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Transgenderism, transsexualism, and gender identity

Transitioning from male to female or vice-versa.

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This is an essay intended for general informational use only. If you believe that you are personally experiencing Gender Dysphoria, we recommend that you not rely upon this essay, but seek professional counseling. If you are feeling seriously depressed, and need immediate support, you might consider an crisis hot line; one may be listed at the front of your telephone book.

About male-to-female (MTF) or female-to-male (FTM) transitioning:

In the past, there was a significant failure rate with gender reassignment surgery (GRS). Some patients underwent the procedures prematurely before they were emotionally ready and/or before it was certain that they suffered from a true case of Gender Dysphoria. In those early years, a significant percentage of clients came to later regret their action.

In 1979, the original set of "Standards of Care for Gender Identity Disorders" was published. 1 This has since been updated through many revisions. The Standards of Care are followed by all or essentially all ethical clinics. If your clinic does not meet these standards, we recommend that you head for the nearest exit with all deliberate speed.

The Standards list a number of prerequisites that need to be met before the person is eligible for GRS:

bulletAge: Generally, they must be over 18 years-of-age.

bullet Certainty of diagnosis: They must exhibit the symptoms of Gender Dysphoria for a significant length of time.

bullet "Real Life Test" (RLT): Clinics generally require a client to live as a person of their perceived gender for a year or more before being considered for GRS. The client must either attend school, engage in volunteer activities, or work. They change at least their first name to match their perceived gender.

bullet Psychotherapy. The individual must usually be recommended for GRS by two psychologists or psychiatrists after extensive evaluation.

bullet Hormones: The individual be on Hormone Replacement Therapy for eight months or more. These treatments alter the body's appearance in order to develop characteristics associated with the new gender: e.g. breasts in MTF transsexuals, and redistribution of body fat and hair growth in FTM transexuals.

At this point they may be ready to proceed with transitioning to their perceived gender. This process may include gender reassignment surgery (GRS), which involves one or more procedures:

bulletFor a MTF transsexual this can involve some of the following:

bulletAltering the appearance and functioning of the genitals by removing the penis, testicles and scrotum and creating structures resembling a vagina, labia, and clitorus.

bulletRaising the pitch of her voice.

bulletRemoval of facial hair.

bulletRe-contouring of various facial features -- e.g. chin, nose, forehead.

bulletAdjusting the length of her upper lip so that she will display her top teeth when she smiles -- a typical female characteristic.

bulletAugment breast size.

bulletReduce the size of her Adam's apple.
bulletFor a FTM transsexual:

bulletAltering the appearance of the clitoris so that it resembles a penis, or the addition of a penile prosthesis

bulletThe labia majora are joined to form a simulated scrotum. Testicular implants may be inserted to simulate testicles.

bulletMastectomy -- removal of the breasts and creating a male-shaped chest.

bulletHysterectomy -- removal of the uterus.

bulletBilateral Salpingo-oophorectomy (BSO) -- removal of the ovaries and fallopian tubes. 2

Many states and countries allow transexuals to revise their birth certificates and/or driver's licenses to have them match their perceived gender. 1

References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. "The Standards of Care for Gender Identity Disorders (Fifth Version)," The Harry Benjamin International Gender Dysphoria Association Inc., 1998-JUN-15, at: (The term "Gender Identity Disorder" is now obsolete and has been replaced by Gender Dysphoria.)
  2. "Sex reassignment surgery (female to male)," Wikipedia, at:

Copyright © 2007 to 2015 by Ontario Consultants on Religious Tolerance
Original posting: 2007-JUN-08
Latest update: 2015-DEC-21
Author: B.A. Robinson

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