Factors Associated with Satisfaction or Regret Following Male-to-Female SRS

By Anne A. Lawrence, M.D., Ph.D.

Abstract of a poster presented at the XVII Harry Benjamin International Symposium on Gender Dysphoria, Galveston, TX, November 1, 2001

Background: Follow-up studies of male-to-female (MtF) sex reassignment surgery (SRS) have generally concluded that transsexual typology, compliance with established treatment regimens, and other social and psychological factors are associated with quality of outcomes. More favorable outcomes (i.e., subjective satisfaction and absence of regret) are reportedly associated with younger age at surgery, childhood femininity, sexual attraction to males, compliance with the Standards of Care, absence of other psychological problems, and good family support.

Method: I surveyed MtF transsexuals who had undergone SRS with a single surgeon (Dr. Toby Meltzer) using a consistent technique (penile inversion vaginoplasty, sensate clitoroplasty) during the years 1994–2000. Respondents, all of whom were at least one year postoperative, completed an anonymous mailed questionnaire. Questionnaire items concerned physical and subjective outcomes of surgery, and multiple preoperative and postoperative medical, psychological and social factors.

Results: Respondents returned 232 valid questionnaires, representing 32% of all eligible persons, and 57% of all those who could be contacted. Most respondents reported high overall happiness with their SRS result, and substantial improvement in their quality of life with SRS. None reported outright regret, and only 15 (6%) expressed even occasional regret. The factors most significantly associated with satisfaction or regret following SRS were a composite measure of the functional results of surgery, and number of postoperative complications. In multiple regression analyses, year of surgery, recalled childhood femininity vs. masculinity, and self-rated adequacy of preoperative psychotherapy were the only preoperative factors significantly associated with satisfaction or regret. Age at surgery, sexual attraction to or experience with males vs. females, previous marriage or parenthood, duration of hormone therapy, duration of real-life experience in cross-gender role, hours of preoperative psychotherapy, preoperative depression, and degree of preoperative family support were not significantly associated with satisfaction or regret.

Discussion: These results suggest that the purely physical and functional outcomes of SRS may be more important than preoperative factors such as transsexual typology or compliance with established treatment regimens in predicting satisfaction or regret following MtF SRS.

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