Seeking an understanding on gender reassignment

Dear Dr. G

I've been reading your articles on the topic of Intersex with great interest.

I've noticed you haven't discussed transsexuality or gender reassignment and while I've heard a lot about transgenderism, I've never had the courage to openly ask about it.

I believe that understanding transgenderism is key to an inclusive society without prejudice and discrimination and now is the perfect time to raise this topic and seek clarification from you, Dr. G.

Could you explain what transgenderism is and what gender reassignment entails? Who decides if someone is suitable for gender reassignment surgery?

How complex are sex change operations? What surgeries are performed to transition from male to female? Conversely, how is the reverse transition achieved? How common are these surgeries, and do people ever regret their decisions? Your clarifications would be greatly appreciated.

Regards, Reassignment Richard

Gender reassignment surgery - previously referred to as sex change operations - is now more suitably termed gender-affirming surgery. It encompasses procedures that modify a person's sexual characteristics to match their identified gender.

Since 1972, when Sweden allowed transgender individuals to legally change their gender, transgender healthcare and Intersex medical interventions have evolved significantly. Medical organizations have established Standards of Care that must be met before one can undergo reassignment surgery. These standards include psychological assessments and a period of experiencing life in the desired gender, followed by thorough pre-intervention evaluations and attentive post-operative care.

Trans women who are assigned male at birth may undergo surgeries like penectomy, castration, vulvoplasty, and vaginoplasty, often accompanied by breast augmentations, facial feminization, and voice feminization procedures. These surgeries are typically done in stages and tailored to the individual.

Trans men who are assigned female at birth may opt for chest reconstruction and internal and external genital operations including hysterectomy, oophorectomy, phalloplasty or metoidioplasty, and scrotoplasty, sometimes with testicular prostheses.

Additionally, non-binary individuals might choose to construct new genitalia while retaining their original organs. Gender nullification is often pursued by those assigned male at birth, and involves removing all external genitalia except for the urethral opening.

These surgeries should not be sensationalized as genital mutilation.

The frequency of transgender-related surgeries is hard to quantify but is generally underestimated. A 2015 survey reported that 25% of transgender respondents underwent such surgery, and a 2021 review found a regret rate of less than 1% in nearly eight thousand patients. Studies suggest the process is effective in alleviating gender dysphoria, with positive outcomes far outweighing negative consequences.

Gender reassignment is a profound decision, usually taken when an individual's birth-assigned gender does not align with their gender identity, causing psychological distress.

The surgeries involved are complex and require a team of specialists like urologists, plastic surgeons, psychologists, and psychiatrists. Though challenging, gender reaffirmation surgery is often misunderstood.

When Dr. G is asked to provide clarity on gender reaffirmation procedures, he believes the approach should focus on psychological understanding rather than physical attributes.