After sex reassignment surgery in Sweden, 1973 to 2003, mortality was 2.8 times higher and suicide 19 times higher
All 324 people reassigned in Sweden over thirty years, against 10:1 population controls: mortality aHR 2.8 (1.8-4.3), suicide aHR 19.1 (5.8-62.9), suicide attempts aHR 4.9, psychiatric inpatient care aHR 2.8. No untreated comparison group.
Suggestive but preliminary. Not settled. how we score evidence
Caveat on this rating: Controls are the general population, not transgender people without surgery, so the study cannot attribute the excess to surgery and the authors do not. Small counts give wide intervals (suicide aHR 5.8 to 62.9). The abstract itself credits surgery with "alleviating gender dysphoria".
This is the study most often cited against the optimism of reclassification, and it is a real study with real limits. Both halves belong on the row.
Significant findings
A "population-based matched cohort study" in Sweden, 1973 to 2003, of "All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males)". Controls were "Random population controls (10:1)" matched by birth year and birth sex or reassigned sex. Hazard ratios were adjusted "for immigrant status and psychiatric morbidity prior to sex reassignment".
"The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8-4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8-62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9-8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0-3.9)." Matching on reassigned sex "yielded similar results".
The authors' conclusion: "Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group."
The other direction
The comparison is against the general population, not against transgender people who did not have surgery. So the study can say that people who had surgery fared far worse than the population; it cannot say whether surgery made things better, worse or neither, because there is no untreated group. The authors' own sentence, "although alleviating gender dysphoria", concedes benefit on the thing surgery targets. The confidence interval on the suicide figure, 5.8 to 62.9, is wide because the count is small. And the cohort spans thirty years of changing care, 1973 to 2003; the abstract reports one pooled estimate across all of it.
What this does not show
It does not compare treatments and does not recommend or advise against any. It does not show that surgery causes the outcomes, and the authors do not say it does. Anyone citing it as proof in either direction is citing more than it contains.
Worth asking
Compared with whom? A number that is high against the whole population may be high, low or unchanged against the people it should be compared with.
Source
Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden — Dhejne C, Lichtenstein P, Boman M, Johansson AL, Långström N, Landén M (2011)
Indexed peer-reviewed journal
Read the source: https://doi.org/10.1371/journal.pone.0016885
DOI: 10.1371/journal.pone.0016885
How this was scored
- Study design
- Cohort study
- Funding
- Funding not disclosed
- Published in
- Indexed peer-reviewed journal
- Sample size
- 324
- Preregistered
- not recorded
- Conflicts disclosed
- Yes
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 29, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "early signal". Suggestive but preliminary. Not settled. It scores 51 out of 100 on our published rubric. One caveat travels with that badge: Controls are the general population, not transgender people without surgery, so the study cannot attribute the excess to surgery and the authors do not. Small counts give wide intervals (suicide aHR 5.8 to 62.9). The abstract itself credits surgery with "alleviating gender dysphoria". The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden — Dhejne C, Lichtenstein P, Boman M, Johansson AL, Långström N, Landén M (2011). Published in: Indexed peer-reviewed journal. DOI: 10.1371/journal.pone.0016885. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Cohort study. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.