Gender reassignment: 5 years of referrals in Oxfordshire

Abstract

Aims and methodTo evaluate the characteristics of individuals seeking gender reassignment, the frequency of subsequent referrals to a specialist centre, and funding approval. Cases were identified from a local referrals database and data were extracted from case notes.ResultsFifty-four individuals attended for assessment; 70% were biological males and 30% were biological females. Mean age at referral was significantly different between the two groups. Over half were taking hormone supplementation and three had already had surgery. Further, 24% had a current and 30% a past mental illness. The majority of individuals were referred to a specialist centre for gender reassignment but only two had funding for surgery approved. Paedophilia was a rare but concerning finding.Clinical implicationsPsychiatric assessment plays an important role in confirming transsexualism and in identifying other relevant diagnoses.

Individuals seeking gender reassignment: marked increase in demand for services

“… 1 – 3 Five years ago, our group published a service evaluation of referrals to the adult (age 18 onwards) Oxford Gender Clinic between 2004 and 2009. 4 In this 5-year period, there were 56 referrals. We found levels of psychiatric morbidity to be lower than described in other samples, and there were significantly more individuals seeking male-to-female transition (70%) than female-to-male transition (30%).…”

“…It has always been considered to be a rare disorder, but in recent years there has been an extraordinary increase in the number of referrals to both adult and child and adolescent gender clinics, with services becoming overwhelmed 1 – 3 . Five years ago, our group published a service evaluation of referrals to the adult (age 18 onwards) Oxford Gender Clinic between 2004 and 2009 4 . In this 5-year period, there were 56 referrals.…”

Ethical issues in psychosocial assessment for sex reassignment surgery in Canada.

“…Reports also exist of transgender individuals who seek dangerous underground alternatives such as unregulated hormone treatments or cheap surgery. For example, Saunders and Bass (2011) reported that of the transgender individuals they interviewed who were currently taking hormones, over half of them purchased the hormones from the Internet, thus potentially consuming unregulated medications and accepting the risk of dangerous side effects that are not properly monitored by a physician. One final consideration unique to Canadians is a large rural population, where geographical distance creates an additional barrier (after long wait times and high cost) to SRS access.…”

“…It is also important to note that transgender individuals often experience behavioral and emotional problems, including anxiety and depressive disorders, as a consequence of nonacceptance of their gender-variant behavior from others (APA, 2013). In one study of individuals who were assessed for SRS suitability, 24% had a current psychiatric disorder and 30% had a lifetime history of psychiatric disorder (Saunders & Bass, 2011). While psychiatric disorders do not necessarily affect capacity for consent, some conditions may impair decision-making ability.…”