Hostname: page-component-55f67697df-px5tt Total loading time: 0 Render date: 2025-05-20T15:14:20.690Z Has data issue: false hasContentIssue false
  • English
  • Français

Systematic Review and Meta-Analysis of Prevalence Studies in Transsexualism

Published online by Cambridge University Press:  26 May 2015

J. Arcelus ,
W.P. Bouman ,
W. Van Den Noortgate ,
L. Claes ,
G. Witcomb  and
F. Fernandez-Aranda
J. Arcelus
Affiliation:
Nottingham Centre for Gender Dysphoria, Nottinghamshire Healthcare NHS Trust, 3 Oxford Street, NG1 5BHNottingham, United Kingdom School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
W.P. Bouman*
Affiliation:
Nottingham Centre for Gender Dysphoria, Nottinghamshire Healthcare NHS Trust, 3 Oxford Street, NG1 5BHNottingham, United Kingdom
W. Van Den Noortgate
Affiliation:
Centre for Methodology of Educational Research, Katholieke Universiteit, Leuven, Belgium
L. Claes
Affiliation:
Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
G. Witcomb
Affiliation:
School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
F. Fernandez-Aranda
Affiliation:
Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain
*
*Corresponding author. Tel.: +44 1158 760 160; fax: +44 1159 475 609. E-mail address: walterbouman@doctors.org.uk (W.P. Bouman).
Get access

Abstract

Background

Over the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data.

Methods

Databases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed.

Results

The overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years.

Conclusions

The overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide.

Keywords

Gender dysphoriaTransgenderPopulationSystematic reviewMeta-analysis
Type
Review
Information
European Psychiatry , Volume 30 , Issue 6 , September 2015 , pp. 807 - 815
Copyright
Copyright © Elsevier Masson SAS 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Ahmad, S., Barrett, J., Beaini, A.Y., et al.Gender dysphoria services: a guide for general practitioners and other healthcare staff. Sex Relat Ther 2013;28(3):173–186. http://dx.doi.org/10.1080/14681994.2013.808884.CrossRefGoogle Scholar
Aitken, M., Steensma, T.D., Blanchard, R., VanderLaan, D.P., Wood, H., Fuentes, A., et al.Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med 2015;12:756–763. http://dx.doi.org/10.1111/jsm.12817.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM3). 3rd ed.. .Washington, DC: American Psychiatric Press; 1980.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). Revised 3rd ed.. .Washington, DC: American Psychiatric Press; 1987.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM4). 4th ed.. .Washington, DC: American Psychiatric Press; 1994.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM4R). Revised 4th ed.. .Washington, DC: American Psychiatric Press; 2000.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM5). 5th ed.. .Washington, DC: American Psychiatric Press; 2013.CrossRefGoogle Scholar
Arcelus, J., Haslam, M., Farrow, C., Meyer, C.The role of interpersonal functioning in the maintenance of eating psychopathology: a systematic review and testable model. Clin Psychol Rev 2013;33(1):156–167. http://dx.doi.org/10.1016/j.cpr.2012.10.009.CrossRefGoogle ScholarPubMed
Bakker, A., Van Kesteren, P.J.M., Gooren, L., Bezemer, P.The prevalence of transsexualism in the Netherlands. Acta Psychiat Scand 1993;87:237–238.CrossRefGoogle ScholarPubMed
Benjamin, H.The transsexual phenomenon. .New York: The Julian Press; 1966.Google Scholar
Bockting, W.O.Psychotherapy and the real-life experience: from gender dichotomy to gender diversity. Sexologies 2008;17:211–224. http://dx.doi.org/10.1016/j.sexol.2008.08.001.CrossRefGoogle Scholar
Bockting, W., Coleman, E., De Cuypere, G.Care of transsexual persons. New Engl J Med 2011;364:2259–2560. http://dx.doi.org/10.1056/NEJMc1104884.Google ScholarPubMed
Borenstein, M., Hedges, L., Higgins, J., Rothstein, H.Comprehensive meta-analysis. Version 2. .Englewood NJ: Biostat; 2005.Google Scholar
Claes, L., Bouman, W.P., Witcomb, G., Thurston, M., Fernandez-Aranda, F., Arcelus, J.Non-suicidal self-injury in trans people: associations with psychological symptoms, victimization, interpersonal functioning and perceived social support. J Sex Med 2015;12(1):168–179.CrossRefGoogle ScholarPubMed
Coleman, E., Bockting, W., Botzer, M., et al.Standards of care for the health of transsexual, transgender, and gender non-conforming people, version 7. Int J Transgen 2012;13(4):165–232. http://dx.doi.org/10.1080/15532739.2011.700873.CrossRefGoogle Scholar
Davey, A., Bouman, W.P., Arcelus, J., Meyer, C.Social support and psychological wellbeing: a comparison of patients with gender dysphoria and matched controls. J Sex Med 2014;11(12):2976–2985. http://dx.doi.org/10.1111/jsm.12681.CrossRefGoogle ScholarPubMed
Davies, A., Bouman, W.P., Richards, C., et al.Patient satisfaction with gender identity clinic services in the United Kingdom. Sex Relat Ther 2013;28(4):400–418. http://dx.doi.org/10.1080/14681994.2013.834321.CrossRefGoogle Scholar
De Cuypere, G., Van Hemelrijck, M., Michel, A., et al.Prevalence and demography of transsexualism in Belgium. Eur Psychiatry 2007;22(3):137–141. http://dx.doi.org/10.1016/j.eurpsy.2006.10.002.CrossRefGoogle ScholarPubMed
de Vries, A.L.C., Kreukels, B.P.C., T'Sjoen, G., Ålgars, M., Mattila, A.Increase of referrals to gender identity clinics: a European trend?. Transgender healthcare in Europe. Book of abstract. Ghent, Belgium: European Professional Association of Transgender Health (EPATH); 2015. 10. Retrieved online from http://epath.eu/wp-content/uploads/2014/07/EPATH-2015-Book-of-Abstracts.pdf on 8th April 2015.Google Scholar
Dhejne, C., Oberg, K., Arver, S., Landén, M.An analysis of all applications for sex reassignment surgery in Sweden, 1960–2010: prevalence, incidence, and regrets. Arch Sex Behav 2014;43(8):1535–1545. http://dx.doi.org/10.1007/s10508-014-0300-8.CrossRefGoogle ScholarPubMed
Drescher, J., Cohen-Kettenis, P., Winter, S.Minding the body: situating gender identity diagnoses in the ICD-11. Int Rev Psychiatr 2012;24:568–577. http://dx.doi.org/10.3109/09540261.2012.741575.CrossRefGoogle ScholarPubMed
Eklund, P., Gooren, L., Bezemer, P.The prevalence of transsexualism in The Netherlands. Brit J Psychiat 1988;152:638–640. http://dx.doi.org/10.1192/bjp.152.5.638.CrossRefGoogle ScholarPubMed
FRA. Being trans in the European Union: comparative analysis of the EU LBGT survey data. Vienna: FRA – European Union Agency for Fundamental Rights; 2014.Google Scholar
Franz, R.C.Sigmoid colon vaginoplasty: a modified method. Brit J Obstet Gynaec 1996;103:1148–1155.CrossRefGoogle ScholarPubMed
Garrels, L., Kockott, G., Michael, N., et al.Sex ratio of transsexuals in Germany: the development over three decades. Acta Psychiat Scand 2000;102(6):445–448.CrossRefGoogle ScholarPubMed
Gerstman, B.Epidemiology kept simple: an introduction to traditional and modern epidemiology. 2nd ed.Hoboken, NJ: Wiley-Liss; 2003. Retrieved from http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0471400289.html on 11th January 2015Google Scholar
Gilbert, N.Disclosure of eating disorders and subsequent help seeking. Unpublished thesis. UK: Birmingham University; 2009. Retrieved online from http://etheses.bham.ac.uk/428/ on 11th January 2015Google Scholar
Godlewski, J.Transsexualism and anatomic sex ratio reversal in Poland. Arch Sex Behav 1988;17(6):547–548.CrossRefGoogle ScholarPubMed
Gómez-Gil, E., Trilla Garcia, A., Godas Sieso, T., et al.Estimacion de la prevalencia, incidencia y razon de sexos del transexualismo en catalunya segun la demanda asistencial. Acta Espan Psychiat 2006;34(5):295–302.Google Scholar
Hahn, T.Jin Xing, a dancer and leader of the Xing Dance Theatre in Shanghai, China, and a transsexual. Ballettanz 2004;3:22–25.Google Scholar
Heylens, G., Elaut, E., Kreukels, B.P.C., et al.Psychiatric characteristics in transsexual individuals: multicentre study in four European countries. Brit J Psychiat 2014;204(2):151–156.CrossRefGoogle ScholarPubMed
Higgins, J.P., Green, S.Cochrane handbook for systematic reviews of interventions Version 5.1.0. NY: Wiley; 2011. Retrieved online from www.cochrane-handbook.org on 11th January 2015Google Scholar
Higgins, J.P.T., Thompson, S.G.Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21(11):1539–1558. http://dx.doi.org/10.1002/sim.1186.CrossRefGoogle ScholarPubMed
Hoenig, J., Kenna, J.C.The prevalence of transsexualism in England and Wales. Brit J Psychiat 1974;124(579):181–190. http://dx.doi.org/10.1192/bjp.124.2.181.CrossRefGoogle ScholarPubMed
Judge, C., O’Donovan, C., Callaghan, G., Gaoatswe, G., O'Shea, D.Gender dysphoria – prevalence and co-morbidities in an Irish adult population. Front Endocrinol 2014;5:87. http://dx.doi.org/10.3389/fendo.2014.00087.CrossRefGoogle Scholar
Keuzenkamp, S., Kuyper, L.Acceptance of LGBT individuals in the Netherlands 2013. .The Hague: The Netherlands Institute of Social Research (ED); 2013.Google Scholar
Kuyper, L., Wijsen, C.Gender identities and gender dysphoria in the Netherlands. Arch Sex Behav 2014;43(2):377–385. http://dx.doi.org/10.1007/s10508-013-0140-y.CrossRefGoogle ScholarPubMed
Landén, M., Wålinder, J., Hambert, G., Lundström, B.Factors predictive of regret in sex reassignment. Acta Psychiat Scand 1998;97(4):284–289.CrossRefGoogle ScholarPubMed
Mepham, N.L., Bouman, W.P., Arcelus, J., Wylie, K.R., Hayter, M.People with gender dysphoria who self prescribe cross sex hormones: prevalence, sources and side effects knowledge. J Sex Med 2014;11:2995–3001. http://dx.doi.org/10.1111/jsm.1269.CrossRefGoogle ScholarPubMed
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G.The PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097.CrossRefGoogle ScholarPubMed
Nanda, S.The Hijras of India: cultural and individual dimensions of an institutionalized third gender role. J Homosex 1985;11:35–54.CrossRefGoogle ScholarPubMed
Nanda, S.Neither man nor woman. The Hijras of India. Second edition. .Belmont, USA: Wadsworth; 1998.Google Scholar
National Institute of Health and Clinical Excellence. The Guidelines Manual. London: National Institute for Clinical Excellence; 2007. Retrieved online from www.nice.org.uk on 11th January 2015.Google Scholar
Nuttbrock, L., Bockting, W., Rosenblum, A., et al.Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study. Am J Public Health 2013;103:300–307.CrossRefGoogle ScholarPubMed
O’Gorman, E.C.A preliminary report on transsexualism in Northern Ireland. Ulster Med J 1981;50(1):46–49.Google ScholarPubMed
Olsson, S.E., Moller, A.R.On the incidence and sex ratio of transsexualism in Sweden, 1972–2002. Arch Sex Beh 2003;32(4):381–386. http://dx.doi.org/10.1023/A:1024051201160.CrossRefGoogle Scholar
Operario, D., Soma, T., Underhill, K.Sex work and HIV status among transgender women: systematic review and meta-analysis. JAIDS 2008;48:97–103.Google ScholarPubMed
Pauly, I.B.The current status of the change of sex operation. J Nerv Ment Dis 1968;147(5):460–471.CrossRefGoogle ScholarPubMed
Poteat, T., Reisner, S.L., Radix, A.HIV epidemics among transgender women. Curr Opin HIV AIDS 2014;9:168–173.CrossRefGoogle ScholarPubMed
Reddy, G.With respect to sex. .Chicago, USA: University of Chicago; 2005.CrossRefGoogle Scholar
Ross, M., Wålinder, J., Lundstrom, B., Thuwe, I.Cross-cultural approaches to transsexualism. Acta Psychiat Scand 1981;63:75–83.CrossRefGoogle ScholarPubMed
Ruan, F.F., Bullough, V.L., Tsai, Y.M.Male transsexualism in mainland China. Arch Sex Behav 1989;18:517–522.CrossRefGoogle ScholarPubMed
Tsoi, W.The prevalence of transsexualism in Singapore. Acta Psychiat Scand 1988;78:501–504.CrossRefGoogle ScholarPubMed
Van Kesteren, P.J., Gooren, L.J., Megens, J.A.An epidemiological and demographic study of transsexuals in the Netherlands. Acta Psychiat Scand 1996;87(4):237–238.Google Scholar
Veale, J.F.Prevalence of transsexualism among New Zealand passport holders. Aust NZ J Psychiat 2008;42(10):887–889. http://dx.doi.org/10.1080/00048670802345490.CrossRefGoogle ScholarPubMed
Vujovic, S., Popovic, S., Sbutega-Milosevic, G., Djordjevic, M., Gooren, L.J.Transsexualism in Serbia: a twenty-year follow-up study. J Sex Med 2009;6(4):1018–1023. http://dx.doi.org/10.1111/j.1743-6109.2008.00799.x.CrossRefGoogle ScholarPubMed
Wålinder, J.Transsexualism: a study of forty-three cases. .Goteborg: Scandinavian University Books; 1967.Google Scholar
Wålinder, J.Transsexualism: definition, prevalence and sex distribution. Acta Psychiat Scand 1968;203:255–257.CrossRefGoogle ScholarPubMed
Wålinder, J.Incidence and sex ratio of transsexualism in Sweden. Brit J Psychiat 1971;119:195–196. http://dx.doi.org/10.1192/bjp.119.549.195.CrossRefGoogle ScholarPubMed
Weitze, C., Osburg, S.Transsexualism in Germany: empirical data on epidemiology and application of the German Transsexuals’ Act during its first ten years. Arch Sex Behav 1996;25(4):409–425.CrossRefGoogle ScholarPubMed
Wilson, P., Sharp, C., Carr, S.The prevalence of gender dysphoria in Scotland: a primary care study. Brit J Gen Pract 1999;49(449):991–992.Google ScholarPubMed
World Health Organization. International Classification of Diseases 9 (ICD-9). Geneva: World Health Organization; 1978.Google Scholar
World Health Organization. International Classification of Diseases 10 (ICD-10). Geneva: World Health Organization; 1992.Google Scholar
Wylie, K., Barrett, J., Besser, M., et al.Good practice guidelines for the assessment and treatment of adults with gender dysphoria. Sex Relat Ther 2014;29(2):154–214. http://dx.doi.org/10.1080/14681994.2014.883353.CrossRefGoogle Scholar
Zhaoji, X., Chuanmin, W., Bullough, V.L.Transsexualism in China in 1995. In: Bullough, B., Bullough, V.L., Elias, J. editors. Gender blending. Amherst, NY: Prometheus Books; 1997. 377–382.Google Scholar
Zucker, K.J., Lawrence, A.A.Epidemiology of gender identity disorder: recommendations for the standards of care of the world professional association for transgender health. Int J Transgen 2009;11:8–18. http://dx.doi.org/10.1080/15532730902799946.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.