Cecilia Dhejne, 1 Paul Lichtenstein, 2 Marcus Boman, 2 Anna L. V. Johansson, 2 Niklas Långström, 2 , 3 and Mikael Landén 1 , 2 , 4 , *
Published online 2011 Feb 22. doi: 10.1371/journal.pone.0016885
Context
The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person’s body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment.
Objective
To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons.
Design
A population-based matched cohort study.
Setting
Sweden, 1973-2003.
Participants
All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973–2003. Random population controls (10∶1) were matched by birth year and birth sex or reassigned (final) sex, respectively.
Main Outcome Measures
Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]).
Results
The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8–4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8–62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9–8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0–3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls.
Conclusions
Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group….
REVIEWS & COMMENTARY
‘Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden’: A review of Dhejne et al’s findings on criminal convictions
21 April 2021 – Murray Blackburn Mackenzie
Background
In 2011 Dhejne et al. published a peer-reviewed academic paper setting out findings from a cohort study aimed at estimating the ‘mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons’ (2011: 1). Using a range of administrative data, including hospital records, census data and criminal convictions data the study ‘captured almost the entire population of sex-reassigned transsexual individuals in Sweden from 1973–2003’ (2011:7). These findings are, to the best of our knowledge, unique, nor are we aware of any comparable quantitative research that rebuts the findings.
Drawing on criminal convictions data, the study showed, among other findings, that male-to-female transitioners were likely to retain the same risk of male-pattern criminality both in relation to crime generally, and to violent crime. Dhejne et al. summarize this finding in the following terms:
‘In this study, male-to-female individuals had a higher risk for criminal convictions compared to female controls but not compared to male controls. This suggests that the sex reassignment procedure neither increased nor decreased the risk for criminal offending in male-to-females.’ (2011: 6)
Although expressed clearly, this finding has been subsequently disputed, principally as a result of comments made by the lead author in an article published in 2015 by The Transadvocate,[1] where Dhejne suggested that some people had misinterpreted the results….
Women and Equalities Committee
Oral Evidence: Reform of the Gender Recognition Act, HC 884
Wednesday 9 December 2020 – House of Commons
Women and Equalities Committee
Written Evidence: Reform of the Gender Recognition Act, HC 884
Professor Rosa Freedman, Professor Kathleen Stock, and Professor Alice
Sullivan –
FOI-202000017446 – Scottish Government email correspondence
MURRAY BLACKBURN MACKENZIE – 21 April 2021 – Murray Blackburn Mackenzie
Scotland, correspondence accessed by Freedom of Information also shows that Scottish Government officials dismissed the relevance of the results to gender recognition reform, on the basis of the Transadvocate comments, and an article published by in Medium,[2] which also referred to the interview.
Against this background, this briefing overviews the key findings as presented in the original paper. We then examine the later comments made by the lead author, and argue that these are not consistent with the original findings. The original paper is open-access and can be accessed here.
NOTE: Dhejne’s 2017 comments
In a further exchange on reddit in 2017, with the same interviewer, Dhejne made the following comments in relation to the findings on criminality, which supports our reading of the study:
“Regarding criminality there are only results from either both trans women and trans men and displayed for the whole period 1973-2003 and for the periods of 1973-1988 and the 1989-2003. If one is only interested in transwomen data is only available for the whole period.”…
Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden
S SINCLAIR – 5 February 2022 – What Do They Know
Dear Scottish Government,
Re: FOI/202000017446 – Swedish Cohort study in sex reassignment surgery
The documents disclosed revealed that when this study was being discussed within government, repeated references were made to an online blog interview with lead author Cecilia Djehne, which appeared to suggest, that the findings of the study were undermined by the subsequent comments.
There was a further online Q&A with Cecilia Djehne and this same blogger in which she clarifies any earlier misunderstandings, and confirms the published findings of the study.
https://www.reddit.com/r/science/comment…
The blogger asked:
“More recently, some sex essentialists have come forward to assert that the post-1989 group that does not show a “male pattern of criminality” only does so because it includes FTM individuals. Would you please clarify this?
* Were the post-1989 MTF group convicted of a similar overall number of crimes as cis males?
Also, can you again restate what “male pattern of criminality” means?
* Are you saying that for the pre or post-1989 group, MTFs were convicted of the same types of crime, at a similar rate as cis men, or were you merely comparing the total number of convictions and not type?”
Djehne answered:
“Regarding criminality there are only results from either both trans women and trans men and displayed for the whole period 1973-2003 and for the periods of 1973-1988 and the 1989-2003.
If one is only intrested in transwomen data is only available for the whole period.
For only assigned med who had transition 1973-2003 they had committed more crimes than cis women and more violent crime than cis women.”
“Having a male pattern means that they did not differ regarding any crime or violent crime if compared with cis men. However even if I can’t say how it is for trans women specific one could see that if the whole group (tran women and trans men) are displayed together there is a very postive time trend.
So after 1989 the transgender men and women together did not differ from cis gender men and women regarding comitting any crime or violent crime. This means that the trana population was not more criminal then the cis population after 1989.”
In light of this further information, please could you provide all references you hold to Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Langstrom, N., and Landen, M. (2011) Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden, published in PloS One,6(2), 1–8, which relate to the findings of this research related to offending rates, including any analysis of the findings of the research, any analysis of any comments by any of the authors about these findings in any later publication, any analysis or discussion of the relevance of the original research to Scottish Government policy, and any correspondence with external organisations related to the research, since February 2020.
Yours faithfully,
S. Sinclair…
Scottish Government – Response
Your Reference: 202200278385
Your Reference: request-830501-0c61784c
2 March 2022
Dear S Sinclair ,
REQUEST UNDER THE FREEDOM OF INFORMATION (SCOTLAND) ACT 2002 (FOISA)
Thank you for your request dated 05 February 2022 under the Freedom of Information (Scotland) Act
2002 (FOISA).
Your request
You asked for the following;
please could you provide all references you hold to Dhejne, C., Lichtenstein, P., Boman, M., Johansson,
A. L. V., Langstrom, N., and Landen, M. (2011) Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden, published in PloS One,6(2), 1–8, which relate to the findings of this research related to offending rates, including any analysis of the findings of the research, any analysis of any comments by any of the authors about these findings in any later publication, any analysis or discussion of the relevance of the original research to Scottish Government policy, and any correspondence with external organisations related to the research, since February 2020.
Response to your request
The Scottish Government does not have the information you have asked for because the published FoI that you mentioned in your request is the only information held. There is no further reference in our records since the published FoI response on 26 March 2020. For ease I include the link to the
published FoI response here; Swedish Cohort study in sex reassignment surgery: FOI release – gov.scot (www.gov.scot)
St Andrew’s House, Regent Road, Edinburgh EH1 3DG
www.gov.scot
CITATION TRACING TOOLS
