Sex change, also called transsexuality, is a procedure by which an individual of one sex is hormonally and surgically altered to attain the characteristics of the other sex. A male is changed into a female or a female into a male, complete with altered genitalia and other secondary sex characteristics.
It has been estimated that one male in every 20,000 to 30,000 wants to become female. The number of females who desire a sex change is not known, but it is estimated that for every female wishing a sex change there may be four males.
Transsexuals usually see themselves as being of the wrong sex early in life. They feel that they are trapped in the wrong body. Though they have sexual desires for persons of the same sex, it is not as a homosexual. A homosexual, one who desires a sexual relationship with someone of his or her own sex, is comfortable with his sex and does not desire to change. The transsexual views himself as a female (or herself as a male) and visualizes his female persona as being mated to a male. As children, transsexuals often will play with the toys of the opposite sex and sometimes will cross dress in clothing of the opposite sex. They also may be more comfortable socializing with members of the opposite sex inasmuch as they view themselves as having similar likes, dislikes, and desires.
Attempts to understand the underlying reasons for a person desiring a sex change have not been successful. Hormone studies have found them to have normal hormonal patterns for their sex. Examination of their childhood and home environment has shown that some transsexuals are from broken homes, others from homes with weak or ineffectual fathers and strong mothers, and still others from homes of loving and sharing parents. Genetic investigations also have found nothing. At least one investigator blames an abnormal prenatal neuroendocrine pattern, so the individual is born with the underlying transsexualism already imprinted. Such a hormonal upset might be caused by trauma to the mother, stress, use of drugs, or other reason while the developing infant was early in growth in the womb. This theory also remains to be proved.
Many potential transsexuals will do nothing about their seeming need to be of the opposite sex. They will marry, have a family, and attempt to fit in with society’s expectations for a person of their sex. Secretly they may cross dress in clothing of the opposite sex. Usually their families know nothing of this practice. A person who wears the clothing of the opposite sex is called a transvestite. A true transvestite enjoys cross dressing but has no inclination to undergo a sex change.
Other persons, however, have feelings too strong to subdue and they will eventually seek professional help in their conversion to the opposite sex. The first documented case of a complete conversion of a male to a female was that of American photographer Christine Jorgenson (1926–1989). Born a male (William Jorgensen, Jr.), he underwent sex-change hormonal therapy and surgery to become a female in 1952. She later married. A number of medical facilities have since been established around the world and specialize in the complex process of transsexualism.
The first steps in the sex change process, more appropriately known as sex reassignment surgery (SRS) or gender reassignment surgery (GRS), involve long sessions of counseling to ascertain that the individual is dedicated to changing sex, has thought it through thoroughly, and will be comfortable with his/her decision. Assuming the counseling provides the physician with information pointing to the resolute determination for a sex change, the patient will move on to the next level.
Hormone therapy, that is replacement of one’s natural hormones with those of the opposite sex, is the beginning of the transsexual process. Women will receive androgens, male hormones, and males will be given estrogen and progesterone, the female hormones that are responsible for the secondary sex characteristics.
Male secondary sex characteristics include facial hair growth, larger muscle development, deep voice, and a heavier skeleton. Female characteristics include the development of breasts, asmoother, more rounded body as a result of a layer of fat that men do not have, a voice higher in pitch because of a smaller larynx and shorter vocal cords, lack of facial hair, and certain anatomic characteristics in the skeleton to facilitate childbirth.
Males will be given large doses of female hormones to override the effects of the androgens. Females will receive testosterone, the male hormone. Changes will become evident very soon after hormone therapy begins. The male will no longer grow whiskers and he may lose the characteristic hair growing on his chest. A woman receiving androgens will experience facial hair growth as well as changes in the pattern of fat deposits in her body. Voices in both sexes will change only minimally because the size of the larynx and the vocal cords are unchanged by hormones. The female who becomes male will have a voice uncharacteristically high for a male, and the male who becomes a female will have an unusually low-pitched voice for a woman. All of these observations are based on averages for males and females. Some small males or large females may seem more completely to change because they have the characteristics of the opposite sex to begin with.
Most surgeons who perform the surgery have very strict requirements and protocols. For instance, many surgeons require two legitimate psychiatric evaluations from either psychiatrists or psychologists recognized or licenses in the field of gender identity. These evaluations must state that the individual is an appropriate candidate for surgery or, indeed, even for breast augmentation (if from male-to-female). Some doctors are hesitant to even schedule a consultation to discuss the procedure unless the candidate has had at least nine months of counseling and psychiatric evaluation. Under some protocols, the candidate is required to meet eligibility criteria for sexual reassignment as listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, published in 2000), ICD 10. Even then, the surgeon retains the right to have the final consultation with the candidate the day prior to surgery. Ensuring the candidate is absolutely certain about their choice is critical, for once the surgery has been performed, it is totally irreversible.
Once the decision has been made and the surgeon is satisfied the candidate is psychologically as well as physically eligible, laboratory work and an human immunodeficiency virus (HIV) test is done. Generally, surgeons refuse surgery to anyone with HIV, herpes, or any other form of venereal disease. Overweight and obese people are poor candidates, and are often refused. Because loss of blood is common, patients may be advised to donate two units of their own blood, to be transfused back following the surgery. Following an interview during which the client is fully informed of the procedures involved in surgery and the implications of its irreversible nature, the client signs a written consent for treatment by all individuals involved in the procedure. Once again, psychological treatment that runs parallel to the entire process is highly recommended.
The transsexual process is enhanced by surgical removal of the individual’s genitalia and construction of genitals of the assumed sex. This is a difficult procedure in either sex, but more so in the female inasmuch as her genitalia are internal.
The surgical procedure on the male involves removal of the penis and the scrotum with the testes. A pseudo-vagina can be constructed from the skin of the penis. This is everted and sewn into a tube that is inserted into the man’s body and sewn to the skin. Steps must be taken during the first few weeks following surgery to keep this makeshift vagina open. Construction of female breasts can be accomplished by using fat from the individual’s body under the skin over the pectoral muscles. The patient also may wear strategically placed padding to simulate breast growth.
Removal of the scrotum and testes also removes the source of the male hormones, so the therapy with female hormones can assume dominance. The secondary sex
Genitalia —The sex organs; in the male, the penis and in the female, the vagina.
Larynx —The voice box or Adam’s apple. It is connected at the bottom to the trachea, the tube leading to the lungs. The vocal cords lie under the epiglottis, the flap at the top.
Secondary sex characteristics —Those unique traits that mark an individual as a male or female. Facial hair is a male characteristic and breast development is a female one, for example.
Uterus —Organ in female mammals in which embryo and fetus grow to maturity.
characteristics of the male will be blunted. Facial hair will stop growing and body contours may change over time to more closely resemble those of the female. The newly created woman will be required to take female hormones for the remainder of her life. Her reconstructed vagina will enable her to have vaginal sex with a male, though of course she is not able to bear children.
Surgery on the female transsexual is more complex. The female reproductive organs are internal, so an incision is required to remove the ovaries, uterus, and vagina. A penis can be constructed and attached, but from that time on the new male must be careful to maintain strict hygiene to prevent bladder infection. Usually the woman’s breasts also are removed, leaving a small scar. Male hormone therapy now will be dominant and the new male will begin to grow facial hair and perhaps hair on his chest. He will still be of slight build compared to the average male and will be unable to father children. An implanted penile prosthesis will enable him to attain an erection, and a scrotum containing prosthetic testes will complete the reconstruction and yield a superficially anatomically correct male.
Whether the transition if male-to-female, or female-to-male, once the surgery has been completed continued counseling and social support, particularly from the family, is highly important to enable the individual to readjust in society as a member of his or her chosen sex. If the individual were socially or emotionally unstable before the operation, more than 30 years of age, or had an unsuitable body build for the new sex, they tend to do less well. In no case studied did the procedure diminish their ability to work, however.
See also Reproductive system.