction at baseline were significantly associated with body satisfaction at follow-up.

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Figures

FIGURE 1
FIGURE 1
A, GD at clinical entry and follow-up displayed per treatments received. UGDS = Utrecht Gender Dysphoria Scale (12 = least dysphoric, 60 = most dysphoric). Baseline and follow-up levels of GD are displayed for the groups without and with hormonal and surgical therapy at follow-up; hormone therapy is mostly cross-sex hormones, surgery includes facial, chest, and/or genital surgery; the displayed n values report the available data per measure; SDno intervention admission = 9.2, SDno intervention follow-up = 12.8, SDhormone therapy admission = 5.4, SDhormone therapy follow-up = 8.8, SDsurgery admission = 5.8, SDsurgery follow-up = 4.3. *Due to a programming error, the follow-up UGDS data were available of nine participants only. B, Body dissatisfaction at clinical entry and follow-up displayed per treatments received. BIS = body image scale (1 = very satisfied, 5 = very dissatisfied). Baseline and follow-up levels of body dissatisfaction are displayed for the groups without and with hormonal and surgical therapy at follow-up; the displayed n values report the available data per measure; hormone therapy is mostly cross-sex hormones, surgery includes facial, chest, and/or genital surgery; SDno intervention admission = 0.59, SDno intervention follow-up = 0.64, SDhormone therapy admission = 0.61, SDhormone therapy follow-up = 0.73, SDsurgery admission = 0.51, SDsurgery follow-up = 0.58. Baseline versus follow-up; UGDS: F(1,168) = 13,668.37, p < .001; BIS: F(1,183) = 202.85, p < .001. Among follow-up groups; UGDS: F(2,170) = 9.54, p < .001; BIS: F(2,187) = 14.02, p < .001. GD = gender dysphoria; SD = standard deviation.
FIGURE 2
FIGURE 2
Dissatisfaction with body areas of all participants (at baseline) and per treatments received (at follow-up). BIS = Body Image Scale (1 = very satisfied, 5 = very dissatisfied). Baseline and follow-up levels of body area dissatisfaction are displayed of all participants at baseline (“admission”) and differentiated for the groups without and with hormonal and surgical therapy at follow-up; The displayed n values report the available data per measure; SDadmission all = 0.54, SDadmission social and hair = 0.72, SDadmission head and neck = 0.71, SDadmission muscularity and posture = 0.68, SDadmission hips = 0.76, SDadmission breasts = 0.82, SDadmission genitals = 0.72; SDno intervention all = 0.64, SDno intervention social and hair = 0.64, SDno intervention head and neck = 0.82, SDno intervention muscularity and posture = 0.77, SDno intervention hips = 0.77, SDno intervention breasts = 1.1, SDno intervention genitals = 1.1; SDhormones all = 0.73, SDhormones social and hair = 0.77, SDhormones head and neck = 1.0, SDhormones muscularity and posture = 0.76, SDhormones hips = 0.80, SDhormones breasts = 1.2, SDhormones genitals = 1.0; SDsurgery all = 0.58, SDsurgery social and hair = 0.74, SDsurgery head and neck = 0.73, SDsurgery muscularity and posture = 0.65, SDsurgery hips = 0.75, SDsurgery breasts = 0.95, SDsurgery genitals = 1.2. SD = standard deviation.
FIGURE 3
FIGURE 3
Social (de)transition of respondents without medical interventions. At/after clinical admission, some participants (had) transitioned to another gender role, of whom some had transitioned back to the role of their gender assigned at birth at follow-up.
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