Wålinder, Lundström & Thuwe (1978)
Psychiatric Research Center, St. Jörgens's Hospital, University of Göteborg, Sweden

In this publication patients who regretted after gender role change, name change and legal sex change (n=3), resp., additional surgical sex change (n=2) are compared with those who were treated surgically and after that, satisfied (n=9). This publication does not belong among the follow-up studies in the strictest sense, but is useful to distill prognostically favorable, resp., unfavorable factors. Eleven of the 14 described patients are regarded already in Wålinder & Thuwe (1975).

• Sample
• Study Methods
• Evaluation Fields and Criteria
• Results
• Follow-up Studies Mentioned
• Authors' Conclusion
• Indication Recommendations
• Remarks

Sample
Research group: Three MFTs who wanted a reversal of their legal sex change-- that is possible under Swedish law independent of surgery -- as well as two other MFTs of a sample from Wålinder & Thuwe (1975) who had already been operated and regretted afterwards but did not apply to reverse the legal classification as a female.
Comparison group: Nine females who were satisfied with the results of the surgical treatment.

Study Methods
The two MFTs out of the sample of Wålinder & Thuwe (1975) were interviewed. For all other persons exclusively the entries in the patient files were used.

Evaluation Fields and Criteria
The existence, resp., the non-existence of the following criteria were evaluated: psychoses, mental retardation, unstable personality, alcohol or drug abuse, criminal convictions, capability to earn a living, social support by the family, distance between patients' residences and the treatment providers, physical characteristics that do not fit in with the new gender role, military service, heterosexual experience, strong sexual interest and age at time of first medical contact.

Results
The group comparison shows that a sum score formed by the first 12 prognostic factors is significantly higher (p<.02) for the five "regret cases" than for the satisfied persons. There were significant group differences in the following variables: unstable personality, criminal convictions, incapability to earn a living, lacking social support by the family, physical characteristics that do not fit in with the new gender role, heterosexual experiences and a higher age at the time of first inquiry about treatment possibilities.

Follow-up Studies Mentioned
Benjamin, 1966; Hertz et al., 1961; Hoenig et al., 1971; Pauly, 1968; Randell, 1969; Wålinder & Thuwe, 1975.

Authors' Conclusion and Indication Recommendations
In reference to the number of all persons who desire a gender reassignment and receive it, is a portion of those who regret this decision little. In view of the small sample size the results should be interpreted cautiously. The existence of a small number of prognostically unsatisfactory factors is no absolute contra-indication for treatment, but if there are more of these factors at the same time, caution is necessary. Also unfavorable can be the long-term interruption of an "other sex" hormone treatment on one's condition and the long-term result of treatment.

Remarks
This publication is one of the few that distills prognostically unfavorable factors in a methodologically clear cut way. It is to be seen cautiously that the "regret cases" are put into two different groups, namely pre-surgical patients, who -- in accordance with Swedish rights -- can already request and receive a name, resp., legal sex change and two operated patients. The first group lived, so to say, in the Real-Life-Test. In the Federal Republic of Germany, the persons could only enforce a first name change in accordance with the Transsexuals' Law. If they abandon the wish for gender reassignment surgery in the course of the experience they make in the new gender role, nothing irreversible has happened. The name change can be reversed at any time. This may be true for most countries that allow legal sex change only after surgery. Thus, the patient always has the option to return to his/her former gender role as long as surgery and legal sex change have not taken place.