Adult desisters from sex reassignment program in France

Since 1991, the transgender unit of Foch Hospital(Paris, France) has been receiving adult patients requesting sex reassignment surgery (SRS). This unit is part of the French Society for the Study and Medical Care of Gender... [ view full abstract ]

Since 1991, the transgender unit of Foch Hospital(Paris, France) has been receiving adult patients requesting sex reassignment surgery (SRS). This unit is part of the French Society for the Study and Medical Care of Gender Dysphoria (SoFECT) created in 2010, which follows the standards of care of the WPATH. We noticed that a significant part of our patients dropped out of our program before undergoing SRS.

We want to assess the proportion and distribution of the “desisters” and understand the reasons for their dropping out. [ view full abstract ]

We want to assess the proportion and distribution of the “desisters” and understand the reasons for their dropping out.

The medical records of the 1297 patients, who consulted one of our psychiatrists between 1991 & 2015, were computerised, listed and studied. [ view full abstract ]

The medical records of the 1297 patients, who consulted one of our psychiatrists between 1991 & 2015, were computerised, listed and studied.

In our reference sample population, 45.5% of all patients dropped out of the program, 15.5% are being assessed, 2% has been refused and 37.5% completed their SRS. We call “desisters” those who dropped out of the SRS... [ view full abstract ]

In our reference sample population, 45.5% of all patients dropped out of the program, 15.5% are being assessed, 2% has been refused and 37.5% completed their SRS. We call “desisters” those who dropped out of the SRS program after coming only once in psychiatric consultation (35.5%), after having only been assessed by a psychiatrist (55.5%), or after having been assessed by a psychiatrist and having initiated the hormone replacement therapy (9%). The average age of all patients is 35.2 y.o.; that of the “desisters” is 35.8 y.o. when that of those who have benefited from SRS is 31.7 y.o.

Among the “desisters”, 77% are male-to-female whose average age is 37.5 y.o. Among those who have benefited from SRS, 56.5% are female-to-male whose average age is 30 y.o. Over 30% of the “desisters” gave an explicit... [ view full abstract ]

Among the “desisters”, 77% are male-to-female whose average age is 37.5 y.o. Among those who have benefited from SRS, 56.5% are female-to-male whose average age is 30 y.o. Over 30% of the “desisters” gave an explicit explanation for their dropping out: hesitations (23.5%), refusing to wait for the two years evaluation (11.5%), fear from the surgery (11.5%), and isolated cases such as dissatisfaction towards the program or the team. Almost 70% simply do not come back. After reading back the “desisters” medical records, the psychiatric team stated the following hypothesis for these patients’ dropping out: severe personality disorder (17.5%), severe psychiatric disorder (15.5%), differential diagnosis (11.5%), parent of minor children (10.5%), renouncement (7.5%), left for another French team (8.5%) or for a foreign team (7%), family opposition (4%), health issues (4%), refusal of the French program (4%), fear from surgery (3.5%). Moreover, a significant part of them (25% at least) was encouraged to drop out by the psychiatrists.

More than 45% of our patients dropped out before undergoing SRS: they are mostly (77%) male-to-female patients and tend to be slightly older. Since the inclusion of the Foch Hospital unit in the French society (SOFECT)... [ view full abstract ]

More than 45% of our patients dropped out before undergoing SRS: they are mostly (77%) male-to-female patients and tend to be slightly older. Since the inclusion of the Foch Hospital unit in the French society (SOFECT) affiliated to the WPATH – in particular, taking into account its Standards of Care – our psychiatrists initiated a noteworthy evolution of the SRS eligibility criteria. Despite all, SRS appears not to be the sole purpose of these people suffering from gender dysphoria: some will settle for a social,and/or legal, and/or medical recognition of their condition, without necessarily undergoing surgery.