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Whether hormonally induced changes, without surgical changes, are sufficient to qualify for the label transsexual, or whether a certain set of procedures to be fulfilled to be labelled transsexual is currently a debated topic, both among the transsexual and transgender community and health care providers. However, it is generally accepted (and is also evident in the Diagnostic and Statistical Manual) that if an individual expresses desire to be of the opposite sex, or to assert that one is of the opposite sex to which they were born, then that person is a transsexual.
Transsexual is one of a number of behaviours collectively referred to as transgender. Transsexuals should not be confused with cross-dressers or drag queens, which are transgender, but usually not transsexual. Also, transvestic fetishism has usually little, if anything, to do with transsexualism.
Those who have not undergone SRS are known as pre-operational ("pre-op") and those who have, post-operational ("post-op"). Some choose to describe themselves as non-operational ("non-op"), indicating that they have not undergone SRS, nor do they intend to do so (for personal or financial reasons).
For male-to-female (MTF) transsexuals, taking estrogens causes the growth of breasts, with concomitant enlargement of the nipples, and redistribution of body fat, among other changes. Permanent removal of unwanted body hair is accomplished with electrolysis or laser hair removal[?]. For female-to-male (FTM) transsexuals, taking androgens (i.e. testosterone) causes a shrinking of breasts, usually some enlargement of the clitoris, growth of body and facial hair, and redistribution of body fat, deepening of the voice, further muscle development and conditioning, among other changes. Some individuals choose to self-administer their medication ("do-it-yourself"), often because available doctors have too little experience in this matter, however this route is potentially dangerous.
Generally speaking, physicians who perform sex-reassignment surgery require the patient to live as the opposite gender in all possible ways for at least a year ("cross-live") prior to the start of surgery in order to assure that they can psychologically function in that life-role. This is part of a battery of requirements. Most professionals in the USA who provide services to transsexuals follow the controversial Standards of Care for Gender Identity Disorders put forth by the Harry Benjamin International Gender Dysphoria Association. Outside the USA, many other SOCs, protocolls and guidelines exist, although the Harry Benjamin SOCs are certainly the best known.
The sex-reassigment surgery, then, is not always completed in a single session but requires multiple procedures and surgeries. For a male to female transsexual, the testicles are removed and the penis may also be removed (penectomy) as in the colovaginoplasty or sigmoid colon procedure (usually performed when the following option is not feasible), or retained and inverted within the abdominal floor to construct the neo-vaginal barrel. For additional vaginal depth, pubic hairs are removed from scrotal tissues via electrolysis prior to the SRS procedure which is then incorporated by the surgeon to extend the vaginal shaft where penal tissues alone were found insufficient. For a female-to-male transsexual, a penis is constructed, and the labia (see vulva) are united to form a scrotum, with prosthetic testicles being inserted.
Many Western societies today have some sort of procedure whereby an individual can change their name, sometimes also their legal gender, to reflect their gender identity. Medical procedures for transgendered people are also available in most Western countries. However, because gender roles are an important part of many cultures, those engaged in strong challenges to the prevalence of these roles, such as many transgendered people, often have to face considerable prejudice. One such case is chronicled in the movie Boys Don't Cry.
A few persons undergoing sexual reassignment surgery will adopt or provide foster care for children in the corresponding sex role which they have assumed. Societies are in some instances challenged to assimilate these men and women into their social institutions such as marriage and the role of parenting. Also, often children exist from the time before SRS. Many of these children stay with their transgender parent. A recent report shows that this does not harm the development of these children in any way.
Style guides used to publish more accurate information about the public and private lives of individuals pursuing or having changed gender and/or undergone sexual reassignment surgery to assist journalists or news reporting agencies to use the appropriate pronouns. Family members often confused about pronoun usage or the definitions of sex are frequently corrected by either the transsexual or the professionals who assist them as they approach that point at which they begin to "pass" as a member of the sex they wish to adopt. After this level of transition and development has been achieved, many transsexuals may wish to blend back in with other members of their new sex and will avoid revealing their past preferring the relative peace and security they find on the other side of a stressful and potentially dangerous transition.
Families with a young member who is trans or trans curious and who has chosen to transition between the sex roles through dress and behaviors may decide to relocate their child and home to another area in order to afford the young person the best opportunity to live in the desired gender role and among a new set of peers and a community to whom they have had no previous acquaintance. Choosing to remain and live within an intolerant society where the local community has had previous experience of the child's birth sex may raise many challenging issues. Gwen Araujo of Newark, California is such a young person who had attempted to cross live in the gender opposite the sex to which she was born (male). She became the victim of violent crimes that resulted in her death, as she attended a party where it was discovered that she was in fact anotomically male.
Ma Vie En Rose (http://www.sonypictures.com/classics/mavieenrose/) (1997), by Alain Berliner, depicts a similar scenario including a trans curious youth who's gender play brings about both family and community conflicts causing them to relocate to a new community.
The necessitiy to relocate, however, depends very much on the social environment. There are also several cases where this was not necessary, particularly in Western Europe. If it is at all possible, this is of course the best solution for the family.
As with every transition, in children and in adults, "experts" often raise the spectre of transitions gone wrong, that is people transitioning back to their original sex. These cases do in fact exist, however, every recent study done on the number of these cases states that their number is below 1%, and that the reasons for retranstioning are very diverse. See this article (http://www.symposion.com/ijt/ijtc0502.htm) for examples.
Compare to: transgender, intersexual, autogynephilia
See also: Legal aspects of transsexualism, transphobia, gender identity disorder, List of transgendered people, Heteronormativity
Youth
Female-to-Male (FTM)
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