Volume II, Number 1, January - March 1998

• Psychological and Social Function Before and After Phalloplasty
• Empirical Data on Epidemiology and Application of the German Transsexuals' Act During Its First Ten Years

Psychological and Social Function Before and After Phalloplasty
James Barrett

Abstract
There are no quantitative assessments of the benefits of phalloplasty in a female transsexual population. The study addresses this question, comparing transsexuals accepted for such surgery with transsexuals after such surgery has been performed.

A population of 23 transsexuals accepted for phalloplasty was compared to a population of 40 who had undergone such surgery between six and one hundred and sixty months previously. The General Health Questionnaire (GHQ), Symptom Checklist 90 (SCL-90), Bem Sex Role Inventory and Social Role Performance Schedule (SRPS) were employed. Additionally, a questionnaire assessing satisfaction with cosmetic appearance, sexual function, relationship and urinary function was used, along with a semi-structured interview quantifying alcohol, cigarette and drug usage, and current sexual practice.

There were significant differences between the populations. The post operative group showed higher depression ratings on the depression subscale of the GHQ. The masculine pre-operative Bem scores were neutral post-operatively as feminine sub-scores increased. There was improved satisfaction with genital appearance post-operatively, but satisfaction with relationships fell, although to a non-significant extent. Most other changes were in the expected direction but did not achieve significance.

Transsexuals accepted for phalloplasty have very good psychological health. Tendency to further improvement is the case after phalloplasty. Depression is commoner, however, and quality of relationships declines somewhat, perhaps in consequence. Surgeons might advise partners as well as patients of realistic expectations from such surgery.

Empirical Data on Epidemiology and Application of the German Transsexuals' Act During Its First Ten Years
C. Weitze, M.D., S. Osburg, M.D.

Abstract
In Europe special legislation for transsexuals was fist passed by Sweden in 1972, followed by Germany in 1981, Italy in 1982, the Netherlands in 1985, and Turkey in 1988.

As far as legislation between different countries with various civil-law systems can be compared, laws relating to transsexuals demonstrate considerable differences. The German Transsexuals´ Act (TSG) provides two options, which may be applied either successively or independently of each other. The first so-called "minor solution" refers to changing the applicant's first name in accordance with Section 1 of the Transsexuals' Act (§1 TSG). The second so called "major solution", legislates gender reassignment according to § 8 TSG. For both proceedings two mutually independent expert opinions are necessary. These expert evaluations have to certify that diagnostic criteria for transsexualism have been in existence for at least three years, and that the condition is of lasting nature. For the "major solution", e.g. the change of legal sex, the applicant has to undergo sex reassignment surgery the extend of which is not precisely defined and adapt his external physical appearance to that of the desired gender. The applicant must furthermore be unmarried and permanently incapable of reproduction. The lower age limit of 25 years, which had originally been required for both proceedings, was eliminated for the legal status change in 1982 according to a decision by the highest German court (Federal Constitutional Court); it continued to be applied for change of first name until 1993. Hormone treatment and surgery do not generally require legal permission; however, a request for castration must be reviewed in advance by two physicians according to the German Castration Act.

We considered the tenth anniversary of the German TSG as an occasion to review the application of this law, and also the epidemiological data arising from its use.