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Transgender individuals,
transsexuals, and gender identity

Transitioning from male
to female, or vice-versa


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 any information in this essay, but seek professional counseling. If you are feeling seriously depressed, and need immediate support, you might consider an crisis hot line. These are called by various names, like crisis center, distress center, suicide prevention center, etc. One should be listed at in front pages of your telephone directory. In the U.S., you can also phone the National Suicide Prevention Lifeline at 1‑800‑273‑TALK (8255) or engage in a live online chat.

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

Some transgender or transsexual children become cisgender as they move towards adulthood. However, those who do not often describe themselves as having a female brain in a male body, or vice-versa. There is no way to alter one's internal brain structure. As they mature, many elect to undergo what was called "Gender Reassignment Surgery" (GRS) or "Sex Reassignment Surgery" (SRS). It is now most often called "Gender Confirmation Surgery" (GCS). This, in essence, alters one's physical appearance to match more closely the gender with which they identify. A new technique is to use puberty blocking medication to delay puberty until the child is sufficiently emotionally mature to decide whether to undergo surgery. 1

In the past, there was a significant failure rate with 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. 2 This has since been updated through many revisions. The Standards of Care are followed by all or essentially all ethical clinics. If you visit a clinic that does not meet these standards, we recommend that you head for the nearest exit with all deliberate speed.

Longitudinal studies conducted by the NHS (National Health Service) in the UK lasting two-decades lhave shown that over 96% of patients with genital reconstruction were satisfied with their results. 2

The largest study to date appears to be a survey of members of the Dutch transgender community who have gone through gender confirmation surgery. They found that 1,280 out of 1,285 patients analyzed were satisfied with the surgery. 5 This study extended over the years 1975 to 1992. Since then, there have been many improvements in the treatment of transgender persons, so the success rate should be higher today.

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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 is 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 gender reassignment surgery (GRS):

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

bullet Altering the appearance and functioning of the genitals by removing the penis, testicles and scrotum and creating structures resembling a natural 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. 3

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Many states and countries allow transexuals to revise their birth certificates and/or driver's licenses to have them match their perceived gender. 2

A detailed essay on GRS/SRS is available online from Juno Medical. 4

References used:

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

  1. Priyanka Boghani, "When Transgender Kids Transition, Medical Risks are Both Known and Unknown," Frontline, 2015-JUN-30, at:
  2. "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.)
  3. "Sex reassignment surgery (female to male)," Wikipedia, at:
  4. "Sex reassignment surgery guide," JunoMedical, 2016, at:
  5. P.J. van Kesteren, An epidemiological and demographic study of transsexuals in The Netherlands," NVBI. 1996-DEC-25, at:

Copyright © 2007 to 2017 by Ontario Consultants on Religious Tolerance
Original posting: 2007-JUN-08
Latest update: 2017-NOV-11
Author: B.A. Robinson

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