Treatment of Gender Identity Issues

In addition to diagnosing patients and providing counsel, mental health professionals also assess a person's eligibility and readiness for hormone therapy and surgery. Not all transgender people need all three phases of therapy; each path to gender reassignment is tailored to the person. And, as we've noted before, not all transgender people undergo surgery.

Before a patient can begin hormone therapy or breast surgery, a mental health professional must write a letter of recommendation to the physician providing medical treatment.

In addition to the letter, the World Professional Association for Transgender Health's Standards of Care require several eligibility and readiness criteria for hormone therapy. A patient must:

  1. Be 18 years of age
  2. Understand what hormones can and cannot do medically and understand their social benefits and risks
  3. Have either a minimum of three months of psychotherapy or a documented three month real-life experience
  4. Show stable or improved mental health
  5. Demonstrate ability to take hormones in a responsible manner [source: WPATH Standards of Care].

After a patient meets these criteria and undergoes a basic physical examination, a physician will then prescribe hormones.

Androgens are given to biological females transitioning to male. Estrogen, progesterone, and testosterone-blocking agents are given to biological males transitioning to female. Hormones are taken orally, by injection or transdermally (a patch).

The Real-Life Experience immerses the individual into life as his or her preferred gender. The candidate is required to maintain full or part-time employment (or attend school full or part-time), legally change his or her first name to one that is gender appropriate and prove that people other than the therapist and doctor know his or her desired gender.

After 12 months of continuous and successful hormone therapy and Real-Life Experience, the individual is eligible for genital surgery. Two letters of recommendation, usually one from the mental health professional and one from the hormone-prescribing physician, are required for surgery. The patient chooses a surgeon -- a gynecologist, urologist, plastic surgeon or general surgeon -- to join the gender reassignment team.

Male-to-female patients may have several genital surgeries including orchiectomy, penectomy, vaginoplasty, clitoroplasty and labiaplasty. A transwoman might also choose reduction thyroid chondroplasty, suction-assisted lipoplasty of the waist, rhinoplasty, facial bone reconstruction (which may include hairline correction, forehead recontouring, brow lift, rhinoplasty, cheek implants, lip lift, lip filling, chin recontouring, jaw recontouring or tracheal shave) and blepharoplasty. Some patients have vocal cord surgery or voice training.

Genital surgery for female-to-male patients may include hysterectomy, salpingo-oophorectomy, vaginectomy, metoidioplasty, scrotoplasty, placement of testicular prostheses and phalloplasty (the creation of a neophallus or surgically constructed penis). A transman may also undergo elective surgeries like liposuction to reduce fat in hips, thighs and buttocks.

But once surgery is complete, do patients ever have regrets? What legal rights do they have as the opposite gender? Find out on the next page.