Transsexuality

A transsexual (sometimes transexual) person establishes a permanent identity with the opposite gender to their assigned (usually at birth) sex. Transsexual men and women make or desire to make a transition from their birth sex to that of the opposite sex, with some type of medical alteration (gender reassignment therapy) to their body. The stereotypical explanation is of a "woman trapped in a man's body" or vice versa, although many in the transsexual community reject this formulation.

Gender reassignment therapy

Most transsexual men and women suffer from great psychological and emotional pain due to the conflict between their gender identity and their original gender role and anatomy. They find their only recourse is to change their gender role and undergo gender reassignment therapy. This may include taking hormones or having sex reassignment surgery to modify their primary and secondary sexual characteristics.

Related Topics:
Gender reassignment therapy - Hormones - Sex reassignment surgery - Sexual characteristic

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Psychological treatment

Mental health approaches that attempt to change the gender identity to one considered appropriate for their assigned sex have universally been shown to be ineffective. It is generally accepted, therefore, that the only effective course of treatment for transsexuals is gender reassignment therapy.

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The need for physical treatment is emphasized by the high rate of mental health problems, including depression, various addictions, and a suicide rate among untreated transsexual people many times the rate in the general population (some estimates are as high as between thirty and seventy percent); many of these problems in the majority of cases disappear or decrease significantly after a change of gender role.

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Transgender and transsexual activists, but also many caretakers, however, point out that these problems are usually not related to the gender identity issue as such, but to problems that arise from dealing with those issues and social problems related to them. Also, those problems are much more likely to be diagnosed than similar problems in the general population, since for both medical treatments and letters of recommendation contacting a healthcare professional is needed, where the patients are routinely screened for these and similar problems.

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A growing number of transsexual and transgender people therefore resent or even refuse often mandatory psychological treatment, since gender dysphoria itself is untreatable by psychological means, and they have no other problems that need treatment. This however can cause significant problems when they try to obtain physical treatment.

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Therapists' records reveal most transsexuals do not believe they need psychological counseling, but acquiesce to legal demands in order to gain rights which are granted through the medical/psychological hierarchy. Legal issues such as a name change, and sex reassignment surgery itself are usually impossible to obtain without a doctor's approval. This leads to the inevitability that transsexuals feel coerced into confirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference in order to see simple legal hurdles granted. Transsexuals face the unattractive option of remaining invisible with no legal rights and possibly incongruent identification, or submitting to a medical hierarchy which alone has the ability to grant legal gender status.

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Requirements for gender reassignment treatment

Main article: Standards of Care for Gender Identity Disorders

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The requirements for hormone replacement therapy vary greatly. Often a minimum time period of psychological counseling or a time spent living in the desired gender role in order to ensure they can function psychologically in that role is required. This is not always possible; transsexual men especially often cannot "pass" this period without hormones. This time period is usually called the Real Life Test (RLT). The most recent revision of the HBIGDA Standards of Care recognize this limitation for some transgender people. So the SOC state that patients may be approved for treatment after either a period of successful cross-living or a period of diagnostic psychotherapy - generally at least three months.

Related Topics:
Hormone replacement therapy - HBIGDA

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Some surgeons who perform sex-reassignment surgery may require the patient to live as the opposite gender in as many ways as possible for a specified period of time (this is termed "cross-living" or real-life-test) prior to the start of surgery. However some surgeons recognize that RLT without at least chest reconstruction may be difficult. So many are willing to perform some or even all elements of SRS without a RLT period. This is especially prevalent amongst surgeons who practice in Asia.

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Generally both physicians who prescribe hormones and surgeons who perform SRS may request letters of diagnosis and recommendation for treatment from the patient's therapist. However, experienced physicians and surgeons sometimes waive this requirement with patients who, by their evaluation, are obvious candidates for treatment.

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Hormone replacement therapy

Main article: Hormone replacement therapy (trans)

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For both transsexual men and women hormone replacement therapy (HRT) causes the development of some of the secondary sexual characteristics of their desired gender. Many of the already existing primary and secondary sexual characteristics cannot be undone by HRT though. For example breasts will grow in transsexual women but they will not regress in transsexual men. However some characteristics like distribution of body fat and muscle as well as menstruation in transsexual men may be reversed by hormonal treatment. Unfortunately generally those traits that are easily reversible will also revert on cessation of hormonal treatment unless surgical castration has occurred. Moreover, especially in transsexual women, but also in some transsexual men, surgery is required to provide a satisfactory physical body. Transsexual women often require extensive epilation to remove unwanted facial hair and, if necessary, body hair.

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Sex reassignment surgery

Main article: Sex reassignment surgery

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Sex reassignment surgery consists of processes transsexual women and men take in order to match their anatomical sex to their gender identity; however, surgery to correct genitalia (SRS) is also very expensive and not covered by public or private health insurance everywhere.

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Prior to surgery, transsexual men and women are often referred to as pre-operative (pre-op); those who have already had the surgery may be referred to as post-operative (post-op) or simply identified by the sex and sexual status they have chosen. Not all transsexual people undergo sexual reassignment surgery (either because of the high cost of such surgery, medical reasons, or other reasons), although they live constantly in their chosen gender role; these people are often called non-operative (non-op).

Related Topics:
Transsexual - Gender role

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A more modern idea suggests the notion that the focus on surgery status is misplaced, and therefore more and more people are refusing to define themselves in terms of operative status.

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