Gender Identity Disorder Information
Prevalence of Gender Identity Disorders
To help you understand why I believe that the "official" numbers released to the press by the American Psychiatric Association (and the same statistic listed in the Diagnostic and Statistical Manual of Mental Illnesses they publish) are wrong, let's first look at what some of the studies they draw from found, and when they were conducted. I then look at the current population of the countries and apply the statistical prevelence to guesstimate how many post-op transsexuals are living in that country right now (note: the studies said nothing about prevelences stated being among only the ADULT segment of the population, so I felt it reasonable to assume they are referring to the whole population of those nations, including children and adolescents - for whom surgical gender reassignments are also not out of the question. My figures are in italics following the study data, to make it clear what the study found).
Jan Walinder conducted a study of transsexual prevelance in Sweden circa 1965. Questioned 474 members of the Swedish Psychiatric Association about the number of transsexual patients being treated. Prevelance was calculated at 1:37,000 for M2F and 1:103,000 for F2M. If this rate remained intact, the current population of Sweden is just over 8 million people, which would mean about 135 M2F and 40 F2M post-op TSs are currently living in Sweden (Total=175)
C. Weitze and S. Osburg, German Study of Empirical Data on Epidemiology and Application of the German Transsexuals' Act from 1981-1990. Study done in 1993. Prevelance calculated based on applications for name changes and change of legal status concerning gender. 1:36,000-42,000 for M2F and 1:94,000-104,000 for F2M. Germany's population is roughly ten times greater than Sweden's, which would put the current post-op TS population at 1,750 (1,350 M2F, 400 F2M).
Hoeniig & Kenna study in the U.K. in 1974 found 1:34,000 for M2F and 1:108,000 for F2M. According to a speech given by the president of the HBSOC at the "London Congress" in 1999: ". . .the incidence of transsexualism is 1 in 30,000 females and 1 in 10,000 males." The current UK population is over 58 million. At the latest rates of prevelence that would mean there are 3,870 post-op TSs living there (2,900 M2F, 970 F2M).
WF Tsoi study in 1988 for Singapore found 1:9,000 for M2F and 1:27,000 for F2M. Singapore's population is estimated at over 4 million people. So roughly 270 post-op TSs live there (200 M2f, 70 F2M).
L. Gooren (et al.) study in the Netherlands in 1992 found 1:11,900 for M2F and 1:30,400 for F2M.
These numbers for Singapore and the Netherlands are very close to those quoted in 1999 in London by the president of the HBSOC.
There appears to be a correlation between how socially "acceptable" transsexualism is and the prevelence reported. This strongly suggests that more transsexuals felt safe in coming forward and seeking treatment, rather than suggesting that more people are "becoming transsexual."
The population of the Netherlands is almost 16 million people. This would indicate there are over 1000 post-op transsexuals there (approx. 780 M2F, 260 F2M)
I. Pauly study in 1968 uncovered a prevelance in the United States of only 1:100,000 for M2F and 1:400,000 for F2M. The currently oft quoted prevelence for the United States is much greater, usually 1:30,000 for M2F and 1:100,000 for M2F ( I could not locate the study that backs up these numbers, however).
According to some data I ran across (unfortuneately not properly referenced) showed a trend toward greater prevelence in the United States. For M2F is was 1:45,000 in 1980, 1:26,000 in 1983, and 1:18,000 by 1986. A similar increase was discovered for F2M prevelance: 1:200,000 in 1980, 1:100,000 in 1983, and 1:54,000 in 1986. This increase in prevelance corresponds with a time period of greater social acceptance of "sexual deviations" (i.e., homosexuality, with which transsexualism is often errantly associated), and better access to SRS procedures simply because more surgeons were performing the operation in more parts of the country.
It would be difficult to think that every three years there are simply MORE transsexuals. The numbers more likely indicate that either more transsexuals are simply being found among patient populations, either due to better skill on the part of clinicians, or that more transsexuals are actively seeking help, or both.
Also, I've seen referenced many times the estimate that 2000 sex reassignment surgeries are performed annually in the United States alone, with an equal number being performed overseas. (again, I have not seen the "study" these numbers are supposedly drawn from referenced anywhere).
The prevelence data for the UK closely parallels that for the United States, so applying the newer, more liberal numbers to the USA with a population of just over 290 million, there would be over 19,300 post-op transsexuals living in the country (14,500 M2F, 4,830 F2M). Using the older prevelence numbers oft cited by the APA the TS population dwindles to just under 6,300 total (4,800 M2F, 1,450 F2M). The first numbers are, however, likely the more accurate ones.
Number of SRS Surgeries Performed
Part of the problem in calculating anything is that many of the surgeons themselves are reluctant to report how many surgeries they've actually performed, and there are more surgeons performing SRS worldwide than the "famous" ones. Post-op TS woman, Lynn Conway, has stated she believes there are as many as 32,000 post-op transsexuals in the United States alone, however another post-op TS woman, Kate Grimaldi, has stated numerous times that she believes there are only 15,000 post-op transsexuals world-wide, and has personally argued her case with Lynn Conway (neither budged). Below are some of the numbers I could locate:
Sanguan Kunaporn (Thailand) reports having performed 165 SRS operation (66 of which were from USA/Canada) between January 1997 and December 2000.
According to the C. Weitze and S. Osburg study in Germany for the period of 1981 - 1990 (based on applications for change of legal status, which would only be granted post-operatively) approximately 100 SRS operations occurred annually in Germany for German citizens thoughout the 1980s for a total of roughly 900 SRS surgeries for that time period. If the same rate continued through the 1990's that would account for about 2000 German operations in the last 22 or so years.
Dr. Preecha Tiewtranon (Thailand) reports having performed 2000 penile-inversion SRS operations in his 20 years of practice and 550 "colon transposition" operations.
Drs. Yvon Menard and Pierre Brassard (Canada) report "more than 2000" SRS surgeries in their 25 years in practice.
Dr. EP Walker (New Zealand) reports 33 sigmoid vaginoplasties before September 2000.
Dr. Toby Meltzer (USA) reports that he performs about three SRS operation/week (156/year) and has already performed more than 1000 surgeries.
Dr. Stanley Biber (USA) reports performing over 4,500 SRS operations since 1969.
I've never seen actual numbers for Dr. Eugene Schrang, but he is considered "on par" with Meltzer and Biber, so must perform at least 100-150 SRS operation per year himself.
Collectively these doctors may account for about 15,000 M2F patients worldwide.
One must take into account that these surgeries span two or three decades and statistically some percentage of those patients will have died due to the high mortality rate among the transsexual population. Most likely die due to suicide, though I've never seen a breakdown of suicide rates for pre-op vs. post-op. Some studies show that post-op transsexuals have no greater incidence of suicide than the general population of their respective countries. According to Diane Wilson's web site she says the rate is 21% for transsexuals (assumed to be both pre and post-op), but she doesn't cite a source for this statistic. Other data suggest that people in the transsexual population are five times more likely to commit suicide than the general population (again, no hard data on this, nor any breakdown of rates for pre-op vs. post-op). So, in a worst case scenario, if one assumes that 50% of any given transsexual population (pre-op or post-op) will die by their own hand or the hands of others, one would have to cut any numbers of prevelence in half over time to account for the attrition by death.
However, these doctors listed are HARDLY the only surgeons performing SRS procedures. We're missing data from other known SRS surgeons like Dr.Chettawut Tulayaphanich, Dr. Suporn Watanyusakul, Peter Haertsch, Dr. Gary Alter, Dr. Micheal Brownstein, Oliver M. Fenton, Michael Royle, Michael Seghers, Harold M. Reed, and Timothy Terry to name but a few. There are also cosmetic and urological surgeons who have performed SRS but don't make a business of it (or prefer it not be widely known they perform such operations for various reasons).
These figures also only pertain to penile-inversion or sigmoid colon vaginoplasty operations. The numbers above also do not reflect F2M phalloplasties. Also, looking at numbers from surgeons in just one country can be misleading since many TS patients travel to surgeons in other countries, which is why I was looking at the worldwide numbers. If you look at the cited prevelences at the top of this page you'll see that the six nations named likely account for over 26,000 post-op transsexuals (almost 19,900 M2Fs and nearly 6,600 F2Ms). Clearly more than 15,000 post-ops worldwide - even if one is only counting M2F operations - because these are the estimated totals for just SIX countries out of the entire world! Add in the population of other countries like Canada, India, Japan, Australia, France, Italy, etc., etc., and the number will continue to escalate. This is probably a far more valid measure of prevelence than polling surgeons anyway, because it indicates the number of transsexuals currently living in the given population, thus not requiring adjustments over time for attrition by deaths as surgical counts spanning decades require. Also, one must keep in mind that the prevelence numbers from the studies I've mentioned only count for those TSs in the population for which the researchers could account by survey or surgical data. Invariably there would be post-op transsexuals in any given population who were overlooked.
In short I'd have to say that Lynn Conway's estimate is probably closer to the truth than Kate Grimaldi's, which is clearly "low-balling" transsexual prevelence when one crunches the numbers.
These numbers, though, only represent those who actually undergo SRS procedures. They don't account for the transsexuals that, for whatever reason, do not undergo surgical reassignment (so-called "non-ops") and those who are yet to undergo the surgery (the "pre-ops"). A lack of reporting from psychotherapists on the prevelance of transsexuals presenting in their practices is a significant factor in why these "official" numbers are probably so far off.
Most early studies concentrated on ONLY those being treated at a few select, regional "gender centers." Since those studies were performed, many of those clinics have been closed. Maybe even more significant is that many transsexuals seeking help are now actively "warned away" from those clinics once they go online looking for information. This has likely led to a greater number of transsexuals seeking help from therapists in private practice with no affiliations with "established" gender clinics, nor is there any reason to believe many of them are "gender specialists" at all.
It does not appear that the American Psychiatric Association has any interest in conducting a survey of it's own members concerning this subject, instead choosing to rely on outdated data from selected sources, rather than a "real world" representation of the prevelance of transsexualism. Furthermore, transsexuals fall on hard times and drop out of therapy or switch therapists, so there is poor follow-up on many transsexual patients. The best "estimates" from gender specialized therapists is that somewhere between 1 in 5 or 1 in 10 go on to undergo SRS, while the others do not.
This means that the ACTUAL prevelance is five to ten times greater than the total number who undergo SRS procedures. That number, even if it were known, would STILL only represent the total number of transsexuals who sought TREATMENT. There are likely as many more who either do not have the means, or are too afraid to even SEEK help in the first place.
This all strongly suggest to me that the "official numbers" are seriously under-representing the TRUE number of transsexual people in any given population.
At first, like many people, I'd say I wasn't certain I'd agree with the LARGE prevelance number Lynn Conway has on her site, but the numbers out of the Netherlands and Singapore (which was about 1:2900 for total TS people, both M2F and F2M) have actual data to back them up. Yet, that prevelence is ONLY for transsexual males and females who sought surgical reassignment. If the unofficial estimates from therapists are correct, the number prevelence of ALL transsexual people who seek therapy is between 1:290 - 1:580 (depending on whether it is 1 out of 10 or 1 out of 5, respectively, who carries through with surgery). This number approximates the estimated prevelance on Lynn Conway's web site.
TRANSVESTICISM (i.e., CROSSDRESSING)
According to a CIA Report on the subject, there are also no accurate estimations for the prevalance of transvesticism. Especially in Western societies, such activity is a social taboo that remains hidden, further complicating study for an accurate picture of frequency. In non-Western societies where crossdressing is more socially tolerated it appears to be relatively common.
Crossdressers can be subcategorized by motivation or frequency of crossdressing activities. The following are VERY rough estimates:
Occasional Crossdressing - usually for parties, plays, or as an aid to sexual role-play (i.e., "for an occasion") may be prevalent among up to 25% of the general population, who have likely engaged in such activity at some point in their lives.
Recurrent Crossdressing - Sometimes stated at 8% of the general population (source unknown). This category would include those who crossdress on a regular or frequent basis as well as those who engage in it sporadically throughout their lives. The following is based on a survey of transvestites that was conducted in the late 1960s by V. Prince and P.M. Bentler. They received survey responses from 504 subscribers to a magazine for heterosexual cross-dressers in the initial study and received an additional 1200 responses when the survey was recirculated some 25 years later.
Full-time Crossdressers - according to the 1993 CIA report, "There is also an intermediate condition called gynemimesis in males and andromimesis in females, where the person dresses and lives continuously as a person of the opposite sex but does not wish for any change in the anatomy." Within the Transgender Community these people may identify themselves as "Full-time Crossdressers," "Transgenderists," "Gender Queers," simply as "Transgender," or as "Non-op Transsexuals." The CIA report cites a study done within Oman, where such people are called "Xanith" and reprsented 2% of the local population.