transsexuals – born in the wrong body
by John Illman
Until recently anyone claiming to be a man trapped in a woman's body or vice versa, faced abuse or ridicule. But new scientific research means that transsexuals can now undergo gender reassignment surgery in the knowledge that their cross gender identity is not 'all in the mind'.
© channel 4
Studies in the last decade suggest that when a child is born, it may not be what it seems – a baby girl may already have the emotions and feelings of a boy, for example. Research also indicates that the brains of men who have undergone gender reassignment surgery are similar to those of normal female brains.
This long-awaited scientific confirmation, along with greater social acceptance, is now making it easier for those seeking gender reassignment, but many transsexuals have always had an overwhelming desire to change sex.
Gender reassignment is a risky business involving commitment and perseverance, but transsexuals can also maintain their humour, families and jobs. The treatment can be very successful and enable transsexuals to lead full and happy lives.
obtaining gender reassignment treatment
The 'wait and see' approach is the way in which transsexuals are diagnosed today. Before transsexuals are considered for surgery, they are expected to live in their chosen gender role for one or two years.
They have to show that they can live in society in this role and can function better socially and psychologically in their chosen gender than previously. For most transsexuals, this is the hardest part of the long process of changing the body they were born with. During this period the transsexual will often look androgynous (being of both sexes) or 'like a transsexual'. In the difficult time before hormones produce major changes and before surgery, the transsexual may experience discrimination, prejudice and even ridicule in daily life. However, this cannot be avoided if they wish to proceed with full surgical gender reassignment.
Such is the yearning to change sex, more than 5,000 transsexuals in the UK have gone down this road. All long-term studies of transsexual people have shown that treatment is 96% successful in improving the quality of their lives.
getting help
The first stop for anyone with a gender identity problem is the GP. Treating transsexualism is a highly specialised business, and, unfortunately, there are only a handful of specialist centres or gender clinics in the UK. Any centre, whether NHS or private, requires a referral from a GP.
Be warned: GPs, like everyone else, vary enormously in their understanding of gender dysphoria. They may be as much in need of information from the various transsexual support groups as you are. Moreover, NHS gender identity clinics are likely to have a waiting list of several months, so don't expect an instant referral. If your doctor is reluctant to refer you, you can approach one of the organisations listed below for advice.
Initial treatment at a gender identity clinic involves an initial assessment before any treatment is prescribed. Transsexuals may also be offered counselling or therapy, but resources are scarce, and it is often better to seek private counselling. Families often also benefit from counselling as the changes they face are often as difficult as those of the transsexual.
You can speed up the process by seeking private treatment or by going abroad. Ensure you choose a reputable clinic if you take this route. Reputable clinics will still require you to undergo the real life experience to check that you are psychologically prepared.
Recent changes in European health care law mean it is possible to have surgery in other European countries, if the UK waiting list exceeds six months. The cost must be comparable to that of the UK, otherwise local health authorities can refuse to pay. Further advice is available (see help and info, below).
Holland, Germany and Belgium have very reputable clinics, but hormonal therapy and surgery in other countries is often outdated, and may even be dangerous. Private provision, as in the UK, is patchy. Again, avoid surgeons without a reputable background in the field. A good surgeon will always show examples of their work, and put you in touch with former patients.
hormone therapy for male-to-female transsexuals
The female hormone oestrogen leads to the development of breast tissue and nipple enlargement, increased and redistributed fat around the hips and thighs; finer tauter skin, softer scalp and body hair and beard. However, balding hair will generally not grow back, except very marginally. The hormone will also make the testes and the penis become smaller and may cause impotence.
Psychological effects of oestrogen in men include a decrease in sex drive, mood swings and emotional upsets. Giving oestrogen to men can also result in an increased risk of blood clots and strokes. Male-to-female transsexuals should have regular blood pressure, liver and blood tests. Breast development brings its own problems, including a slightly increased risk of cancer. But one advantage is a reduced risk of heart attack.
hormone therapy for female-to-male transsexuals
The male hormone testosterone will stop periods within weeks. The voice 'breaks' within about four months. It then leads to growth of body hair, thinning of scalp hair, thickening and coarsening of the skin and gradual development of a beard. The clitoris will also enlarge, but not enough to resemble a penis.
As with male transsexuals, hormone treatment also causes fat redistribution – but in the reverse direction. Changes in fat deposition make the shoulders look broader and the hips and waist smaller. Regular exercise builds muscle and further enhances the male-looking physique.
Just as female hormones can reduce the risk of heart disease in men, so male hormones will increase the risk in women. Once again, regular blood pressure, liver and blood tests are important.
surgery for male-to-female transsexuals
All transsexuals can choose between operations that are merely cosmetic and those providing a varying degree of sexual functioning in the chosen gender.
For male-to-female transsexuals, the creation of a new vagina means removal of the core of the penis and testes. Scrotal and penile tissue is pushed inside out to form a vaginal canal just in front of the rectum. The exit of the urethra will be re-sited, and a clitoris can be fashioned from the head of the penis. The scrotal tissue will be reshaped to form small flaps, labia, at the opening of the new vagina.
The success of the operation depends upon the skill of the surgeon and on the amount of tissue available for reshaping. Since oestrogen therapy makes the penis and testes shrink, it is important to plan ahead – keeping hormone doses lower during the pre-surgery years.
Transsexuals who opt for vaginoplasty, to give the operation its surgical name, should not expect miracles. In skilled hands the results can be remarkable, but a natural female vagina, with its highly specialised lubrication system and nerve supply is impossible to copy exactly.
It is essential to find a well-qualified surgeon (see help and info, below).
Further cosmetic surgery, including breast implants, nose reshaping and even reduction of the Adam's apple can all be done at a later stage, with varying degrees of success. A continuous programme of jaw remodelling, peeling off coarse skin and hair transplantation is also possible, but rarely on the NHS.
surgery for female-to-male transsexuals
Standard surgical procedures for female-to-male transsexuals – removal of breasts and womb – is at least as successful as for their male counterparts. But cosmetic surgery to construct a penis, particularly a functional one, is difficult and still experimental.
The breasts are removed in a single operation and the nipples may be repositioned to produce a more natural looking male chest. Removal of the ovaries, womb, cervix and fallopian tubes can also be carried out in a single operation similar to that performed routinely for certain female cancers.
Surgery to form a penis is much less successful. Many female-to-male transsexuals opt for surgery that releases the enlarged clitoris (that has developed in response to hormone treatment) and includes implants inserted to give the appearance of testes.
Construction of a realistic penis (phalloplasty) is complex. The penis is built by wrapping flaps of skin from other parts of the body, usually the inside forearm, or the lower torso, around the enlarged clitoris. The urethra can be extended so that it is possible to urinate through the new penis, but this can cause problems. It is impossible to simulate the increased blood flow to the penis necessary for an erection. But surgeons are using inflatable implants, previously used to treat impotence, with some good results.
Again, as with any major operation, a good surgeon is essential – as is discussing all the pros and cons before proceeding. Anyone planning a phalloplasty should also talk to other transsexuals who have had this type of surgery before deciding whether to go ahead. Further advice is available below in help and info.
transsexuals and the law
Since 1996, transsexuals have had full protection from discrimination in the workplace, and since 1999 they have been entitled to receive their treatment on the National Health Service. In 2002 the European Court of Human Rights held that British transsexuals must be able to change the gender on their birth certificate and to get married. The Gender Recognition Act, which received Royal Assent in July 2004, enables Gender Recognition Panels to receive applications from transsexual people for legal recognition in their acquired gender. Following recognition, transsexual people will have the right to marry in their acquired gender and be given birth certificates that recognise their acquired gender. It also allows transsexual people to obtain benefits and the state pension just like anyone else of that gender (see help and info for more information).
help and info
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organisations
The Beaumont Society
27 Old Gloucester Street
London WC1N 3XX
Info Line: 01582 412220 (24 hr)
Helpline: 07000 287878 (Tues & Thurs 7pm-11pm)
E-mail: enquiries@beaumontsociety.org.uk
Website: www.beaumontsociety.org.uk
Provides advice and support to the transgender, transvestite, transsexual and cross-dressing communities in the UK (and to wives and partners). The info line gives regional support contacts and opening times. Runs local groups and produces a newsletter and publications.
Depend
BM Depend
London WC1N 3XX
E-mail: info@depend.org.uk
Website: www.depend.org.uk
Offering free, confidential and non-judgemental advice, information and support to all family members, spouses, partners and friends of transsexual people in the UK. A helpline and administration number are being planned.
FTM Network
BM Network
London WC1N 3XX
Helpline: 0161 432 1915 (Weds 8pm-10.30pm)
E-mail: membership@ftm.org.uk
Website: www.ftm.org.uk
An informal self help group, open to all female to male (FTM) transgender and transsexual people, or those exploring this aspect of their gender.
Gender Identity Research and Education Society
Melverly
The Warren
Ashtead KT21 2SP
Tel: 01372 801554
E-mail: admin@gires.org.uk
Website: www.gires.org.uk
Promotes and communicates research and provides education to all those in a position to improve the lives of people affected by gender identity.
Gender Trust
PO Box 3192
Brighton BN1 3WR
Helpline: 07000 790347 (Mon-Fri 7pm-10pm)
Tel: 01273 234024 (24 hour answerphone)
E-mail: info@gendertrust.org.uk
Website: www.gendertrust.org.uk
Registered UK charity which specifically helps adults who are Transsexual, Gender Dysphoric or Trangender i.e. those who seek to adjust their lives to live as women or men, or to come to terms with their situation despite their genetic background. They can also provide some information on intersex but may refer individuals on to other organisations with whom they work closely.
Mermaids
BM Mermaids
London WC1N 3XX
Helpline: 07020 935066 (Mon-Sat 3pm-7pm)
E-mail: mermaids@freeuk.com
Website: www.mermaids.freeuk.com
Support and information for children and teenagers who have gender identity problems, and for their families, friends and carers.
Press for Change
BM Network
London WC1N 3XX
E-mail: letters@pfc.org.uk
Website: www.pfc.org.uk
A political lobbying and educational organisation, which campaigns to achieve equal civil rights and liberties for all transgender people in the United Kingdom, through legislation and social change. The website provides information about the trans rights campaign, and details about the legal, medical, political and social issues surrounding the people it represents, including the Gender Recognition Act 2004.
websites
Boys will be girls
http://society.guardian.co.uk/health/story/0,7890,1022281,00.html
Guardian article from 2003 examining the rise of gender identity disorder.
The Crissy Wild Transgender Library
www.crissywild.com
This comprehensive site describes itself as a gateway to all and everything transgendered.
The Department for Constitutional Affairs - Transsexual People
www.dca.gov.uk/constitution/transsex/index.htm
The Department for Constitutional Affairs has responsibility for Government policy on transsexual people. Here you will find information about the Gender Recognition Act 2004 which gives transsexual people legal recognition in their acquired gender and ensures that transsexual people are afforded all the rights and responsibilities appropriate to that gender.
Gendys info
www.gendys.info
A site dealing with gender dysphoria, lesbianism, love, personal freedom and rebirth. Developed by male-to-female transsexuals who describe their experiences and offer a forum for support.
Gendys Network
www.gender.org.uk/gendys
A support network for all who have encountered gender identity problems: transsexuals, transgendered people, gender dysphoric people of either sex, and those who provide professional or lay care. A quarterly journal is published for members and biennial conferences are held.
Transgender UK
www.transgender.freeserve.co.uk
Website dedicated to helping people of diverse gender expression achieve their full potential within society, and offer information and support during that process.
Transgender Zone
www.transgenderzone.com
Educational website founded on academic research. Has feature articles, medical and health resources and forums, including one offering advice.
Transsexual UK
www.transsexual.org.uk
Aims to connect trans people and their allies to clubs, groups, individuals, information, organisations, professionals and resources in the UK and beyond.
reading
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Conundrum by Jan Morris (Faber and Faber, 2002) |
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Crossing: A memoir by Deirdre McCloskey (University of Chicago Press, 1999) |
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Finding the Real Me: True Tales of Sex and Gender Diversity by Tracie O'Keefe (Ed) (Jossey Bass Wiley, 2003) |
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The Transgender Debate: The crisis surrounding gender identities by Stephen Whittle (South Street Press, 2000) |
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My Gender Workbook by Kate Bornstein (Routledge, 1998) |
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She's Not There: a Life in Two Genders by Jennifer Finney Boylan (Broadway Books, 2003) |
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Transgender Warriors by Leslie Feinberg (Beacon Press, 1997) |
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Transmen and FTMs: Identities, Bodies, Genders and Sexualities by Jason Cromwell (University of Illinois Press, 1999) |
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Transsexual People in the Workplace (Press For Change, 1998) |
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Transsexualism: The current medical viewpoint (Press for Change, 1996) |
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Thanks are due to Stephen Whittle, Reader in Law, Manchester Metropolitan University and Vice-President of Press for Change for his help with this feature and for providing additional resources.
(updated January 2003, resources updated January 2005)
