SOYOUWANNA GET A SEX CHANGE?

There are men and there are women. There are men who want to become women and women who want to become men. There are also people who are still wearing acid-washed jeans, but we're not gonna talk about them. They're freaky.

We know we might piss a few off here, but we need to make it clear that this article focuses on the male to female sex change, because it's much more common than the alternative (female to male). But the resources with which we'll provide you are generally helpful, no matter what your situation may be. Hey, at least we're addressing the general subject, so no complaining, OK?

Also, note that this SYW is not intended to be a comprehensive guide to changing genders; rather, this a solid "starting off" point for those interested in such pursuits. We'll do our best to dispel some common myths, outline your options, and show you how to deal with the emotional side of this life-altering decision. We expect cold beer in return. The colder the better.

1. LESSEN SOME CONFUSION

To get you started, there are certain terms with which you should familiarize yourself if you want to be a hip and happenin' gender-savvy individual:

First off (whoops maybe we shouldn't say that in this SYW), when you hear talk of people who are "transgender," you can assume that this refers to a fairly broad category of people who live outside the gender "norms" into which they were born. They do not conform to the ways that many people believe men or women should behave as appropriate to their genders. Note that the transgender community does not include homosexuality in and of itself; that's because gay people do not necessarily have any issues with their own gender identification. However, homosexuality may be coupled with any of the transgender categorizations below.

People who are transgender can usually be broken down into one (or more) of several categories:

• Crossdressers: Previously known as "transvestites," this group of individuals is content with their birth gender, but chooses to dress up as and use the mannerisms of the opposite gender. Crossdressers clothe themselves in the clothing of the opposite gender not for the purpose of entertaining others (as drag performers do), but because they feel more comfortable dressed as such. Note that crossdressers are NOT necessarily gay, nor do they necessarily want to undergo sexual reassignment; it is purely a choice they make about how to dress.
  
  
• Drag performers: Drag performers, the male half of which is sometimes referred to as "drag queens," are individuals who dress up as and use the mannerisms of the opposite sex for the purpose of entertaining an audience. Think RuPaul. Some drag performers identify themselves as transgendered, and some do not.
  
  
• Transsexuals: This group of individuals was born into one gender but identifies emotionally and psychologically with the other. The medical term often used to describe this situation is "gender dysphoria" or "gender identity disorder." The complexities of this state are numerous, and people in different stages of their "coming out as a transsexual" process may refer to themselves in very different ways. Male transsexuals may choose to use hormones, have surgery, or do neither in order to live as women. The point is, these are people who feel that they were born in the wrong body and will often do anything they can to remedy it.
  
  
• Intersexed: An intersexed person is someone who was born with ambiguous genitalia, so doctors assigned him/her a specific gender at birth. Sometimes this assignment doesn't correlate with the biological XX or XY gender. These children are socialized as a certain gender, but as they grow older, they might not necessarily identify as they were assigned and would want to switch to the opposite gender.
  
  
• Gender-blenders, androgynes, etc.: This group is made up of people who identify as transgender but do not fit themselves into any other category that we list above. They may wish not to constrain themselves to these gender categories and will live with aspects of both male and female genders. It's the mush pot.

Again, we must remind you that people who identify as transgender may date men, women, both, other transgendered people, or no one at all. Sexual orientation and gender identity are two very distinct concepts that are not necessarily linked together.

We hope that it is becoming obvious that this whole "gender" business is not as simple as it may appear. There are no clear labels or definitions into which everyone fits. By the way, if you're not sure about the difference between "sex" and "gender," think of it this way: "sex" refers to your biological identification to being male or female (you either are XY or XX); "gender" refers to the social institutions that we think of as enforcing "maleness" and "femaleness" - it's the stuff that isn't biological.

Any of the people belonging to any of the categories above, or any other category, may choose in their life to change genders to better suit their psychological and emotional selves. The most common category to do this is that of transsexuals. Male to female transsexuals feel that they are really women on the inside -- that some kind of "cosmic mistake" has been made. Some transsexuals may feel content with their inner identity and have no need to alter their physical selves. Others, however, may desire a look that better goes along with who they feel they are and desire "the proper equipment" to feel whole.

2. KNOW HOW TO GET STARTED

he main goal of a sex change is to help an individual live comfortably in his/her body. But it's a lot more complicated than grabbing a scalpel and a needle; before undertaking something as extreme as a sex change, the patient must consider all of the options. That's where the HBIGDASCGID comes in.

The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders (HBIGDASCGID) is a document that was first drawn up in 1979 and last revised in 1998. It seeks to help manage gender identity disorders and the treatment for them. So to get started in the sex change process and aid the transition, the document suggests that male to female transsexual activities may include:

1. Manner of dress: crossdressing unobtrusively with undergarments, dressing unisexually, or dressing in a feminine fashion.
   
   
2. Body modification: changing the body through hair removal (e.g., electrolysis, body waxing) as well as minor plastic cosmetic surgical procedures.
   
   
3. Practice: increasing grooming, wardrobe, and vocal expression skills.
   
   
   And for both genders may include:
   
   
   
4. Education: learning about transgender phenomena from support groups and gender networks, communication with peers through the Internet, and reading relevant lay and professional literature about legal rights pertaining to work, relationships, and public cross-dressing.
   
   
5. Activities: involvement in recreational activities of the desired gender.
   
   
6. Lifestyle: episodic cross-gender living.

The Association also suggests some internal processes that an individual might go through to help begin the transition. These include:

1. Acceptance of personal homosexual or bisexual fantasies and behaviors (orientation) as being completely distinct from gender role aspirations.
   
   
2. Acceptance of the need to maintain a job, provide for the emotional needs of children, honor a spousal commitment, and to not distress a family member as currently having a higher priority than the personal wish for constant cross-gender expression. (This doesn't mean that you can't do what you want; just that you should realize that your decisions affect a lot more people than merely yourself.)
   
   
3. Integration of male and female gender awareness into daily living.
   
   
4. Identification of the triggers for increased cross-gender yearnings and effectively attend to them; for instance, develop better self-protective, self-assertive, and vocational skills to advance at work and resolve interpersonal struggles to strengthen key relationships.
   
   
5. Seeking spiritual comfort.

All of these options should be considered by any individual thinking about going through with the procedures of a sex change operation. They should certainly be thought about before any other permanent steps are taken.

3. LIVE AS A WOMEN BEFORE SURGERY

Throughout history, there have been many stories about individuals who were miraculously changed into the opposite gender. Funk & Wagnall's Standard Dictionary of Folklore, Mythology, and Legend tells many tales of sex changes. In one account, the Greek goddess Venus Castina was assigned the task of responding with sympathy and understanding to the yearning of female souls locked in male bodies. In keeping with this myth, we are also told of the tale when the Sythians' rear guard pillaged the temple of Venus at Ascelon. The goddess Venus was so enraged that she made women of the plunderers.

Times, thankfully, have changed. There are now many surgical options available to an individual who feels that he/she is living under the wrong sex. Understandably, such a decision should not be made on a whim; once a man loses his appendage, it's he can't get it back. Furthermore, one oft-cited study found that about half of all men who undergo surgery and change their sex are no happier after their surgery than before. Granted, the validity of this study has been questioned, but it nonetheless indicates that Sexual Reassignment Surgery (SRS) will not be the answer to all of life's problems. It's for this reason that there are systems in place to make sure that you don't jump right onto the surgery boat; rather, men who want to become women are required to first live life as a woman before the operation. That way, there's still a chance for the man to change his mind and not undertake permanent measures.

There are many options that do not require expensive surgical procedures. One popular option is that of hormones.

Hormones

Believe it or not, there are several requirements to satisfy before a pre-operative transsexual can even begin taking hormones. The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders states that before beginning a hormone regimen, the following criteria must be met:

1. The patient must be of legal age (at least 18 years old).
   
   
2. The patient must have demonstrable knowledge of what hormones can medically do and not do, and be aware of their social benefits and risks.
   
   
3. Either:
   
   • A documented real life experience should be undertaken for at least three months prior to the administration of hormones.
     
     OR
     
     
   • A period of psychotherapy of a duration specified by the mental health professional after the initial evaluation (usually a minimum of three months) should be undertaken.
   
   

The Association also provides "Readiness Criteria." This means that they are not requirements per se, but are judgment calls to be made by the patient's doctor:

1. The patient has had further consolidation of gender identity during the real-life experience or psychotherapy.
   
   
2. The patient has made some progress in mastering other identified problems leading to improving or continuing stable mental health. This basically implies an absence of mental problems such as sociopathy, substance abuse, psychosis, or suicidal tendencies.
   
   
3. Hormones are likely to be taken in a responsible manner.

Male to female transsexuals use the hormone estrogen to feminize their voices, faces, and body characteristics. This hormone changes their fat distribution, increases their breast size, and decreases their body hair. One thing that this hormone does not do, however, is to eliminate facial hair. Transsexuals must often go through painful and expensive treatments such as electrolysis to remove this hair. Estrogen also shrinks the penis and testicles, so the decision to go through with hormones is a fairly permanent one (though nowhere nearly as extreme as surgery).

Any medical doctor, including a psychiatrist, can prescribe hormones once they determine that their patient is suitable for them. Again, these hormones will not be administered until the requirements above have been satisfied. Once both the doctor and patient are satisfied that the patient is ready for the hormones, the therapy can begin.

4. KNOW YOUR SURGICAL OPTIONS

When the decision is made to go through with surgical options, a great deal of consideration must be used. After all, even though surgeons were able to do wonders for John Bobbitt (of Lorena Bobbitt fame), that was a matter of mere reattachment; when a man becomes a woman, doctors will completely reform the penis into a vaginal cavity. That's pretty tough to undo.

The first step in getting surgery is for you to have your case reviewed by both psychologists and medical doctors, who will in conjunction decide if you meet the desired criteria for the operation. These doctors will not only make the judgment about your psychological and emotional stability to go into the procedure, but if they clear you, they will also help you through your transition.

As defined by the now familiar Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, there are several criteria that every individual must satisfy in order to be eligible for the transitional surgery. These include:

1. Legal age of majority in the patient's nation (18 in the United States).
   
   
2. Twelve months of continuous hormonal therapy for those without a medical contraindication.
   
   
3. Twelve months of successful continuous full-time real life experience. Periods of returning to the original gender may indicate ambivalence about proceeding and should not be used to fulfill this criterion.
   
   
4. If required by the mental health professional, regular responsible participation in psychotherapy throughout the real life experience at a frequency determined by the mental health professional. Psychotherapy is not always required; only if the doctor feels that it is.
   
   
5. Demonstrable knowledge of the cost, required lengths of hospitalizations, likely complications, and post surgical rehabilitation requirements of various surgical approaches.
   
   
6. Awareness of several different competent surgeons. Hey, this is a time when you shouldn't hesitate in getting a second opinion.

As you can tell, you will have to rely quite a bit on your doctors. That's because the medical industry wants to make sure that you are as knowledgeable and mentally healthy as possible before you make any final decisions. The Association also includes what they refer to as "Readiness Criteria." These are much mushier and subjective evaluations by doctors, which include:

1. Demonstrable progress in consolidating the evolving gender identity.
   
   
2. Demonstrable progress in dealing with work, family, ad interpersonal issues resulting in a significantly better state of mental health (this implies an absence of problems such as sociopathy, substance abuse, psychosis, and suicidality, for instance).

If you jump through all these hoops, you'll finally be ready to face your potential surgery. Sexual reassignment surgery (SRS) is an expensive procedure that, for male to female transsexuals, is relatively successful. It can cost anywhere from $3,000 to $100,000 to get a sex change, none of which is covered under medical insurance. There are several parts to the surgery, which may any or all of the following: orchiectomy, penectomy, vaginoplasty, and augmentation mammoplasty.

A vaginoplasty involves the removal of the testes to create labia. It also involves the inversion of the penis to create a vagina -- this requires extensive surgery and many follow-up visits. The good news is that these newly constructed vaginas look amazingly like the real thing.

As for augmentation mammoplasty (that is, a boob job), it may be performed if the physician prescribing hormones, the surgeon, and the patient have all documented that after undergoing hormone treatment for two years, the patient is still not comfortable in his/her gender role.

Many male to female transsexuals also have cosmetic surgery to feminize their facial features and reduce the size of their Adam's apple. Other surgeries can include: suction-assisted lipoplasty of the waist, rhinoplasty, facial bone reduction, face-lift, and blephroplasty. It is important to remember, however, that most of these procedures are irreversible.

Some individuals choose to get some part but not all of the surgery, for financial or personal reasons. Hey, whatever floats your boat.

5. EMBARK ON YOUR NEW LIFE

Once you are happy with your new self, the possibilities are limitless. Whether you have decide to live as a woman merely through your clothing, or if you take hormones, or if you go for the full overhaul, you're hopefully feeling a little more comfortable with yourself.

The next big struggle is to learn how to deal with the social ramifications of your new life. Unless your sex change is part of your placement in the Witness Protection Program, you probably will know at least a couple of people (parents, close friends, parole officer) to whom you're going to have a bit of 'splaining to do.

Our first recommendation is that you join a support group in your area. This will help you meet other transsexuals who are in various stages of the exact same process, and it will give you a venue to vent any emotions you have. The websites listed at the end of this article all provide resources for finding such support groups.

Second, you must be prepared to answer questions about your operation and your feelings. People will ask you incredibly repetitive questions, such as:

Q: Can you have children?
A: "Only if I adopt them. I don't have a uterus or eggs, so I can't bear my own children."

Q: Will you get all PMS-y and stuff now?
A: "No. I don't have a uterus or eggs, so I won't menstruate. My bad moods will be legitimate."

Q: Why did you do it?
A: "Because this is who I am. This is who I'm supposed to be."

Of course, the answers won't be the same (we just put them in as potential suggestions), but you should definitely prepare a repertoire of answers for such questions. You'll also be asked intensely personal questions such as: "How did your parents react?" "Can you, you know, orgasm?" "Do you sleep with men or women?" These questions are nobody's business but your own, so don't ever feel obliged to answer anything. You'll figure out what level of information you're comfortable revealing and when you're comfortable revealing it.

Third, realize that most of the questions and comments you'll hear come from a real lack of knowledge, not meanness. Please be as tolerant of others as you'd like them to be of you.

Finally, NEVER be afraid to assert your own rights; you have just as much a right to a job, family, and life as anyone else has. So if you feel that you are experiencing any kind of discrimination, report it to the proper level of authority. In many companies, for instance, it is illegal to not hire someone because they had a sex change.

Here are those other sites we promised you. Poke around and learn some more:

www.transsexual.org
www.genderPAC.org
www.PFLAG.org
www.tgforum.com