As an opening statement to the following it should be noted that gender is between your ears and sex is between your legs. I was once asked when I presented this presentation in General Psychology why I would out myself. The reason is simple, if one person discovers that gender dysphoria is a birth disorder and not a lifestyle or choice then it was worth it. I have had many people mention how different my male life was compared to my female life. I did what was required for me to survive in a time when this was not a hot talk show topic. I lived the life society expected me to live because I knew no better. I over compensated in the masculine areas as did many other transsexuals that grew up during the same time period. There are many things about my past life that I am proud, my daughters and my naval career are just two of them. Not all of my male life was bad but it consisted of many years of unhappiness that I kept to myself in order to fit in with polite society. I buried it for many years and that was my mistake. In all my 53 years of life I have never been happier and more content since I began my transition to become female. There is nobody to blame for gender dysphoria it is just one of those things that happen. This is written in regard to the male-to-female transsexual, but there are also many female-to-male transsexuals out there. The gender dysphoria section is based on pure research and is accurate to the best of my belief.
Gender dysphoria is one of the most devastating birth disorders that someone can have. It is a hidden birth disorder that is not know for many years. The latest studies indicate that a person is born with gender dysphoria. All fetuses start out as female. Those fetuses that are to be male receive a testosterone flush across their brain. This produces what is called the brain's hardwiring, or subconscious mind. When this does not happen the brain develops with a female subconscious mind and the body develops male. Years later the conflict arises when the brain and body do not agree. Gender dysphoria does not go away. It can be buried and suppressed but it always rears its ugly head. Each time this happens it gets harder and harder to bury, finally one day it can no longer be buried. I have often wondered how many suicides that have no known reason were because of gender dysphoria.
The Harry Benjamin Sex Orientation Scale
The American Psychiatric Association has listed gender dysphoria in DSM-IV. The diagnostic features for Gender Identity Disorder as outlined in DSM-IV are shown below.
"There are two components of Gender Identity Disorder, both of which must be present to make the diagnosis. There must be evidence of a strong and persistent cross-gender identification, which is the desire to be, or the insistence that one is of the other sex (Criterion A)."
"This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex. There must also be evidence of persistent discomfort about one's assigned sex or sense of inappropriateness in the gender role of that sex (Criterion B)."
"The diagnosis is not made if the individual has a concurrent physical intersex condition (e.g., androgen insensitivity, syndrome or congenital adrenal hyperplasia) (Criterion C)."
"To make the diagnosis, there must be evidence of clinically significant distress or impairment in social, occupational, other important areas of functioning (Criterion D)"
"Adults with Gender Identity Disorder are preoccupied with their wish to live as a member of the other sex. This preoccupation may be manifested as an intense desire to adopt the social role of the other sex or to acquire the physical appearance of the other sex through hormonal or surgical manipulation."
Adults with this disorder are uncomfortable being regarded by others as, or functioning in society as, a member of their designated sex. In private, they may spend much time cross-dressed and working on the appearance of being the other sex. With cross-dressing, hormones and electrolysis many individuals with this disorder pass convincingly as the other sex.
"There is no diagnostic test specified for Gender Identity Disorder. In the presence of a normal physical examination, karyotyping for sex chromosomes and sex hormone assays are usually not indicated. Psychological testing may reveal cross-gender identification or behavior patterns".
"There is no recent epidemiological study to provide data on prevalence of Gender Identity Disorder. Data from smaller countries in Europe with access to total population statistics and referrals suggest that roughly one per 30,000 adult males and one per 100,000 adult females seek sex-reassignment surgery".
There has been a lot of conversation on the various gender bulletin boards concerning the Harry Benjamin International Gender Dysphoria Association Standards of Care. There are those who feel surgery on demand is their right. Some feel that the Standards of Care are too demanding and are unnecessary. The majority of those who have gone through transition and had sex reassignment surgery and the majority of those in transition feel that the Standards of Care are there to protect the patient. There are documented cases where individuals have lied and gone to surgeons who do not follow the Standards of Care and received their surgery only to regret their decision at a later time.
The pertinent parts of The Harry Benjamin International Gender Dysphoria Association Standards of Care are given for your information. The hormonal and surgical sex reassignment of gender dysphoric persons (Revised Draft 1/90) contains a series of principles and standards to be followed by the psychiatrists, clinical behavioral scientists and surgeons who are involved in reputable gender clinics.
The basic minimal requirements for sex reassignment surgery as outlined by the Harry Benjamin International Gender Dysphoria Association Standards of Care (Revised Draft 1/90) are discussed in the following paragraphs.
In order to be considered for sex reassignment surgery the individual must have been on hormone replacement therapy for a minimum of one year. The individual must have successfully completed one year of living full-time in his or her chosen gender. They must prove their ability to earn a living in their new gender. The individual must have two recommendations for sex reassignment surgery. One recommendation must come from a psychiatrist and the other from a psychologist who has a background in gender dysphoria or from a licensed social worker who has a Master Degree and is known for his or her work in gender dysphoria counseling. The second recommendation can also come from a second psychiatrist. The final requirement is that the patient be HIV negative. The HIV test is done upon admission to the hospital, and surgery will be done only if the initial test is negative.
There are several reputable surgeons all over the world who perform sex reassignment surgery and follow the standards of care of the Harry Benjamin International Gender Dysphoria Association. A partial list of these surgeons includes the following: Dr. Eugene A. Schrang, Neenah, Wisconsin, Dr. Toby Meltzer, Portland, Oregon, Dr. Stanley Biber, Trinidad, Colorado, Dr. Royal, London, England, and Dr. Yves Mennard, Montreal, Canada.
One of the former requirements for sex reassignment surgery has been dropped. It is no longer necessary for the individual to be divorced. More and more couples are staying together through transition and after sex reassignment surgery has been completed. Also noted on the various internet gender related bulletin boards and on the internet relay chat is that, as a general rule, sexual preference does not change through transition and after sex reassignment surgery. Those individuals that were attracted to females usually end up in lesbian relationships and those individuals that were attracted to males prior to transition and sex reassignment surgery normally stay attracted to males and end up in what would be considered a heterosexual relationship after surgery. The reason for this is not known other than sexual preference is a trait that you grow up with and is somehow wired into the subconscious mind. It should also be noted that many of the ladies experiment with male and female sexual partners after surgery and generally return to their pre-transition sexual preference.
Copyright 1998 by Denise Anne Fell� updated December 31, 2001