Medical Standards

The existence of intersexed and transsexual individuals is usually not acknowledged by society in general. Even the relativity of gender is little known or understood by the general population. For decades the medical profession has insisted that gender is learned rather than being part of the essence of the individual, the gender identity part of one's soul.

However, that belief is being openly questioned and show to be in error. A new book, ``As Nature Made Him'' written by Canadian journalist John Colapinto, tells of a botched circumcision and the resulting insistence by the doctors to change the sex of the baby to female, with the resulting feeling wrong sensation as the child grew and matured. As reported in the book (see Medical Error), the result was:

``I was raised as a girl. I was not comfortable with the situation. That was not the true me,'' Reimer said.

This description is identical to what people born intersexed or transsexed feel. The essence of the individual, the part of one's soul that is our gender, knows that the identification of sex at birth by the medical profession is wrong.

Because of that erroneous identification of gender (see also Baby Gender), intersexed or transsexed individuals attempt to correct that error. The general belief within our society that changing one's gender simply involves booking the surgery and making the change is wrong. Instead, the medical Standards of Care (2001 version) describe a process that requires a minimum of two years, usually much longer.

The Los Angeles Times has printed a feature, Through the Gender Labyrinth, about gender and gender's perception within society. The feature, based upon Lynn Conway, delves into gender, asking many very interesting questions. Very interesting, and thought provoking reading.

Evaluation Stage

The first stage is evaluation. The transsexual must spend a minimum (note that word minimum) of three months with a qualified therapist. The Standards of Care even identify the minimum qualifications of the primary therapist. It is during that evaluation period that the therapist tests the transsexual and begins a long period of therapy.

Hormone Stage

Once evaluated and identified as gender dysphoric, the therapist will, upon request from the transsexual, issue a letter identifying the transsexual as in therapy and ready (in the view of the therapist) to begin hormone therapy. However, beginning hormone therapy isn't simply a matter of a medical doctor accepting a letter from a therapist, then the doctor issuing a prescription for estrogens (for male to female gender changes) or testosterone (for female to male gender changes). Instead, the medical doctor gives the transsexual a full, very complete physical. The medical doctor must be assured through tests that the transsexual's body can stand the changes that result during hormone therapy.

After completing the physical, the transsexual begins taking hormones. These hormones make shifts in the transsexual's body through a second puberty. Those shifts are toward the transsexual's true gender. Therapy continues also during this period. A minimum of six months into the hormone therapy stage, the transsexual is approved to begin the real life test (RLT) stage.

RLT Stage

It is during the RLT stage that the transsexual begins living full-time as a member of their true gender. During this stage, the transsexual replaces the false shell under which they've attempted to live their lives. The transsexual builds their support organizations through professional or social groups, hopefully through family, friends, and churches who are willing to accept the physical changes the transsexual is under going. It is during this stage that the transsexual experiences the greatest rejection from family, friends, professional and social groups, churches, and society. Both hormone use and therapy continues during this stage.

Surgery

After a minimum of one year in the RLT stage, the transsexual can be approved for surgery. That approval requires a letter of recommendation from the transsexual's primary therapist, a second letter of recommendation from a second therapist (the standard second opinion), and a letter from the medical doctor who monitors the hormone use by the transsexual.

Currently, booking surgery requires its own period of waiting.  One surgeon alone is booked approximately 18 months in advanced. However, that delay allows for a longer period of RLT before surgery, permitting the transsexual a better chance to look into and understand more about themselves as they make the adjustments needed to remove the false gender shell under which they've lived and live as their true selves.

While many transsexuals have sexual reassignment surgery approximately three to four years after beginning transition, others encounter delays (usually financial). For those transsexuals who wait longer, or who decide to remain non-operative, they must decide how to handle the hormone situation. For example, it is not uncommon for a male-to-female transsexual to decide to have an orchidectomy. Having an orchidectomy allows for lower estrogen intake -- usually via an estrodiol patch -- without a need to further suppress the body's production of  testosterone.

Research

Unfortunately, little research about the causes of gender dysphoria (transsexualism) is being published. And, those studies that are published come from outside the United States of America. One acquaintance, a medical doctor, was not successful in publishing her studies as the professional medical magazine described the topic (transsexual) as too controversial.

My own experience has been one of educating my doctors -- primary care and gynecologist. Not just the medical end, but the underlying psychological whys as well. Again, this lack of information by the medical and even the psychological professions, is due to intersexed and transsexed subjects being hidden or taboo within society.

You may also wish to visit the Gay, Lesbian, Bisexual, Transgender Health Webpages or TransGenderedCare for information.

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Revised: 10 Feb 2008 20:47:21 -0800.