Difficulties of gender identity begin in early childhood though people of all ages have been found to report feeling of being trapped into the body of a woman or vice versa. Mental health conditions arising out of this constant internal conflict is called Gender Dysphoria. It is usually characterised by anxiety and depression.
Gender identity isn’t about anatomy or sexual orientation. It’s about self identification of gender status one is comfortable with which can be masculine, feminine, agender or gender fluid.
Some keep their struggles to themselves, others express and seek transition.
Transitioning to other gender is two-fold:
- Social transition- change of clothing, name and pronouns
- Medical transition- change in physical appearance with treatments like hormone therapy and surgical procedures.
Depending on the need some may want both transitions, some just one some neither.
Gender transition is a unique process for each individual and they may choose to undergo a complete process or just few of it. The series of the procedures are also called gender reassignment.
One has to be diagnosed with gender dysphoria, previously known as gender identity disorder (GID)
Not only having persistent feeling of not being aligned with his/her gender identity but must also show at least two of the following features:
- Expression of gender different from what society expects
- Wish to be of other gender
- Desire to be treated as a different gender
- Strong urge to get rid of the primary and secondary sexual characteristics of the “wrong” gender
- Desire to have the sexual characteristics of other gender
- Belief their emotional and physical reactions are of a different gender
Hormone therapy needs to be started months prior to surgery to alter secondary sex characteristics to the desired gender. Most physical changes are managed with hormone therapy advised by an endocrinologist to suppress certain characteristics (such as muscle mass) or enhance others (such as breast growth). Hormone therapy takes at least two years before best results are achieved.
World Professional Association for Transgender Health (WPATH) has drawn gudelines for Standards of Care for Gender Identity Disorders (SOC).
Not everyone needs to undergo all the procedures. Surgeries are tailored on a person to person basis depending on the need and finances. Few procedures are medically necessary to treat gender dysphoria, while other surgeries like rhinoplasty and brow lifts are cosmetic;
Surgeries for transition to men are:
- Bilateral mastectomy(both breast removal)
- Hysterectomy (uterus removal)
- Reconstruction of the genitalia to construct a phallus from the clitoris
- Ring metoidioplasty (lengthen the urethra)
- Scrotoplasty (construction of a scrotum with or without implant)
- Vaginectomy (close of the vaginal canal)
- Phalloplasty (construction of the penis with or without penis implant)
Surgeries for transition to female are:
- Clitoroplasty (construction of a clitoris)
- Labiaplasty (construction of labia are done from scrotum)
- Orchiectomy (removal of testes)
- Prostatectomy (removal of prostate)
- Urethroplasty (reconstruction and shortening of the urethra)
- Vaginoplasty (creation of the vagina,usually from a colon graft)
- Penectomy (removal of the penis)
- clitoral hood construction from the glans of penis.
Transition to women is more common and is cheaper than vice versa.