The Use of Sex Reassignment Procedures

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The extent to which the alignment between biological sex and gender identity is reinforced in our culture is dramatically illustrated in the treatment strategies that physicians and psychiatrists have employed to treat transsexual adults. In the 1960s, following the widely publicized news of Christine Jorgensen’s successful sex change, Benjamin, a New York endocrinologist, published “The Transsexual Phenomenon” (1967). He clearly advocated sex reassignment surgery as a form of humane and compassionate treatment for persons whose genitals did not match their gender. Three years later Green and Money (1968) published an edited textbook that established a medical protocol for sex reassignment at Johns Hopkins University. Within 10 years, there were more than 40 university-based gender clinics in the United States. The standard treatment protocol in place currently requires persons to seek counseling and adhere to a series of specific procedures. These are outlined in the Standards of Care developed by the Harry Benjamin International Gender Dysphoria Association (Meyer et al., 2001).*

Basically, transsexual persons are diagnosed as having gender dysphoria (defined as psychological discomfort with one’s biological sex) and as such are considered “sick.” The standards dictate that persons seeking hormonal and surgical reassignment receive counseling and obtain official letters of recommendation by qualified mental health professionals. Those interested in surgical reassignment are also mandated to live as their desired gender for approximately one year (called the “real-life experience”). The treatment objective of the medical and psychiatric establishments is for gender dysphoric persons to alter their bodies and adapt a new gender presentation so they can “pass” (conceal the fact that they are differently gendered) successfully and not be “read” or discovered. In most instances, the costs of treatment are covered by insurance only if the patient has been diagnosed with gender identity disorder as defined in the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR; American Psychiatric Association, 2000). Currently, the DSM–IV–TR deems cross-dressing a “fetish” and transsexualism a gender identity disorder.

Current treatment protocols for transsexuals place helping professionals in the unique and awkward position of being potential gatekeepers to their clients. Even in the days of increasing use of cosmetic surgery, there are no other instances in which therapists are required to sanction surgical interventions. Many transsexuals are able (with the aid of hormonal and surgical interventions) to successfully pass as their desired gender without detection. However, it is important to note that others are less successful in doing so. Either the medical procedures are too costly and painful, or their basic body morphology makes their attempt to transition more noticeable to others.