The cause of transsexualism is unknown, although many theories have been suggested. Abnormal hormone levels, psychological or social influences have not been proven. Also, hormonal and psychiatric treatments have had no long term success. However, anatomic differences in the brains of male to female transsexuals have been recently been identified.

Several other gender identity diagnoses are sometimes incorrectly confused with transgenderism/ transsexualism. Homosexuality is not considered a gender identity disorder by the medical profession, but refers to an individual’s sexual preference for members of the same sex. Gay men want to be men, but prefer having relationships with other men. Lesbians are women who want to remain women, but prefer to have relationships with other women. As opposed to transgender people, neither gays nor lesbians want to change their gender, they just prefer being with people of the same sex. Bisexual people also want to remain in their original gender, but are comfortable having relationships with both males and females. Transvestites also want to maintain their original gender, but enjoy dressing in the clothes of the opposite gender. Transvestites are usually homosexual, but not always. Intersex individuals are born with anatomy that is neither clearly male nor female, and often are forced into the gender decided by their obstetrician or parents. Sometimes they are given inappropriate surgery based on mistaken gender identity.

The history of transgenderism goes back centuries. Transgender individuals were well known and described in ancient Greek and Roman times. These individuals lead very confused and disturbed lives, always wishing to be the opposite of their biologic gender. There have been many stories throughout history about trans people mutilating themselves or undergoing crude surgical procedures to appear more like the gender of their desire.

The term transgender was first used by Hirschfeld in 1923. It was not until the 1940s when the term “transsexual” was used to describe individuals who want to live permanently in the gender role of the opposite sex and who want to have reassignment surgery. Gradually, professionally trained surgeons began doing more sophisticated surgery for these patients. The first reported case of gender reassignment surgery by a trained surgeron was by Dr. Abraham in 1931. Dr. Georges Burou, a French surgeon practicing in Morocco and Dr. Fogh Anderson in Denmark became world famous in the 1950s doing these surgeries.

Dr. Harry Benjamin, an endocrinologist in New York City, tried to help male to female transgender patients and prescribed female hormones to help them become more feminized. He studied these individuals carefully, kept accurate records over many years and in 1966 wrote the first comprehensive textbook on this subject. Dr. Benjamin was the first to use the term “gender dysphoria” as the medical diagnosis for these patients. Following publication of his book, the medical profession began to recognize this entity more and more, and surgeons began performing gender reassignment surgery more frequently. The first well known medical centers doing this work in the U.S. were the John Hopkins Hospital in Baltimore, M.D. and the Stanford Medical University Center in California.

The Harry Benjamin International Gender Dysphoria Association (HBIGDA) was formed in 1978 and represents a variety of professionals interested in the evaluation and treatment of transgender individuals. The association includes psychiatrists, psychologists, therapists, endocrinologists, urologists, gynecologists, sociologists, lawyers, surgeons and others interested in the care of these people. Standards of care have been established by HBIGDA to assure quality standardized care. For example, prior to having gender reassignment surgery, the candidate must meet certain criteria: the individual must have psychiatric clearance for surgery, have been on hormones a minimum of 1 year, have lived and dressed full-time in the role of their desired gender a minimum of 1 year and be of adult age (18 or 21 depending on the state they live in). Also, they should preferably have other feminizing or masculinizing surgeries prior to genital reassignment.

Some non-genital surgeries that transgender patients frequently have are rhinoplasty (nasal surgery), chin or cheek enlargement or reduction, breast removal (for female to male individuals) or breast enlargement (for male to female individuals), liposuction, Adam’s apple reduction, hysterectomy (removal of uterus, fallopian tubes, and ovaries),orchietomy (removal of testes) and other cosmetic procedures.

Some non-surgical procedures that transgender individuals frequently request are hair removal, skin care, voice training, hair styling, make-up and fashion training, and legal services (for name change, discrimination issues, etc).

The surgery for genital reassignment should take place in an accredited hospital under general anesthesia and can be done in one stage. The procedure usually takes 4 to 5 hours and the patient remains in the hospital for about 1 week. At our Center in Philadelphia our patients usually remain in the hospital for three or four days and then move to an apartment located in the same building as our office for another seven to ten days. The patient should then be followed by the surgeon for at least a year and by the mental health specialist for as long as necessary to assure long-term mental and emotional stability. The results of gender reassignment surgery, if performed by a well trained and experienced surgeon, are usually excellent esthetically and functionally. However, the surgery is complex and, as with all surgical procedures, complications are possible and may require additional surgery.

Following reassignment surgery, transgender patients usually maintain the same type of relationships, often with the same individuals, as prior to surgery. It is important to understand the difference between the terms “gender” and “sexual orientation”. Gender refers to the role, male or female, that an individual wants to present to themselves and to the world. Sexual orientation is a completely different issue and refers to whether an individual wants to have sexual relations with another individual of the same or different gender. For example, a transgender patient may wish to present as a male or a female and have a “normal” heterosexual life in that role. However, this individual may wish to have homosexual relationships in the new gender role. These sexual orientation issues are separate from the issue of gender identification.
Individuals planning to have gender reassignment surgery are often asked the following question by their therapist or surgeon: would you do this surgery if you knew you could never have sex again? The answer is usually yes if they are a true transsexual patient, because the gender they present to themselves and the world is more important than the ability to have sexual relations. However, the ability to have sexual relationships is preferable and desirable.

Transgender patients often lead difficult, frustrating, and problematic lives. They are frequently discriminated against in school, the work place, and socially. Prior to gender reassignment surgery, transgender patients have a high incidence of attempted suicide; this is dramatically reduced once transitioning surgery has been completed. Surgery has proven to be the only treatment offering long term emotional relief, happiness and success for these individuals. On the other hand, many trans people are perfectly happy without undergoing a GRS procedure.

Transgender people want to be treated like any other person of their chosen gender. They are usually extremely gratefully to those professionals who are “trans-friendly” and trying to help them. At the Philadelphia Center for Transgender Surgery we treat trans people with understanding, sensitivity, kindness, compassion, and respect and do our best to help them safely and successfully achieve their goals.

For more information and to schedule a private consultation call 610-667-1888