3 The Medical Viewpoint

4   Dealing with Being Transsexual

There are a number of ways in which transsexuals deal with their condition, and many transsexuals will pass through several of these as 'stages' on their journey to self-fulfilment.


This is not a way of dealing with being transsexual, but is something that all transsexuals probably go through in the early stages. Trying to convince themselves that they are not really transsexual, or will grow out of it, or 'ignoring it and seeing if it goes away', all characterise the denial phase. Denial does not usually work for long, and there is considerable evidence that transsexuals who fail to escape this stage frequently commit suicide. Figures suggest that as many as thirty percent of transsexuals are not diagnosed and treated soon enough to prevent them from taking their own lives.

No Action

A few transsexuals come to a realisation of what they are, but consciously choose to live with the discomfort of an inappropriate body and gender role, perhaps because of religious beliefs or perhaps for the sake of wife or children. In a few cases, transsexuals may live in a way more reminiscent of transvestites, only expressing their true gender on agreed occasions. This type of adaptation is nearly always found to be unsatisfactory for the true transsexual, and similar problems to those of the Denial phase then occur.

Social Reassignment

For many transsexuals, the most pressing need is the need to alter their gender role and to live in accordance with their gender identity. This means, for a male-to-female transsexual, living completely as a woman. This is usually, but not always, done as a step in a journey leading to hormonal and surgical gender reassignment, but some people choose to stop here (and usually label themselves as 'transgenderists'), or maybe even to live a 'mixed-gender' lifestyle --- a few people with Gender Dysphoria feel that they are neither truly male nor truly female.

For male-to-female transsexuals, permanent removal of facial hair by electrolysis is usually a necessary step, and is usually done before, or just after, social reassignment. It is time-consuming, expensive and painful: two years of treatment at two or three hours per week is often required, at a cost that can often exceed £25 per hour. Many people find the pain barely tolerable, even with a local anaesthetic. It is normally impossible to obtain electrolysis from the NHS, so the transsexual must pay for private treatment.

Hormonal Reassignment

Most transsexuals undertake hormone treatment to bring their body shape and appearance into closer accord with their gender identity. Hormone treatment may start before or after social reassignment: a few transsexuals can 'pass' in their new social role without hormone treatment, many may require some months of treatment before undertaking social reassignment. In Britain, hormones can only be prescribed by a consultant psychiatrist as part of a gender reassignment programme.

The initial hormone treatment is largely reversible if stopped early, and this is often used as a safety check to prevent people who are not truly transsexual (such as confused transvestites who convince themselves that they are transsexual) from taking a disastrous course of action. Since transvestites have male brain structure and core identity, and their behaviour is mediated by male sex hormones, their cross-dressing behaviour stops when female hormones are administered. This effect is used to 'weed out' people who are not true transsexuals: a true transsexual will feel natural and happy under the effects of female hormones, anyone else will feel wrong and will stop their apparent cross-gender behaviour as male hormone function ceases.

Large doses of hormones are used to overcome the body's own sex hormones, which carry some risk of side effects. After genital surgery, the dosage is greatly reduced as the body no longer produces hormones in opposition to the prescribed ones, but a post-operative transsexual will need to take a maintenance dose of hormones for life.

Some transsexuals continue in a pre-operative state for long periods, taking hormones and living in their preferred gender role, but perhaps never having surgery. There is evidence that continuing the high hormone dosages required for pre-op transsexuals for long periods may be harmful.

Male-to-female hormone treatment causes development of breasts, usually rather small, as well as redistribution of body fat and a general feminisation of the figure, hair and skin. Body hair is often reduced but not removed, and hormones seldom have any large effect on facial hair. Hormones will not alter a male voice (nor will genital surgery), so male-to-female transsexuals must usually undertake some kind of speech training, learning to raise and soften the voice as well as using more feminine inflection and vocabulary.

Surgical Reassignment

This is seen by some as the entire purpose of the long process of gender reassignment, while others feel that it is more of a final step to achieve congruity of body and mind after the really hard work of establishing a life in the proper gender role has been done.

The process, for male-to-female transsexuals, involves removal of the male genitals and the construction of a set of female genitals (excluding uterus and ovaries, of course) using material from the male genitals. Present state-of-the-art surgical technique produces a very good approximation to natural female genitals (even gynaecologists have been known not to realise that a patient is a post-op transsexual), with fairly good nervous sensation, although of course it is dependent on the skill of the surgeon.

The operation is a major surgical procedure (requiring about ten days in hospital, and four hours or more under anaesthetic), is quite painful and invariably expensive. Many transsexuals in Britain opt for private treatment as it has become very difficult, and impossible in many areas, to obtain NHS treatment and the waiting lists are very long.

No reputable surgeon will perform surgical reassignment without recommendations from two psychiatrists. It is normally impossible to obtain permission for surgery without performing a 'Real Life Test' --- living and working as a woman for at least one year.

5 Social, Economic and Legal Implications




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