In 1953 an ex-GI who journeyed to Denmark for a "sex-change operation" made headlines. She became known as Christine (formerly George) Jorgensen. Since then, thousands of transsexuals have undergone gender-reassignment surgery. Among the better known is the tennis player Dr. Renee Richards, formerly Dr. Richard Raskin.
Gender-reassignment surgery cannot implant the internal reproductive organs of the other gender. Instead, it generates the likeness of external genitals typical of the other gender. This can be done more precisely with male-to-female than female-to-male transsexuals. After such operations, people can participate in sexual activity and even attain orgasm, but they cannot conceive or bear children.
Transsexuals experience gender dysphoria. That is, according to John Money (1994), they have the subjective experience of incongruity between their genital anatomy and their gender identity or role. They have the anatomic sex of one gender but feel that they are members of the other gender. As a result of this discrepancy, they wish to be rid of their own primary sex characteristics (their external genitals and internal sex organs) and to live as members of the other gender. Transsexualism is thought to be rare. Experts estimate the number of transsexuals in the United States to be about 25,000. Perhaps 6,000 to 11,000 of them have undergone gender-reassignment surgery (Selvin, 1993).
Patterns of sexual attraction do not appear to be central in importance. Some transsexuals report never having had strong sexual feelings. Others are attracted to members of their own (anatomic) gender. They are unlikely to regard themselves as gay or lesbian, however. From their perspective, their lovers are members of the other gender. Still others are attracted to members of the other anatomic gender. Nonetheless, they all want to be rid of their own sex organs and to live as members of the other gender.
No clear understanding of the nature or causes of transsexualism has emerged (Money, 1994). Views on its origins somewhat parallel those on the origins of a gay male or lesbian sexual orientation, which is surprising, given the fundamental differences that exist between the two.
Psychoanalytic theorists have focused on early parent-child relationships. Male transsexuals, in this view, may have had "close-binding mothers" (extremely close mother-son relationships) and "detached-hostile fathers" (fathers who were absent or disinterested) (Stoller, 1969). Such family circumstances may have fostered intense identification with the mother, to the point of an inversion of typical gender roles and identity. Girls with a weak, ineffectual mothers and strong, masculine fathers may identify with their fathers, rejecting their own female identities.
There is some evidence that male transsexuals tend to have had unusually close relationships with their mothers during childhood. Female transsexuals tend to have identified more with their fathers and to have perceived their mothers as cold and rejecting (Pauly, 1974). Yet one problem with the psychoanalytic view is that the roles of cause and effect may be reversed. It could be that in childhood, transsexuals gravitate toward the parent of the other gender and reject the efforts of the parent of the same gender to reach out to them and engage them in gender-typed activities. These views also do not account for the many transsexuals whose family backgrounds fail to match these patterns. Moreover, these views lack predictive power. Most children--in fact, the vast majority-with such family back-grounds-- do not become transsexuals.
Transsexuals may also be influenced by prenatal hormonal imbalances. The brain is in some ways "masculinized" or "feminized" by sex hormones during prenatal development. The brain could be influenced in one direction, even as the genitals are being differentiated in the other direction (Money, 1987a).
Gender reassignment for transsexuals has been controversial since its inception. Yet psychotherapy is not considered a reasonable alternative, because it has been generally unsuccessful in helping transsexuals accept their anatomic genders (Roberto, 1983; Tollison & Adams, 1979).
Surgery is one element of gender reassignment. Since the surgery is irreversible, health professionals usually require that the transsexual live openly as a member of the other gender for a trial period of at least a year before surgery.
Once the decision is reached, a lifetime of hormone treatments is begun. Male-to-female transsexuals receive estrogen, which fosters the development of female secondary sex characteristics. It causes fatty deposits to develop in the breasts and hips, softens the skin, and inhibits growth of the beard. Female-to-male transsexuals receive androgens, which promote male secondary sex characteristics. The voice deepens, hair becomes distributed according to the male pattern, muscles enlarge, and the fatty deposits in the breasts and hips are lost. The clitoris may also grow more prominent.
Gender-reassignment surgery is largely cosmetic. Medical science cannot construct internal genital organs or gonads. Male-to-female surgery is generally more successful. The penis and testicles are first removed. Tissue from the penis is placed in an artificial vagina so that sensitive nerve endings will provide sexual sensations.
Source: Essentials of Human Sexaulity: . Rathus S.A.,. Nevid Jeffrey S, Finchner-Rathus L, Allyn and Bacon, 1998