Simona-Politta, 1983
Psychiatric University Clinic, Bern, Switzerland

This is a medical dissertation that analyzes a small sample from Bern with the use of the abbreviated evaluation scale by Hunt & Hampson (1980a). The sample described here was again used -- except for two females who could not be reached anymore -- in the follow-up study by Dudle (1989).

• Sample
• Study Methods
• Evaluation Fields and Criteria
• Results
• Suicide Attempts/Role Re-reversal
• Follow-up Studies Mentioned
• Authors' Conclusion
• Remarks

Study Methods
Semi-structured interviews of two to nine hours in length. Evaluation of clinic files and indication expertise for pre-surgical evaluation.

Evaluation Fields and Criteria
Evaluated were personality, socio-economic situation, sexuality, legal position, psychopathology and the subjective evaluation of the surgical results. For the evaluation the slightly modified scale by Hunt & Hampson (1980a) was used that was presented in the publication, pages 47 to 50.

Results
The results were presented in the form of raw data in tabular form for all persons in the sample as pre-post comparison, but do not allow, because of the low case number, a significant calculation in the comparison of gender groups or the pre-surgical and post-surgical evaluation. In the person-centered descriptive view form, in almost all variables, improvements were found for some persons; for others there were no improvement and for others, even worsenings. The following text is based on the table figures:
Females: Two females had pre- and post-surgically stable employment. Regarding the stability of partnerships for one female a pre- and post-surgical frequent change of sex partners is noted; two females had post-surgically a little stable, and one a long-term stable partnership. The satisfaction with social relationships was unchanged for four females post-surgically; for one it had decreased. Psychopathologic symptoms improved in two females post-surgically; six females used marijuana occasionally pre- and post-surgically, alcohol or tranquillizers. One previously drug-addicted was clean afterwards. Three females had never, four sometimes but not severe doubts, if the decision to undergo surgery was right. All felt always or mostly female. Four females selected unchanged exclusively or mostly males as sexual partners; one each behaved in comparison to the time before surgery more strongly homo-, resp., heterosexual. The sexual satisfaction had improved for two females, for one each it was unchanged, resp., worsened; one female for whom pre-surgical data is not available felt unsatisfied frequently post-surgically. With one exception, all females were not accepted as females by some family members. Overall it is noticeable that much data is lacking and that no female is ever put in the worst category - either pre- or post-surgically.
Males: Four males had stable employment post-surgically, among them one improvement. The partnerships were post-surgically more stable for three males; satisfaction with social relationships was greater for four males. In three males previously documented psychopathologic characteristics were not observed any more following surgery. The occasional marijuana, alcohol or tranquillizer use was unchanged for all. Criminal convictions were not observed. Post-surgically all felt mostly or always as males and selected exclusively females as sexual partners. All males were accepted by males by their family members. Overall much data are lacking and the worst category was never used.

Follow-up Studies Mentioned
Benjamin, 1964a, 1966; Gunn-Sechehaye, 1964; Hamburger et al., 1953; Hastings & Markland, 1978; Hertz et al., 1961; Hoenig et al., 1970b; Hore et al., 1975; Hunt & Hampson, 1980b; König et al., 1978; Kröhn et al., 1981; Meyer & Reter, 1979; Money, 1971; Pauly, 1965; Randell, 1969; Stürup, 1976; Wålinder & Thuwe, 1975; Wyler, 1978

Authors' Conclusion
"The sample does not give a statistically significant result for the comparison pre-surgically/post-surgically in both groups. Viewing the results individually it can only be described which one of the subjects had changes in a positive or negative direction. In a descriptive way improvement can be noted in the comparison pre-surgically/post-surgically in two subjects, no negative consequences in four subjects and an unchanged state in four subjects. In two subjects is objectively notable that there is a worsening, even though only one subject regrets the surgery subjectively" (p. 76).
"The number of positive results (in half --six-- subjects) and those who are unchanged pre-/post-surgically --four-- results overall that in 84% of the subjects the sex reassignment surgery led to an improvement or at least to no worsening" (p. 75).

Remarks
In the data of this research it is very much noticeable that the evaluation scale by Hunt & Hampson (1980a) is hardly useful when there are changes in positive or negative direction to be measured if pre-surgically high values have been assigned (roof effect; comp. p. 51). Also the sample was too small to make a sensible statistical calculation. Because of this, the author tried to amplify the results descriptively by personal data. Then again, the descriptions are so inexplicit that -- at the end -- no useable picture about the course can be attained; because of this, the total evaluation of the results -- as the author did it -- has hardly any validity.