By the American Educational Gender Information Service (AEGIS)

General Issues

Hundreds of thousands of people have a condition known by medical professionals as gender identity disorder (GID). The condition is characterized by feelings of inappropriateness in the gender one is assigned as birth. It may manifest as crossdressing, frequent or occasional, or in the case of transsexualism, as a desire to change sex.
Gender Identity Disorder

GID is a late 20th-Century term of a condition which has existed in all cultures throughout history. In many societies, transgendered and transsexual people have played important and respected roles. In the West, many professionals have come to view transgendered behavior as a normal variation of the human condition rather than as a disorder.

Crossdressers

The desire to wear the clothing of the other sex is independent of one’s sexual orientation. Many gay, bisexual, and heterosexual men like to wear womens’ clothing in public, and may even fantasize on occasion about becoming a woman. Most, however, have no desire to change their sex. These men are called crossdressers or transvestites. Women also crossdress in larger numbers than has previously been acknowledged.
Transsexualism

Men and women who desire to rid themselves of their primary sexual characteristics and live as members of the other sex are called transsexual. Many transsexuals undergo sex reassignment, in which they come to live as members of the “other” biological sex. Hormonal and surgical techniques make this possible, but sex reassignment is a difficult, disruptive, and costly process, and must not be undertaken without psychological counseling and careful planning and a realistic understanding that medical technology has its limits.

Transgenderists

Many men and women prefer to steer away from male/female extremes and prefer an androgenous presentation of gender. They incorporate elements of both masculinity and femininity in their appearance. They may be seen by some persons as male and by others as female. They may live part of their life as a man and part as a woman, or they may live entirely in the new gender, but without plans for surgery.

Many individuals who self-identify as crossdressers and transgenderists seek medical treatment to masculinize or feminize their bodies. These persons are on average less likely than transsexuals to have worked through the profound financial, social, and medical implications of obtaining such treatment. Anyone who seeks hormonal therapy and genital sex reassignment surgery (SRS) is subject to the same medical and psychological safeguards that have been set up for transsexual men and women.

Medical Procedures

The Harry Benjamin International Gender Dysphoria Association Standards of Care (SOC) safeguard both transsexual people and the men and women who provide professional services for them. The SOC divide the transition process into a series of discrete steps. Following those steps maximizes the chance that SRS will be successful and minimizes the chances of regrets. The first step a transsexual should make is to locate a therapist who is familiar with the SOC. It is also important to find a good support group.

Hormonal Therapy

Sex hormones can masculinize female bodies and feminize male bodies. The changes take place over a period of years, but eventually can become quite profound. Hormones have global effects on one’s emotional state, fertility, and sexuality, and can have severe medical consequences, especially when self-administered.

Hormones should never be taken without a prior period of therapy and should be used only when under the supervision of a physician who periodically monitors these medications.

Real-Life Test

The SOC mandate a real-life test (RLT) period in which the individual must live 24 hours a day and work as a member of the other sex for a minimum of one year. The RLT gives the individual an opportunity to see what life will be like after transition, but before SRS, which is a non-reversible procedure. As transsexuals risk job discrimination, rejection from their friends and families, and ridicule or harassment from the general public, the RLT can be an eye-opening experience.

Sex Reassignment Surgery

SRS is the culmination of a long process, and should never be performed before the person has established a viable life in the gender of choice; nor should it be forced upon a transgendered person by a helping professional. It should not be the primary focus of one’s transition, but merely the final confirmation of the new gender.

Persons with gender identity issues should realize that SRS is not a requirement in order to live in the gender of choice. Genitals are private areas, hidden from the view of the general public. Many transgendered and transsexual persons crosslive happily with no plans to have SRS; however, SRS is available for those who successfully cross-live for a minimum of one year, can provide two letters from therapists, and do not have a contraindicating health condition.

When performed by an experienced, competent surgeon, male-to-female (MtF) SRS can result in a cosmetically pleasing and functional neovagina. Vaginoplasty is usually a one-stage procedure (with an optional follow-up for minor revision); cost in the US is $13,000 and up.

Penile inversion surgery is the most common MtF SRS procedure. Some surgeons use a section of colon to line the neovagina, but other surgeons have expressed concern about this procedure for primary vaginoplasty.

The ability to have orgasm is not universal in post-operative MtF transsexuals. Independent studies have found a self-reported orgasm rate of 25%.

Female-to-Male (FtM) transsexuals undergo top surgery, a procedure in which a male chest contour is created. The SOC consider this to be genital surgery (thus requiring a RLT), but many FtMs, especially those with large breasts, find it difficult to live in the male role before top surgery.

Bottom surgeries include phalloplasty, in which tissue from other areas of the body is used to fashion a penis (which is incapable of erection); metadioiplasty, which creates a small, erectile phallus; and scrotoplasty, in which the labia are fashioned into a scrotum. Silicone testicular prostheses are sometimes implanted. Metadioiplasty costs from $12,000 up; phalloplasty can range in price from $50,000 to more than $100,000.
The Transgender Community

Transgender is a term used to refer to the entire constellation of persons who transgress traditional gender norms. The transgender community is a loose association of support groups, advocacy agencies, activists, and information services. While the term transgender does not have universal acceptance, it has come to have widespread recognition in recent years.
Society and Gender Identity

Transgendered and transsexual people are really no different from other individuals of their age and social situation; however, society does not generally recognize or acknowledge this. Gender-nonconforming children and adults are at grave risk for bias and harassment. Even walking down the street can be dangerous. Job discrimination is often overt and basic medical care and social services may be denied. Many individuals, even helping professionals and police officers, react viscerally at the sight of a transgendered or transsexual person.

In the past several decades, transgendered persons have made astonishing gains in the social arena. However, inaccurate media portrayals remain the rule.

Banyan Counseling Center wishes to thank the American Educational Gender Information Service(AEGIS) for allowing it to use information from its Gender Identity Brochure for this home page. You can contact them at aegis@gender.org.