Adults who undergo sex reassignment—even in Sweden, which is among the most LGBT-affirming countries—have a suicide rate nearly 20 times greater

According to a report by the U.S. Transgender Survey, an association aimed at defending the rights of transsexuals, 39% of trans people suffered severe psychological distress in the month prior to the interview

Context The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person's body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment.   Objective To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons.   Design A population-based matched cohort study.   Setting Sweden, 1973-2003.   Participants All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973–2003. Random population controls (10∶1) were matched by birth year and birth sex or reassigned (final) sex, respectively.   Main Outcome Measures Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]).   Results The overall mortality for sex-reassigned persons was higher…