WHY DO I FEEL THAT I AM TRAPPED IN WRONG BODY?
To understand this, we have to understand the difference between sex and gender. While ‘sex’ represents physical differentiation as male or female, indicated by the external appearance of body, ‘gender’ is the psychological recognition of self, and wish to be regarded by others, as fitting into the social categories such as boy/man or girl/woman. In short, a person’s sex is what one is seen as (external appearance as male/ female) and gender being the identity is what one feels (playing the role of and living the life of male/ female). Experience of a discord by a person, between his/her sex and gender is known as gender dysphoria. Transsexualism is the most extreme form of this disorder. These individuals feel themselves to be trapped in the wrong body (transsexual phenomenon). They have a strong sense to change their external appearance with hormones and surgery to bring it into alignment with their gender identity.
CAN MY CONDITION BE CORRECTED?
Yes. Gender, being genetically hardwired into brain, is not subject to change (reassignment). It can at best be confirmed (affirmed) by bringing the external appearance (sex) of the person to become congruent with his/her gender. There are many terms coined for sex change surgery, such as sex reassignment surgery, gender reassignment surgery, sex reconstruction surgery, sex affirmation surgery, feminizing or masculanizing genitoplasty. Thus, the most appropriate term may be gender affirmation surgery (GAS). Transsexuals undergoing female to male (FTM) transition are known as transmen and those undergoing male to female(MTF) transition are known as transwomen.
HOW COMMON IS THIS CONDITION? AM I THE ONLY ONE?
The prevalence of transsexualism in the Netherlands is estimated to be 1:11900 males and 1:30400 females. In Sweden, it is 1:37000 among males and 1:30000 in females. The estimates for USA are 1:100000 for males and 1:400000 for females. No definite figures are available for India. However, with better awareness, diagnosis and treatment now available, more persons are coming forward for treatment. On an average, we receive around 30-35 new persons every year.
WHY AM I LIKE THIS? IS IT MY FAULT?
The answer is no. From an early age, people develop a sense of being male or female, their gender identity. Transsexuals however identify themselves with a psychological sex, opposite to their physical sex and hence feel trapped in the wrong body. Recent research indicates that there may be a neural and genetic basis for this phenomenon. Transsexualism is strongly associated with unusual neurodevelopment of brain at the foetal stage. Many sexually dimorphic nuclei have been found in hypothalamus in brain. One of these is the central subdivision of Bed nucleus of Stria Terminalis (BSTc). In human males, the volume of this nucleus and its number of neurons is twice compared to females. In transsexuals, this nucleus had a sex reversed structure, i.e. in transwomen, it was similar to female controls and vise versa. This would suggest a neurologic basis to transsexualism. Dr. Eric Vilain discovered 54 genes that link to gender. 18 of these genes are produced at a higher level in males and 36 in females. There is activation of these genes, earlier to the SRY genes in Y chromosome, responsible for testosterone production and hence masculinization of foetus. This refuted the earlier held belief that fetal brain only needed exposure to testosterone to become male. In another study DNA samples were collected from 112 transwomen and genetic differences were compared with non transsexuals. It was discovered that transwomen were more likely to have longer version of a gene which is known to modify the action of testosterone. These genetic differences may reduce testosterone action and reduce the masculinization of brain during foetal development. Hence there is a genetic basis for gender and this identity evolves even before the production of sex hormones and sexual differentiation as a male or female.
WHAT SHOULD I DO? HOW SHOULD I PROCEED?
You should contact our Gender Team. We have a team consisting of Plastic Surgeons, Mental Health Professionals (Psychiatrists) and Endocrinologist, for the purpose. Before starting treatment, certain conditions must be met and criteria satisfied. These are -
To meet our coordinator/ contact person for charting a course of treatment. Depending on availability, you may also be able to meet a person, who has completed his/her transition to preferred sex.
A get a firm diagnosis for the transsexual condition. This is established by our team of mental health professionals (psychiatrists).
To meet the Plastic Surgeon and get an idea regarding the surgeries involved. In a case of female to male transsexual (transman), the surgeries are bilateral breast reduction, removal of female internal organs and construction of male organs. In a male to female transsexual, the surgeries are breast augmentation, removal of external male organs and construction of female genital organs. However, the surgeries are not limited to these and more may be done as per requirement.
To meet the endocrinologist. He will explain to you the pros and cons of hormone therapy, assess your suitability for the same, start you on hormone therapy and monitor for any side effects. Trans -sex hormonal treatments are important for a smooth gender transition, both physically and psychologically in selected individuals with gender identity disorders. In the absence of a natural source, hormone therapy is medically necessary for successful living in the role of patient’s new sex. When physicians administer androgens to biologic females and estrogens, progesterone, and testosterone -blocking agents to biologic males, patients feel and appear more like members of their preferred sex.
To get the necessary investigations such as blood work and x rays done.
To meet the designated lawyer, for getting necessary affidavits.
After a suitable period, depending on above, surgeries can be carried out.
Genital Surgery (Penis, Scrotum and Urethra Reconstruction) in a female to male transsexual.
Bilateral Breast Reduction (Subcutaneous Mastectomy) in a female to male transsexual.
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