To estimate gender-affirming treatment prevalence, satisfaction with treatment decisions, and unmet treatment need among people in Sweden who currently or formerly identified as transgender.
Approach:
Design and setting: Survey substudy of the Swedish BLISS national population-based cohort; responses were collected from February to April 2025.
Participants: Of 95 people invited based on current or past transgender identity, 83 consented and 72 completed the survey.
Analysis: Treatment experiences and satisfaction were reported descriptively; sociodemographic and transgender-related characteristics were compared by gender identity.
Key Findings:
About one-third of participants reported gender-affirming surgery (23; 32.4%); ongoing hormone treatment was reported by 30 (42.3%).
Among participants assigned female at birth, masculinizing chest surgery was reported by 43.5%; among those assigned male at birth, hair removal was reported by 32.0%.
All participants who had received gender-affirming hormones, surgery, or procedures reported satisfaction with their treatment decisions.
Many participants who had not received particular treatments said they wanted them. Chest surgery was most desired among participants assigned female at birth; hair removal, orchiectomy, and voice therapy were commonly desired among those assigned male at birt…
Interpretation:
The authors report that most treatments had low prevalence, with masculinizing chest surgery, hair removal, and hormone treatment as exceptions. A substantial proportion of participants wanted treatments they had not received. The authors note that the absence of reported dissatisfaction may relate to treatment standards, motivation among people pursuing treatment, and Swedish circumstances, including prolonged wait times.
Limitations:
Substantial attrition and a small sample constrain estimates; respondents differed from transgender participants lost to follow-up in age and birthplace.
The study included adults only, so findings should not be generalized to children.
Sweden’s health care, institutional trust, and changing legal context may limit generalizability to other settings.
Conclusion:
In this small Swedish adult cohort, reported satisfaction with gender-affirming treatment decisions was universal among those treated, while many participants reported wanting treatments they had not received.
