What is the Gender Unit at IM CLINIC?
The Gender Unit at the Dr Ivan Mañero Plastic Surgery Institute is comprised of a multidisciplinary, intensively trained medical team. Not only do they possess great sensitivity but have extensive experience in the different techniques and specific, diverse surgical operations required for sex reassignment. They also offer surgical and medical techniques in face and body feminisation and masculinisation.
What is gender dysphoria or transsexuality?
In order to understand this concept we need to be familiar with the terms “sex”, “gender” and “gender identity”.
Sex: Every human being is born with a genetically predetermined biological sex. In the case of males, the sexual chromosome is XY, and for females, XX. Likewise, each sex develops a set of physical, biological, anatomical and physiological characteristics that will define that individual as a man or a woman.
Gender: This is the set of social, cultural, political, psychological and legal characteristics that society assigns people as typical of men and women. In other words, it is a sociocultural construct that has evolved throughout history, referring to the features that society attributes to what it considers “feminine” or “masculine”.
Gender identity: This encompasses the internal experiences, private sensations and subjective experience of a person regarding their own gender.
People do not generally question the concept of gender identity because a conflict rarely exists between it and their chromosomal sex. Nevertheless, some people experience a divergence between the sex they were assigned at birth and that which they experience, think and feel of as their own. These people, who experience suffering from the rejection their sexual anatomy causes in them and the role the latter implicitly infers in society, are called transsexuals.
So we define transsexuality as a disorder in an individual’s gender identity.
Transsexuality can be male or female. Male transsexuality refers to a person who is born with the biological sex and attributes of a woman, but who feels like a man. On the other hand, female transsexuality describes a person who is born with a male biological sex and attributes, but who feels like a woman.
Transsexual people no longer suffer when they dress, act and develop the social role that matches the gender with which they identify. In most cases, they need to receive hormone replacement therapy to feminise or masculinise their body, along with psychological support to help them overcome dysphoria and, eventually, surgery to remove the sexual or anatomical features characteristic of their biological sex and/or incorporate those of the opposite sex.
Lastly, it is important to clarify that transsexuality is not related to sexual orientation, that is, the attraction an individual feels towards another person due to their sex.
Transsexuality throughout history
Little is known of how transsexual people were treated in the past. Nevertheless, from neolithic societies down to current times, not forgetting the aborigines of Siberia or American Indians, transsexuality seemed to be an admitted fact and, in most ancient cultures, was assimilated by society.
However, after the rise of Western civilisation and with the introduction of the man/woman binary concept, disorders of identity or sexual orientation were pathologised – transsexuals and homosexuals (among other minorities) along with them. Any manifestation outside that binary view was persecuted, punished and forced into hiding.
In the 18th and 19th centuries, as a consequence of the growth of the movement of homosexuals, transvestites and transsexuals in the world, added to the appearance of regulations governing human rights, such identities were initially considered illnesses, for which a “cure” was demanded.
Towards the late 19th and in the early 20th century, various studies were undertaken, encompassing the terms we use today, such as homosexuality, transvestism and transsexuality, into what was called “sexual inversion”.
In 1923, a German sexologist called Magnus Hirschfeld developed the theory of the third sex or intersexual state, which he determined as an intermediate state between male and female. Notwithstanding, many of his works – revolutionary for the period – were destroyed and burnt on 6 May 1933 when the Nazis burned the library and destroyed the Institut für Sexualwissenschaft after coming to power.
From the 1950s onwards, thanks to professionals such as Cauldwell and Harry Benjamin, terms like homo/hetero/bisexuality, transsexuality, transgenericity and transvestism were separated into independent definitions. It was Harry Benjamin who in 1966 published the famous book The Transsexual Phenomenon, which became the precursor to what is called “tripartite therapy”, considered ideal for transsexual patients, alluding to the need for multidisciplinary contributions when approaching such patients.
The World Professional Association for Transgender Health (WPATH) is a professional organisation dedicated to the study and treatment of transgender people. The organisation was created in 1979 by Harry Benjamin and compiles standards of care for the health of transgender people (transsexual, transgender or gender-nonconforming people), while providing information for professionals and patients, sponsoring scientific conferences and offering ethical directives for professionals.
In 2011, WPATH published the seventh version of its Standards of Care for the Health of Transsexual, Transgender and Gender-Nonconforming people. The new regulations propose the following treatment options for these patients:
- Psychotherapy, whose aim is to maximise the transsexual patient’s psychological well-being, quality of life and personal satisfaction. It is important to clarify that under no circumstances does it try to change a person’s gender identity so that it is congruent with their birth sex but rather that psychological therapy seeks to alleviate dysphoria.
- Real-life test, which involves changes in the social expression of the person’s gender, such as living partially or fully in a gender role consistent with the gender identity they feel is their own.
- Hormone treatment, to masculinise or feminise the body.
- Surgery, through changes in the primary and secondary sexual characteristics, and genital gender confirmation surgery.
Transsexuality in children
WPATH’s Standards of Care discusses approaching manifest transsexuality during childhood and suggests deferring genital gender confirmation surgery while awaiting the arrival of adolescence before beginning a hormone treatment to delay puberty as soon as such changes begin, recommending that the patient has reached Tanner Stage II. Meanwhile, adolescents 16 years or older may be eligible to begin cross-sex hormone treatment.
Current legislation in the Autonomous Community of Catalonia
Catalan Law 11/2014 guarantees the rights of lesbian, gay, bisexual, transgender and intersexual people (LGBTI) and legislates to eradicate homophobia, biphobia and transphobia.
The president of the Government of Catalonia
“Let it be known to all citizens that the Parliament of Catalonia has passed and I hereby enact, in the name of the King, pursuant to the contents of Article 65 of the Statute of Autonomy of Catalonia, the following Law 11/2014, dated 10 October 2014, to ensure the rights of lesbian, gay, bisexual, transgender and intersexual people and to eradicate homophobia, biphobia and transphobia.”
Its Article 16 (“Health”), section (i), establishes: “Incorporate into the health system comprehensive care of transgender and intersexual people, in accordance with the current portfolio of services, taking into account its revision concerning scientific developments, and defining the access criteria both for hormone treatment and for surgical intervention. The will of the person affected should be taken into account in decision-making, whenever their life is not at risk or their health conditions will not be negatively affected, pursuant to current regulations. Insofar as legal minors are concerned, the right to the unhindered development of their personality and their capability and maturity in decision-making must furthermore especially be taken into account.”