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by John Illman
Until recently anyone claiming to be a man trapped in a woman's body or vice versa, faced abuse or ridicule — and even electric shock therapy in psychiatric hospitals. But transsexuals can now undergo sex change surgery in the knowledge that scientific research has finally accepted that their cross gender identity is not 'all in the mind'.
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 sex change surgery are similar to those of normal female brains.
This long-awaited scientific confirmation is now making it easier for those seeking sex change surgery, but many transsexuals have always had an overwhelming desire to change sex.
The Channel 4 documentary, History of the Sex Change, tells a story that even now almost defies belief. It features the medical profession at its most ingenious and pioneering; lifelong suffering and despair; and courage and scandal in equal measure.
not even 007 could tell the difference
Tula (Caroline Cossey), the transsexual Bond girl, ranked high in the scandal stakes. Appearing with Roger Moore in For Your Eyes Only in 1981, she even achieved notoriety as a nude model before being exposed as 'a fella' in the British tabloid press. The world's newspapers then declared (you've guessed it) that not even 007 'could tell the difference'.
Jokes like these overshadow the suffering of the UK's estimated 15,000 transsexuals who almost without exception tell you that they have always known something is wrong. As infants they feel unhappy and as they grow older, their 'gender dysphoria' starts to manifest itself in behaviour disturbances.
By the age of 11 or 12, many transsexuals identify what is wrong, and become increasingly desperate as puberty rushes them down the inevitable road to the fully formed body they feel shouldn't be theirs.
the start of it all
The German physician, Dr Magnus Hirschfeld, who coined the term transsexualism, was the first true sex change pioneer. He founded the world's first sexology institute in Berlin, where the first complete 'male to female' sex change operation was performed in 1930.
After a series of operations the patient died from surgical complications after spending only 14 short months as a woman. In the '20s and early '30s, Berlin was renowned as a liberal city which celebrated sexuality and where the lines between men and women were blurred; but Hirschfeld was a gay Jew and became a prime target for Nazi storm troopers who destroyed his institute in 1933.
Ironically, Hitler and the Nazis, albeit unwittingly, played a key role in advancing sex change surgery — simply by going to war in 1939. Wars have always accelerated the pace of scientific progress, and none more so than the First and Second World Wars. Many plastic surgery techniques evolved in the aftermath of battle. None has proved more enduring than 'flap surgery' — which initially involved treating war wounds with healthy flaps of skin and tissue taken from other parts of the patient's body. Flaps were later made into tubes from which 'penises' were sculptured.
the father of modern plastic surgery
Sir Harold Gillies, internationally renowned as the father of modern plastic surgery, played a pioneering wartime role in Britain developing flap surgery. What is not so well known is that Sir Harold was also one of the pioneers of sex change surgery.
In 1945, he and a colleague carried out the world's first sex change of a woman into a man on a young aristocrat, Michael Dillon, formerly Laura. Michael is also believed to be the first woman to have taken the male hormone testosterone in order to look like a man. Within months of starting testosterone, he had grown a beard and was living as a man. It was the dramatic transition in his appearance that finally persuaded Gillies to operate.
wait and see approach
His 'wait and see' approach set in train a policy that is still in use 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 initial 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 their day to day life. However, this cannot be avoided if they wish to proceed with the 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 the 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 will be 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.
It is possible to speed up the process of gender reassignment 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.
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 a space of 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-females
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)
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 degree 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-males
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 which 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
The UK is one of the very few European countries that will not issue revised birth certificates to transsexuals. This causes embarrassment in many different areas of life, such as obtaining life insurance for a mortgage, sorting out a pension in work, or simply having to prove one's identity — but bodies such as Press for Change (see help and info) are campaigning for change. The European Court of Human Rights is due to consider two UK cases early in 2002. However, since 1966, transsexuals have had full protection from discrimination in the workplace.
help and info
organisations
Beaumont Society
27 Old Gloucester Street
London WC1N 3XX
Helpline: 01582 412220 (24hr message service)
Website: www.beaumontsociety.org.uk
Provides advice and support for transvestite people, but also has some transsexual members. Answerphone 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
Offers free, confidential and non-judgmental advice, information and support to all family members, partners, spouses and friends of transsexual people.
FTM Network
BM Network
London WC1N 3XX
Helpline: 0161 432 1915 (Wednesdays 8-10.30pm)
Website: www.ftm.org.uk
Offers free advice and support to FTM (female-to-male) transsexual and transgender people, and to families and professionals. Also provides a buddying scheme, a newsletter and an annual national meeting.
Gender Trust
PO Box 3192
Brighton BN1 3WR
Helpline: 07000 790347
Tel: 01273 234024 (Mondays to Fridays 9am-5pm)
E-mail: info@gendertrust.org
Website: www3.mistral.co.uk/gentrust/
Offers information and support for transsexual and transgendered people, and to partners, families, carers and allied professionals such as employers. Has a membership society and produces a quarterly magazine with a confidential contact system for transsexual people.
Gires
Gender Identity Research and Education Society
E-mail: bernardgi@aol.com
Website: www.gires.org.uk
Exists to promote and communicate research that improves the lives of people affected by gender identity and intersex issues. Literature, education and also a telephone information service are available. Aims to reach out to the people directly affected and all those who can support them, including the members of their families, care providers and policy makers.
Mermaids
BM Mermaids
London WC1N 3XX
Helpline: 07020 935066 (12noon-9pm when staffed)
E-mail: mermaids@freeuk.com
Website: www.mermaids.freeuk.com
Support and information for children and teenagers who are trying to cope with gender identity issues, and for their families and carers. Please send SAE for further information.
Press for Change
BM Network
London WC1N 3XX
Website: www.pfc.org.uk
Campaign for equal civil rights for transsexual and transgendered people. Also provides legal help and advice for individuals; information and training for professionals; and speakers for groups. Produces a newsletter and publications. Please send SAE for further details.
websites
Change
www.members.aol.com/ts1change/homepage.htm
UK-based support group for people born with transsexual syndrome, with details of specialist publications and information on how to get help with funding for surgery.
FTM International
www.ftm-intl.org
International site supporting female-to-male transgendered people and transsexual men through information, newsletters, meetings and special events. Membership scheme available as well as specialist publications.
Gendys dot 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.
reading
Gender Outlaw: On Men, Women, and the Rest of Us by Kate Bornstein (Vintage Books, 1995) $11. Not available in the UK. Available to order on-line through www.amazon.co.uk.
This popular book not only explains about transsexual and transgender lives, but also challenges everyone to re-think what they know about sex and gender.
The Transgender Debate: The Crisis Surrounding Gender Identities by Stephen Whittle (Garnet Publishing Ltd, 2000) paperback £3.50
This short book is intended to be a resource primarily for both trans and non-trans people who wish to get a simple grasp on current transgender issues. Perfect for older high school students, university undergraduates, and for family and friends of trans people who simply want to understand.
Transsexual People in the Workplace (Press For Change, 1998) £3.50
A guide for employers to the law. Also provides practical advice to enable them to ensure a fair and safe workplace for transsexuals they employ.
Transsexualism: The Current Medical Viewpoint by Russell Reid (Press for Change, 1996) £1.50
This short book gives a clear overview of what doctors currently think about transsexualism and what treatments are recommended.
Trueselves: Understanding Transsexualism — For Families, Friends, Coworkers, and Helping Professionals by Mildred L Brown and Chloe Ann Rounsley (Jossey-Bass, 1996) £16.95
A helpful in-depth look at transsexualism for family members and other friends which would help those who are having difficulties coming to terms with the changes in their transsexual family member or friend.
for female-to-male transsexuals
A Self-made Man by Paul Hewitt, Jane Warren (Headline, 1996) £10.99
An easily read autobiographical account of the process of undergoing a 'sex change' from female to male.
Body Alchemy: Transsexual Portraits by Loren Cameron (Cleis Press, 1996) $72.42. Not available in the UK. Available to order on-line through www.amazon.co.uk.
A highly praised collection of photographs of female-to-male transsexuals, which shows what hormone therapy and surgery can achieve.
Dear Sir or Madam: The Autobiography of a Female-to-Male Transsexual by Mark Rees (Cassell, 1996) £15.99
A classic autobiography of a female-to-male transsexual, which many female-to-males find easy to understand and to identify with.
for male-to-female transsexuals
Conundrum by Jan Morris (Penguin, 1997) £8.99
Tells the story of the former soldier who climbed Mount Everest, went on to become a world-renowned travel writer and Times journalist who took her own very personal journey from male to female.
Crossing: A Memoir by Deirdre McCloskey (University of Chicago Press, 1999) £9.50
A highly enjoyable autobiography of how a middle-aged, middle-class man finally worked up the courage to change his life to that of a woman. It tells of the bad times along with the good, but is in the end a story with a happy ending.
My Story by Caroline Cossey (Faber, 1992) £60
Autobiography of Tula, the Bond Girl and model who was outed as transsexual in the 1980s. It tells of her sex change whilst a young adult, with the support of her family and friends.
For details of other organisations and websites, go to our get help directory.
If you have a further question or want to talk to one of our advisers, go to just ask.
January 2002
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.
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