Everybody is born with a gender identity that may be male or female. That identity tends to manifest itself naturally in early childhood, when the boy or girl begins to understand the “I” concept and identify as a member of one gender or the other.
In the case of the female transsexual, they feel like a girl despite having been born with male biological and chromosomal sex. So a female transsexual is defined as a person born with the sex and attributes of a male but who identifies as a woman.
As mentioned above, in its Standards of Care for the Health of Transsexual, Transgender and Gender-Nonconforming People, WPATH proposes criteria for the surgeries that transsexual patients undergo.
In the case of vaginoplasty, the criteria it proposes are the following:
- Persistent, well-documented gender dysphoria
- Capacity to make a decision and fully informed consent to treatment
- Be a legal adult in the country concerned
- If there are medical or psychological problems present, they should be under reasonable control.
- Twelve continuous months of hormone treatment appropriate to the patient’s gender goal (unless there are medical contraindications or the patient cannot take hormones)
- Twelve continuous months of real-life experience in the role of the gender that is consistent with their gender identity.
Below, we describe the recommendations for hormone treatment, real-life experience and the psychological evaluation that every transsexual patient must undergo to embark on genital gender confirmation surgery.
Hormone treatment is very important for transsexual patients, both in the anatomical transition process and the psychological process.
In all cases, the hormone treatment must be prescribed by a doctor specialising in endocrinology, who will provide evaluation, adjust the dosage required in each case in particular, evaluate the risks for each patient and conduct the appropriate monitoring.
The final aim of hormone treatment for the female transsexual patient is to attain a hormonal environment similar to a biological woman, through which she will moreover acquire features typical of the female sex.
During the hormone treatment, the patient will experience the following changes:
- Growth of mammaries
- Softer skin
- Reduction in body hair
- Fat redistribution (giving her a feminine appearance)
- Delay or interruption of the hair loss process
- Reduction of strength
- Reduction in fertility
- Reduction of testicle size
- Less firm and less frequent erections
To undergo genital gender confirmation surgery, WPATH recommends that the patient has received hormone treatment appropriate to the patient’s gender goal for 12 continuous months (unless medical contraindications exist, or the patient cannot or prefers not to take hormones).
It is important to clarify that after genital gender confirmation surgery, it is generally necessary to maintain hormone treatment for life, although at lower doses.
Adverse effects. It must be remembered that an excessive dosage can cause hepatic (liver) problems, while total abandonment after surgery may give rise to osteoporosis, among other problems.
Psychological and psychiatric analysis
Psychological monitoring of the patient is essential in diagnosing a true case of transsexuality and dismissing partial or transitory gender identity disorders, as well as other psychiatric alterations that may arise when altering the perception of reality.
A mental health professional (psychologist or psychiatrist) is the right professional to guide the patient towards accepting their new female role. He or she will assess the suitability of continuing or abandoning hormone treatment and genital gender confirmation surgery
Furthermore, they can demand that the patient continue with psychotherapy during the period of real-life experience.
Real-life test: female role
Genital gender confirmation surgery produces irreversible changes. It is therefore an indispensable requirement to dismiss any transitory sexual identity disorder.
As mentioned above, WPATH recommends 12 continuous months of real-life experience in the role of the gender that is consistent with their gender identity.
What is real-life experience?
Acceptance of the role means that the patient must live, for a minimum of one continuous year, as a person of the gender to which they wish to belong. This means that they must live as a woman in each and every one of the situations they face daily and make that circumstance the core of their day-to-day life. Even if many patients already do so naturally, there are others who must change their name to a woman’s name, dress and style themselves suitably, modify their behaviour, refer to themselves in the female gender and change their way of speaking, among other things.
This can cause some problems at first, especially in job, family and social settings. However, it is an essential process in any transsexuality diagnosis, both if the patient decides to undergo the operation or continues solely under hormone treatment. Breaking the barrier that society imposes will allow them to fully develop as a woman and feel confident in themselves. Having family or social support is very important for anyone going through this process.