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Treatment of Transsexual and Gender Identity Disorder, Sex Gender Change Surgery

Written by: Wendy Moelker, psychologist in charge of Emergis, Goes, the Netherlands.

First version: 22 Jul 2008. Latest revision: 24 Aug 2008.

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Like with most disorders, one must first ask if it really is a disorder, i.e. if it makes the person miserable and have a need for help. Milder forms of transgender personalities are sometimes best treated by just getting the person to accept him/herself as a transperson - the problem is not with the person, but with the people in the environment. Sometimes the main need is to find communities in which transgender is accepted. Many transpeople have no wish for actual reverse-role sex, and it is importan to educate their friends to this fact, since many people wrongly see transgender as only a variant of homosexuality.

In the treatment we always face the question of whether the feeling should be adjusted to the body or the other way around. For the milder forms of gender identity disorders psychotherapy can be used.

Since it is often hard to treat, the only alternative seems to be to adjust the body to the sex characteristics. In the first phase of this treatment, the psychological and psychosexual development, the individual capacity and the social environment of the patient are investigated. This phase is also meant to screen off people with completely different motives for sex change and patients who are confused about their gender identity.

The second phase is the 'real life test': the person practices with the role of the desired sex. Relevant people (boss, parents, family, friends, etc) must be informed and a new name must be chosen. The social role during this real life test is supported by hormones. Hair and voice hardly change because of hormones; speech therapy and cosmetic interventions are used for this. If the real life test is successful, the patient is referred for surgery.

In the case of a woman-man change the breasts are always reduced. In some cases a penis is made; and a vagina is often created.

After all the medical interventions the time has come to learn to live with the new body, with scars, fears of being discovered, uncertainty about what to tell and what not to tell to a new partner and many questions about sexuality. Those in the environment of the person may also have difficulties. This means that continued counselling is useful. Having to take hormones for life is difficult for some and requires continuous motivation on the part of the doctor.

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