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The treatment for transsexualism includes removal of body hair, vocal training, and cross-sex hormonal treatment aimed at making the person's body as congruent with the opposite sex as possible to alleviate the gender dysphoria. Sex reassignment also involves the surgical removal of body parts to make external sexual characteristics resemble those of the opposite sex, so called sex reassignment/confirmation surgery (SRS). This is a unique intervention not only in psychiatry but in all of medicine. The present form of sex reassignment has been practised for more than half a century and is the internationally recognized treatment to ease gender dysphoria in transsexual persons.[3], [4]
The poorer outcome in the present study might also be explained by longer follow-up period (median >10 years) compared to previous studies. In support of this notion, the survival curve (Figure 1) suggests increased mortality from ten years after sex reassignment and onwards. In accordance, the overall mortality rate was only significantly increased for the group operated before 1989. However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.[35]
Inpatient care for psychiatric disorders was significantly more common among sex-reassigned persons than among matched controls, both before and after sex reassignment. It is generally accepted that transsexuals have more psychiatric ill-health than the general population prior to the sex reassignment.[18], [21], [22], [33] It should therefore come as no surprise that studies have found high rates of depression,[9] and low quality of life[16], [25] also after sex reassignment. Notably, however, in this study the increased risk for psychiatric hospitalisation persisted even after adjusting for psychiatric hospitalisation prior to sex reassignment. This suggests that even though sex reassignment alleviates gender dysphoria, there is a need to identify and treat co-occurring psychiatric morbidity in transsexual persons not only before but also after sex reassignment.
For the purpose of evaluating the safety of sex reassignment in terms of morbidity and mortality, however, it is reasonable to compare sex reassigned persons with matched population controls. The caveat with this design is that transsexual persons before sex reassignment might differ from healthy controls (although this bias can be statistically corrected for by adjusting for baseline differences). It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia.[39], [40] This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit.
The word has undergone several changes of meaning since it was first coined and is still used in a variety of senses. Today, the term transvestite is commonly considered outdated and derogatory, with the term cross-dresser used as a more appropriate replacement.[2][5][6] This is because the term transvestite was historically used to diagnose medical disorders, including mental health disorders, and transvestism was viewed as a disorder, but the term cross-dresser was coined by the transgender community.[2][7] In some cases, however, the term transvestite is seen as more appropriate for use by members of the transgender community instead of by those outside of the transgender community, and some have reclaimed the word.[8][9]
Hirschfeld himself was not happy with the term: He believed that clothing was only an outward symbol chosen on the basis of various internal psychological situations.[10] In fact, Hirschfeld helped people to achieve the first name changes (legal given names were required to be gender-specific in Germany) and performed the first reported sexual reassignment surgery. Hirschfeld's transvestites therefore were, in today's terms, not only transvestites, but a variety of people from the transgender spectrum.[10]
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Genital Reassignment Surgery (GRS) is commonly recognized as the surgical alteration of genitalia to align transsexuals' bodies with their chosen gender identities in order to alleviate the persistent discomfort of Gender Identity Disorder (GID). Clinical and psychological evaluations of the outcomes of GRS have focused primarily on the individual benefits of the surgery and on the aesthetic or functional aspects of newly created genitalia. Left out of medical and social science research is attention to the patient's hopes for social gains and benefits following GRS. Critically assessing the current biomedical model of transsexualism and its treatment, this study considers not only the different meanings GRS holds for patients (contrasting life-world concerns with biomedical concerns), but also explores what GRS is expected to contribute to the everyday experiences of transsexuals. Through participant observation and person-centered interviews, I examine what patients expect to gain from GRS socially, what kinds of hopes they have invested in the surgery, how they intend to integrate their past and present gendered histories, and whether they feel that undergoing GRS will significantly improve their social status. This study thus offers a patient-centered perspective on the meaning of surgical intervention for a socially stigmatized condition. I find that while GRS can provide individual benefits for transsexuals through eliminating body dysphoric feelings through the surgical alignment of the mind with the body, the surgery does not, and cannot, eliminate their social history of transsexual embodiment. The socially liminal positions that many transsexuals experience prior to surgery are thus likely to remain unchanged as the main barrier to social acceptance or social equality lies primarily in the history of gendered embodiment and not in the bio-medical assumption of mind-body disjuncture. 041b061a72