Also, a study such as I mentioned:
http://www.sciencedirect.com/science/article/pii/S1158136006000491
And yes, they noted, in scientific wording, that if you were disturbed/crazy before the operation, you would be after as well.
Damnable paywall... So going from the summary page...
Of the 107 Belgian sample group (all those that underwent sexual reassignment surgery from 1986-2001, and were still alive) 62 answered the questionnaires and submitted to interviews. So round 58% of that set. Aside from the sample size issues I'd say there is a major self selection problem. I don't think reliable conclusions can be drawn.
"Results
On the GAF (DSM-IV) scale the female-to-male transsexuals scored significantly higher than the male-to-females (85.2 versus 76.2).
While no difference in psychological functioning (SCL-90) was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors.
Conclusion
While sex reassignment treatment is an effective therapy for transsexuals, also in the long term, the postoperative transsexual remains a fragile person in some respects."
So from their sample; it appears that underlying issues were less likely to be improved by reassignment surgery in comparison to the general population. I can't read the paper directly, but I have strong suspicions that while it may not actually be cherry picked, if with the flaws you still probably only get to makes no difference mostly, on the macro this elective surgery for psychological reasons is something to be highly suspicious of... follow the money and politics ect.
But, libertarian inclinations and some transgendered
friends associates; micro has the full thumbs up from me to the degree of fists and noses.