Transsexuals are people who have a long-standing and persistent feeling that one's sexual identity is incongruent with one's anatomic sex. Therefore, Sex Reassignment Surgery (SRS) might be one of the biggest issue among transsexuals. There is no reason that one who lives as a member of the opposite sex must have genetic surgery, because there are a lot of lifestyles which can bring relief to transsexuals. Also, SRS doesn't guarantee that it solves every problem that transsexuals have. However, their need for any kind of treatment is very strong because they have a profound disturbance of their core gender identity, and have endured a lifetime of ridicule from significant others. SRS can be definitely one of the way they want to try to solve their problems. Therefore, understanding the meaning and procedures of SRS will be worthy to transsexuals even further to the significant others around them and those who are interested in transsexuals.
oWhat is the SRS? oWho does SRS? oWhen is SRS performed? oProcedures of SRS oHow do those transsexuals feel after SRS? What is the SRS?
Sex reassignment surgery refers to the administration of surgery to change the sex appearance according to one's sex identity. There are two kinds of surgery.
1.Genital surgical sex reassignment: surgery of the genitalia and/or breasts performed for the purpose of altering the morphology in order to approximate the physical appearance of the genetically other sex. 2.Non genital surgical sex reassignment: any and all other surgical procedures of non-genitalia or non-breast, conducted for the purpose of effecting a more masculine appearance in a genetic female or for the purpose of effecting more feminine appearance in a genetic male. As a former step of SRS, there is a hormonal sex reassignment, which is the administration of androgen to genotype females, and administration of estrogen and/or progesterone to genotype males, for the purpose of effecting somatic changes in order for the patient to more closely approximate the physical appearance of the other sex.
Who does SRS?
SRS should be done by specialists, called Clinical behavioral scientists. They should have documented training and experience in the diagnosis and treatment of a broad range of psychological and sexual conditions. They should have proven competence in general psychotherapy, sex therapy, and gender counseling and therapy.
When is SRS performed?
The time that people start feeling of belonging to the opposite sex is 2-3 years of age. According to the outcome of many researches, early treatment would prevent unnecessary sufferings. Physical outcome of an early treatment can be expected to be more satisfactory by comparison with starting later, especially MFs (male to female). This is an enormous and lifelong advantage instead of having to live with a deep voice and other scar. Thus, the earlier the SRS is performed, the easier transsexuals can adjust themselves according to their sex identity, and they can avoid the confusion about themselves. But SRS is usually performed at the age of 18-21. There are two reasons for this long delay. First, most children with gender identity disorder will not grow up to become transsexuals. Second, adolescents in many countries are still legally dependent on the consent of their parents when deciding on medical treatment.
Procedures of SRS
Step1.
Clinical behavioral scientists gather the information of SRS applicant to differentiate between the transsexuals and other types of gender disorders. To do this, they interview about general and gender development of the applicant, the way the parents have dealt with their child's gender disorder, the family backgrounds of the parents themselves, identification figures, relationship with same sex and opposite sex parents, first conscious cross gender feelings, aspects of sexuality, and so on. Applicant must have a confirmed, working diagnosis of transsexuals and have completed at least 3 months of psychotherapy in order to obtain evaluation for hormone therapy. During this time, the MF transsexual patient can start electrolysis, if desired, to remove unwanted facial hair.
Step 2.
Upon receiving a written evaluation for hormone therapy, the applicant may then take a copy of the evaluation to an endocrinologist who offers monitoring of relevant blood chemistries and routine physical examinations. This is especially important because hormone therapy may have some irreversible effects and may lead to mild or serious health-threatening complications. However, if a patient is followed by a qualified physician who explains what the patient may expect from the hormones, both positive and negative outcome, and regularly monitors the patient's lab work, he is less likely to run into complications. If MF patient has not already started electrolysis for removal of the beard, it should be started during the early stages of hormone therapy.
Step 3.
The next step is a period of one to two years of cross living while the patient continues hormone therapy. The patient lives 24 hours a day in the gender of choice. Thus, this period is called "real life test". During this time, the patient must demonstrate stability and prove functional ability, become self-supporting, and be socially active. Hormone therapy should be started as a partial hormone therapy. It blocks the action of sex steroids in a reversible way. The MF bodies do not masculize any further, and FMs (female to male) stop menstruation and sometimes experience a weakening of breast tissue. On the contrary, full hormone treatment is not reversible. It masculinizes the female body, and feminizes the male body. It is given before 18. Minimal duration of the real life test is 1 year for FMs, 1.5 years for MFs. This difference is due to the fact that the gender role change seems to have more impact on the life of MF than on that of FM, and MFs need more time to adjust to the new situation.
Step 4.
At the end of a cross living, an orchidectomy (to remove the sex glands of a male) may be performed for the MF transsexuals. Implants or breast augmentation and other optional non-genital surgical sex reassignment procedures are often done at this time. Mastectomy (to remove the breast) and hysterectomy (to remove the uterus) for the FM transsexual is usually begun after one year of cross living. Most patients consult a plastic surgeon for the mastectomy and a gynecologist for the hysterectomy. It is also recommended that the FM transsexuals be in complete understanding with the surgeon who does his phalloplasty (to implant the male sex organ to female). Some FMs who have been on androgen for a while tend to get so much clitoral enlargement, that they choose not to have that phalloplasty at all.
Step 5.
At this point, final psychological evaluation before surgery should be decided. Two written evaluations are required by at least two clinical behavioral scientists; at least one of which is a doctoral level clinical behavioral scientist and one of whom has known the patient in a professional relationship for at least six months, before surgical approval.
Step 6.
Operating surgery.
Step 7.
Post operative or follow-up care after a patient has completed SRS, for a period of at least three months is required, however, six months are recommended. This is a period of recovery, necessary for immediate psychological and social readjustment.
How does transsexuals feel after SRS?
On the whole, most of the transsexuals who have performed SRS were satisfied with sex change itself. Nevertheless, many of them were dissatisfied with the way their new physical Appearance. The reason for dissatisfaction is first, MFs have to do with retention of bodily features and aspects of the overall appearance that could not be changed completely by either surgery or hormonal manipulation. For example, remains of the beard, large feet and hands, quality of the voice, and persistence of Adam's apple. Social pressure on woman to pay more attention to their appearance is also one of the reason. FM transsexuals are usually dissatisfied with their new genitals. But, the most important thing is that they could live in the new gender role feeling that their identity is fitting to themselves. They have more comfortable relationship with other people around their environment.
References:
The Harry Benjamin International Gender Dysphoria Association. (1985).
Standards of care: The hormonal and surgical sex reassignment of gender
dysphoric persons. Archives of Sexual Behavior, Vol 14: 79-90
Rakic, Z., Starcevic, V., Maric, J., and Kelin, K. (1996). The Outcome of sex
reassignment surgery in Belgrade: 32 patients of both sexes.
Archives of Sexual Behavior, Vol. 25: 515-525
Ceccarelli. P, and Paulo. S. (1997). Transsexualism, sex and gender.
Int Forum Psychoanal Vol 6: 141-146
Cohen-Kettenis, P.T. and Van Goozen, S.H.M. (1997). Sex reassignment of
adolescent transsexuals: a follow-up study. J. of Am. Acad. Child. Adolesc.
Psychiatry, 36:2 263-271
Bradley, S. and Zucker, K.J. (1997). Gender identity disorder: a reciew of the
past 10 years. J. of Am. Acad. Child. Adolesc. Psychiatry, 36:7 872-879
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