What is Transsexualism ?

Transsexualism is a medical condition that affects between 1 in 3,000 and 1 in 10,000 people regardless of Class, Colour, Religion or socialisation. Transsexualism is a condition in which a person's sense of identity as a man or a woman does not correspond with their genitalia and other anatomic sexual characteristics. In other words, a person who is biologically  male may feel like a woman, a person who has a female body may have a sense of "really" being a man. Transsexuals are not delusional, they are very aware of their actual biological sex. However, those characteristics that signify their sex - genitalia as well as breasts, beard, voice, etc. - feel wrong to them. It seems like these parts don't belong and that they misrepresent who the person really is. Transsexualism is not a learned behaviour, so transsexuals are not persuaded to become transsexual by anybody and many transpeople know there is something different about themselves from a very early age.

What causes Transsexualism ?

Nobody knows for certain. However, there are several theories. It is known that every fetus in a womb starts life as female and remains that way until about the sixth week of pregnancy. Then the mother's body produces a rush of hormones, either Testosterone, the male sex hormone or Estrogen, the female sex hormone. The fetus continues to develop as female or changes and continues its development as male. It could be said that every male child has undergone a natural sex-change before birth. It is believed that, in the case of people who become transsexuals, something goes wrong in the womb during this stage of pregnancy which doesn't show itself until the child is old enough to understand the difference between male and female.

What can be done for Transsexuals ?

There is no need for Transsexuals to suffer in the 21st century as treatments are available. There is a set of guidelines called, The Standards of Care (SOC), they are Clinical Guidelines. The SOC are intended to provide flexible directions for the treatment of persons with gender identity disorders.  The Standards of Care (SOC) articulate this international organization's professional consensus about the psychiatric, psychological, medical, and surgical management of gender identity disorders. The general goal of psychotherapeutic, endocrine, or surgical therapy for persons with gender identity disorders is lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment.

The first thing a transperson would need to do on discovering there is something wrong is to see their own doctor and ask for a referal to a psychiatrist or  gender therapist who has knowledge of gender issues. You will usually be evaluated by that professional to ensure that you are transsexual and not a confused transvestite, someone struggling with their sexual orientation, or a person who suffers from delusions. These tests are necessary for your own protection, and the protection of the Psychiatrist, Surgeon and Hospital where you are treated.

If you are diagnosed as Transsexual the psychiatrist or gender therapist will usually referr you to an Endocrinologist who will prescribe hormones for your correct gender. In the case of Male to Female Transsexuals the psychiatrist will prescribe Estrogens, Progestins and Anti-Androgens, and in the case of Female to Male Trannsexuals will prescribe Testosterone and depending on your individual blood work, an Estrogen Blocker. Some people ask  how do can someone obtain hormones without seeing a doctor.  Even though this is achievable, I am not going to tell you. Hormones in the 'Wrong' body can be extremely dangerous and it is essential that you are monitored by a medical professional, since there are numerous health risks.  

The next part is extremely difficult to start, but an absolute necessity. This next step is called the Real Life Experience (RLE), also known as the Real Life Test (RLT) is the act of fully adopting a new or evolving gender role or gender presentation in everyday life. The RLE or RLT is essential to the transition to the gender role that is congruent with the patient's gender identity. Since changing one's gender presentation has immediate profound personal and social consequences, the decision to do so should be preceded by an awareness of what the familiar, vocational, interpersonal, educational, economic, and legal consequences are likely to be.  Change of gender role and presentation can be an important factors in employment discrimination, divorce, marital problems, and the restriction or loss of visitation rights with children. These represent external reality issues that must be confronted for success in the new gender presentation.

Real-Life Experience versus Real-Life Test. Although professionals may recommend living in the desired gender, the decision as to when and how to begin the real-life experience remains the person's responsibility. Some begin the real-life experience and decide that this often imagined life direction is not in their best interest. Professionals sometimes construe the real-life experience as the real-life test of the ultimate diagnosis. If patients prosper in the preferred gender, they are confirmed as "transsexual," but if they decided against continuing, they "must not have been." This reasoning is a confusion of the forces that enable successful adaptation with the presence of a gender identity disorder. The real-life experience tests the person's resolve, the capacity to function in the preferred gender, and the adequacy of social, economic, and psychological supports. It assists both the patient and the mental health professional in their judgments about how to proceed. Diagnosis, although always open for reconsideration, precedes a recommendation for patients to embark on the real-life experience. When the patient is successful in the real- life experience, both the mental health professional and the patient gain confidence about undertaking further steps.

Sex Reassignment is Effective and Medically Indicated in persons diagnosed with transsexualism or profound GID.  Sex reassignment surgery, along with hormone therapy and the real-life experience, is a treatment that has proven to be effective. Sex reassignment is not "experimental," "investigational," "elective," "cosmetic," or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID.

Prior to performing any surgical procedures, the surgeon should have all medical conditions appropriately monitored and the effects of the hormonal treatment upon the liver and other organ systems investigated. This can be done alone or in conjunction with medical colleagues. The medical record should contain written informed consent for the particular surgery to be performed. Genital Surgery have various eligibility criteria. These minimum eligibility criteria for various genital surgeries equally apply to biologic males and females seeking genital surgery. They are:

1. Legal age of majority in the patient's nation;
2. Usually 12 months of continuous hormonal therapy for those without a medical contraindication.
3. 12 months of successful continuous full time real-life experience. Periods of returning to the original gender may indicate ambivalence about proceeding and generally should not be used to fulfill this criterion;
4. If required by the mental health professional, regular responsible participation in psychotherapy throughout the real-life experience at a frequency determined jointly by the patient and the mental health professional. Psychotherapy per se is not an absolute eligibility criterion for surgery;
5. Demonstrable knowledge of the cost, required lengths of hospitalizations, likely complications, and post surgical rehabilitation requirements of various surgical approaches;
6. Awareness of different competent surgeons.

Readiness Criteria. The readiness criteria include:

1. Demonstrable progress in consolidating one's gender identity;
2. Demonstrable progress in dealing with work, family, and interpersonal issues resulting in a significantly better state of mental health (this implies satisfactory control of problems such as sociopathy, substance abuse, psychosis, suicidality, for instance).

Can Surgery Be Provided Without Hormones and the Real-Life Experience? Individuals cannot receive genital surgery without meeting the eligibility criteria. Genital surgery is a treatment for a diagnosed gender identity disorder, and should undertaken only after careful evaluation. Genital surgery is not a right that must be granted upon request. The SOC provide for an individual approach for every patient; but this does not mean that the general guidelines can be ignored. However, if a person has lived convincingly as a member of the preferred gender for a long period of time and is assessed to be a psychologically healthy after a requisite period of psychotherapy, there is no inherent reason that he or she must take hormones prior to genital surgery.

Conditions under which Surgery May Occur. Genital surgical treatments for persons with a diagnosis of gender identity disorder are not merely another set of elective procedures. Typical elective procedures only involve a private mutually consenting contract between a patient and a surgeon. Genital surgeries for individuals diagnosed as having GID are to be undertaken only after a comprehensive evaluation by a qualified mental health professional. Genital surgery may be performed once written documentation that a comprehensive evaluation has occurred and that the person has met the eligibility and readiness criteria. By following this procedure, the mental health professional, the surgeon and the patient share responsibility of the decision to make irreversible changes to the body.

Ideally, the surgeon you select should be knowledgeable about more than one of the surgical techniques for genital reconstruction and should be a urologist, gynecologist, plastic surgeon or general surgeon, and Board-Certified as such by a nationally known and reputable association. The surgeon should have specialized competence in genital reconstructive techniques as indicated by documented supervised training with a more experienced surgeon. They should be able to consult with  the patient and able to choose the ideal technique for the individual patient.

Transition doesn't stop after surgery, long-term postoperative follow-up care is encouraged in that it is one of the factors associated with a good psychosocial outcome. Follow-up care is important to the patient's subsequent anatomic and medical health and to the surgeon's knowledge about the benefits and limitations of surgery. Long-term follow-up care with the surgeon is recommended in all patients to ensure an optimal surgical outcome. 

Postoperative patients may also sometimes exclude themselves from follow-up care with the physician prescribing hormones, not recognizing that these physicians are best able to prevent, diagnose and treat possible long term medical conditions that are unique to hormonally and surgically treated patients. Postoperative patients should undergo regular medical screening according to recommended guidelines for their age. The need for follow-up care extends to the mental health professional, who having spent a longer period of time with the patient than any other professional, is in an excellent position to assist in any post-operative adjustment difficulties.