Everybody is born with a gender identity that may be male or female. In a natural way, that identity tends to manifest itself in early childhood, when the boy or girl begins to understand the “I” concept and to identify as a member of one gender or the other. This is when they discover that their anatomy does not match their gender. In the case of the male transsexual, they feel like a boy despite having been born with female biological and chromosomal sex.
So a male transsexual is defined as a person born with the sex and attributes of a woman but who identifies as a man.
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 phalloplasty or metoidioplasty, 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 extremely important in the processes of both anatomical and psychological transition of adults with gender identity disorders. From a medical viewpoint, these hormones are necessary for a person’s adaptation to their new gender.
When the patient follows the treatment prescribed by the specialist, they feel like and more closely resemble members of the gender they desire to be.
As has been shown, male transsexual patients undergoing hormone treatment experience certain changes.
The most habitual are:
- A lower tone of voice
- Greater upper body force
- An increase in weight
- Reduction in adipose volume in the hips (the accumulated fat in this region decreases)
- Increase in facial hair
- Increase in body hair
- Baldness in a similar distribution to males
- Mild atrophying of mammaries
- Permanent enlargement of the clitoris
- Greater sexual interest
- Greater capacity for arousal
It is possible that the maximum effects do not occur until one or two years after hormone treatment is started. Each patient’s response to this treatment depends on their genetic inheritance.
The patient’s psychological monitoring is essential in diagnosing a true case of transsexuality or gender dysphoria, while dismissing partial or transitory gender identity disorders and 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 male role. He or she will assess the suitability of continuing or abandoning hormone treatment and genital gender confirmation surgery.
Furthermore, the psychologist or psychiatrist can demand that the patient continue with psychotherapy during the period of real-life experience.
Real-life test: male role
Genital gender confirmation surgery (GGCS) produces irreversible changes. So it is extremely important that the patient’s transsexuality or gender dysphoria is real and not a transitory dysfunction.
Before GGCS it is essential to have successfully surpassed the real-life experience for at least 12 continuous months. The existence of periods of regression to the original gender may indicate indecision over whether the patient truly wishes to undergo the operation or not. In such cases he should not undergo GGCS and the mental health professional should re-evaluate the patient.
What is role acceptance or real-life experience?
Real-life experience 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 they must behave as a man in each and every one of the situations that occur daily and make that circumstance the axis of their everyday life.
Even if many patients already do so naturally, there are others who must change their name to a man’s name, dress and style themselves suitably, modify their behaviour, refer to themselves in the male 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 man and feel confident in themselves. Having family or social support is very important for anyone going through this process.