From TerraNet, San Juan Capistrano, CA (714) 248-2836

               TRANSSEXUAL GUIDE
                      A J2CP Pamphlet



     The historical  records of  human behavior clearly indicate that
transsexualism existed long before it found a name.  But until modern medicine
recognized, defined, and developed therapies for this condition, the transsexual
was left to cope with his1 difficulties by more or less unsatisfactory, and often
tragic, means of his own devising.  The individual whose firm conviction that the
sex which his body expresses contradicts the sex to which he feels himself to
belong need no longer resign himself to this predicament.   Skilled professional
help is now available to him, help that is given with understanding and free from
false moral judgments.
           
     The course of sex reassignment is a  complex one, involving many physical, 
social and  emotional readjustments.    It is  an  ongoing process, of  which
surgery, while it  is the culmination,  is but one  of many essential  elements
of transformation.   Once your  physician  makes  a diagnosis  of  transsexualism, 
he will require, and you should require of  yourself, that the way toward  surgery
be  carefully prepared,  in order  to eliminate  possible  practical problems  and 
embarrassments,  and  the  more  serious  possibility of belated doubts, which 
might otherwise arise after  surgery has been performed.  Even after the
successful completion  of surgery, certain  physical and  emotional precautions
must  be  taken, to ensure your continuing health and well-being.

     The  forgoing reminders were not set  down to discourage you from seeking
help, but  with the object of promoting  a realistic  approach to  therapy.   Most
instances  of difficulties in  post-surgical  adjustment  to sex  reassignment 
may be  attributed to careless  or  insufficient  preparation.    On  the  other
hand,  physicians report marked  success in the  vast majority of  cases  where
preparation has been intelligent and thorough. 
           
    This booklet is designed to inform you s to how you may best  help yourself,
and obtain the best  possible help from others, in  building a new life.
           
                         SELF HELP
           
          THE TRIAL PERIOD
           
               No part  of your  preparation for  sex reassignment  is more
          important than  the first-hand  experience of dressing,  working,
          living   in  the  desired  gender  role   for  a  continuous  and
          considerable  period  of time  prior  to  surgery.   Most  gender
          identity  clinics,  and  many  physicians  in  private  practice,
          require  from one  year to two  years of  constant 24 hour  a day
          cross-gender  experience   before  recommending  a   patient  for
          surgery.
---------------------------------------------------------------           1 
Masculine pronouns are used throughout, unless the genetic  female is  
referred  to specifically, for the sake  of clarity.
---------------------------------------------------------------

           This may seem an  excessively long period to you  before you
          begin,  but  experience  has  shown  that  no other  test  is  so
          effective  in  preventing the  tragedy  of a  wrong  decision for
          surgery, the results  of which  are irreversible.   On the  other
          hand, there is no better means of laying the groundwork for every
          aspect of your  new life, and  strengthening your confidence  for
          it, than this preparatory period.
           
               It will  be helpful  to review  two typical  cases in  which
          people  who considered  themselves  transsexuals decided  against
          surgery as a direct result of their cross-gender experience.

               A married man who occasionally wore women's clothing when he
          accompanied his  wife to  nightclubs, and  who found  intercourse
          more pleasurable when  he dressed in  feminine lingerie, began  a
          trial period in which  he lived alone and wore  feminine clothing
          consistently.   One evening,  he picked up a  man and brought him
          home.  Far from  finding sexual relations more satisfying,  as he
          had expected, the experience was very  distressing to him.  Later
          he found himself  missing his  wife, who was  sympathetic to  his
          intermittent  desire  to cross-dress,  and  the life  they shared
          together.  Finally, he  returned home with relief, thankful  that
          he  had  not  taken prematurely  a  decision  that  could not  be
          reversed.  Counselors  should recognize that  this man was not  a
          transsexual, but a transvestite, whose final decision reflected a
          realistic adjustment to that condition.

               Another man, who lived with a  male lover decided to prepare
          himself for transsexual  surgery.  He  was of slender build  and,
          with his delicate  features and tasteful grooming,  presented the
          appearance of an  attractive  young woman when "dressed."  It was
          necessary for him  to leave  his high-salaried professional  job,
          and he found  employment as a secretary  in the same field,  with
          considerable  loss of  income  and of  the mental  stimulation he
          previously enjoyed in his work.  This man was accepted completely
          as a woman, socially  in his office, and on the  street, where he
          attracted many admiring  glances from men.   Yet he decided  that
          surgery was not for him.  Why?

               As  Bill  tells  it, "This  is  definitely  a  mans's world,
          whatever they say about Women's Lib.  I just couldn't get used to
          that  condescending  manner most  men have  toward  women.   If I
          offered an  opinion  to any  of the  bosses at  work,  even on  a
          subject  I  knew a  lot  more about  than they  did,  they either
          ignored me or let  me know that I was  out of line.  At  a party,
          when the men were talking about  something that interested me, it
          was  the same thing.  And if I  saw a man there who attracted me,
          he backed away if I took the initiative."

               "And of course living on so much less than I was used to and
          counting  pennies  was hard  to  take.   And  all because  I wore
          skirts!   When I went to  see Dr. X, I wanted  to operation right
          away, and I couldn't understand why he insisted I give it a trial
          first.   Now,  am  I glad  he did!    Surgery would  have been  a
          terrible mistake for  me."  Bill has  found himself a new  job at
          his  original  status,  and  accepts  his homosexual  nature  and
          relationships more fully than he ever did before.

               Apart from  winnowing out those  who would not  benefit from
          sex  reassignment,  the  trial  period  serves  several  positive
          functions  for  those who  would.   No  matter how  powerful your
          personal conviction that you are trapped in the body of the wrong
          sex, nothing can  reinforce your confidence in this conviction as
          effectively as the experience of being treated as a member of the
          gender of choice  -- all day,  every day,  by everyone you  meet.
          Continuous daily practice in the new  role, socially and at work,
          is essential for  the development of  the habit patterns and  the
          inner assurance  that will  evoke this  gratifying response  from
          friends and associates.

               As certain as you may be of your inner identity, and even if
          many of your behavior  patterns already conform to it,  there are
          likely to be  a number of subtle ways of expressing gender -- for
          example, choice of  words, and loudness  or pitch of laughter  --
          that only  observation and  practice can  perfect.   Furthermore,
          some of the social adjustments that made problems for Bill may at
          first trouble you  to some degree, until  you find a way  to live
          with them.   It is essential,  then, that the cross-gender  trial
          period  be long  enough  to allow  you  to overcome  awkwardness,
          establish   new  behavior   patterns,  and   approach  unfamiliar
          situations with  an  unforced  inner confidence.    If  you  have
          achieved  this,  the moment  will  have  arrived for  surgery  to
          confirm the bodily changes  for which you have so  well prepared.
          Yet, perhaps as  many as  90% of  people who, at  one time,  were
          totally and strongly convinced that surgery was THE answer change
          their mind --  not necessarily because of  a psychotherapist, but
          because the real life experience of trying cross-living proved to
          not be the answer they were seeking.  Hopefully,  of course, this
          change of mind occurs BEFORE irreversible surgery.

          PREPARING YOURSELF

               Younger  transsexuals generally  have  an  easier time  than
          older transsexuals in easing into the new role, since their peers
          tend  to be more accepting and to hold more generous and flexible
          concepts  of  gender identity.   In  addition,  people in  a more
          advance age  group usually have  more at  stake, emotionally  and
          economically, in making the change.  They may have to disentangle
          themselves from marital commitments, and sometimes they will have
          to forfeit  an advance  career, with  the higher  income and  the
          professional status to which they have  become accustomed.  It is
          also true  that our  masculine  and feminine  habits become  more
          ingrained with time.   Moreover, transsexuals, such  as teachers,
          whose  jobs require them  to work under the  public eye, may even
          have over-compensated  (i.e., exaggerated their manner  and dress
          to  conform  with their  officially recorded  sex)  as a  form of
          protective camouflage.  This is not to say that modes of behavior
          cannot be altered later in life.   It simply means that the older
          transsexual may have to work a little harder and  longer than may
          his younger counterpart.   Many  gender identity clinics  require
          that the older transsexual  have a longer real life  trial period
          (2-3  years)  than  the younger  patient.    This  is often  very
          necessary and important even though the older patient often feels
          that  because  his time  "is running  out"  he should  be granted
          surgery even faster than the younger patient.

               It is  not advisable  to postpone  your testing  of the  new
          identity  until  the  hormones  administered  by  your  physician
          produce adequate physical changes.  Like an actor preparing for a
          new role, hold our rehearsals in private, consulting your  mirror
          and perhaps using  a tape  recorder, and then  try several  dress
          rehearsals before holding your first public performance.  A close
          friend or  friends, visiting  with you  for an  evening at  home,
          might be  your first audience.   For your next effort,  you might
          arrange  to spend a  weekend away from home  with a friend, going
          out with him in  cross-dress only in the evening.   When you feel
          more fully prepared and confident--and this  is a moment only you
          will recognize--take a walk in daylight  in a public place.   You
          will know that your performance is  successful if no one you pass
          turns to take a second doubtful look as you go by.
               The idea,  basically, is  don't burn  bridges until  you are
          absolutely sure you won't  need to get  back.  (Remember that  as
          many as 90% of self-diagnosed transsexuals do change  their mind,
          and  every single one of them would  probably have been angry and
          insulted if anyone had dared suggest that they might change their
          mind--that  is, until  the real  life cross  gender trial  period
          showed them with  their own eyes  that changing sex didn't  solve
          the problem.)

               Not burning bridges here means that the patient should first
          cross-dress  in  private, then  in front  of close  and accepting
          friends, then in front  of strangers (try the shopping  center in
          the next  town where  you won't be  recognized in  case you  just
          aren't  convincing  enough  yet),  then  closer  to  home--before
          announcing  to   the  world   (family,  friends,   neighbors  and
          coworkers)  what you  are preparing  to do.   It  is sometimes  a
          tragic mistake to lose family and  job by prematurely dressing in
          public, and then  finding out you  just can't make  it, or  don't
          like it, in the new gender role.

               It  has been observed  that some male-to-female transsexuals
          tend to over-do  in makeup and  dress.   It is always  advisable,
          when you are uncertain, to understate rather than exaggerate your
          appearance, which might  otherwise attract  undue attention.   If
          you are  now fairly sure of yourself, but still have some doubts,
          you may decide to take  a course in grooming.  This,  too, may be
          accomplished during the trial period.

               A charm or model  school can offer good guidance  in helping
          you to polish your  mannerisms and in providing tips  on behavior
          in  various  social situations.    (Beauty schools  usually limit
          their instruction  to hair-dressing  and makeup techniques;  they
          will not be as useful for your purposes.)  In enrolling in such a
          school, use your judgement  about confiding in the director.   As
          with people  in any walk of  life, some may  be unsympathetic and
          reject your application,  while others will be  more cooperative,
          and perhaps arrange for you to be instructed privately.

               Above all, realize  that most people  will take you at  face
          value without speculating about your sexual status, especially if
          you are not  apologetic in your manner.   You can  reinforce this
          awareness by taking  note of how  many hairy, muscular women  and
          how   many  beardless,   somewhat   feminine-appearing  men   are
          unquestioningly accepted  as members of their genetic  sex by the
          people around them.   Few individuals physically  approximate the
          masculine or feminine  ideals of the magazine  ads and television
          commercials.  The  key to  being accepted by  others is your  own
          self-acceptance.   Remember that  the confidence  with which  you
          approach them will be the determining factor in their response to
          you.

               In  a later section,  we will  discuss the  physical changes
          achieved through  hormone therapy,  which you  will be  receiving
          during the  preoperative period.   You  will  find these  changes
          highly  beneficial  in  reinforcing   your  confidence  and  your
          acceptance by others.

          ADDITIONAL TIPS

               Hormones will  effect some important physical changes during
          the preoperative period, but there are  other steps you will want
          to  take  to  improve your  appearance  in  the  new role  before
          surgery.

          [Female to Male tips not transcribed.  LH]

          Male-to-Female Transsexuals

               The penis may be concealed by bending it backward toward the
          anus and  securing it  with surgical  or masking  tape or  gauze,
          covered with a kotex pad.  A girdle is then worn to secure it  in
          place.  Loose pants or shirts will help hide the crotch.

               Avoid the use of  public restrooms whenever possible.   When
          this is  not feasible, always urinate  in a seated position  in a
          locked cubicle.  If you stand, your head may be seen over the top
          of the door,  or it  may be  noticed that your  feet are  pointed
          toward instead of away from the commode.

          POSITIVE ATTITUDES

               Other people can be of assistance to you in many ways during
          your transition to  the new role,  particularly if their help  is
          intelligently  sought   and  gracefully  received.     Experience
          physicians  will  provide   the  essential  medical  care.     An
          understanding friend, relative or employer, even if you know only
          one such person, can offer invaluable moral or practical support.
          Some  physicians  and  counselors   who  specialize  in  treating
          transsexuals  schedule  regular  group  meetings  in  which their
          patients meet to discuss  their mutual problems and benefit  from
          shared experiences.   But it  is a  mistake for anyone  to depend
          solely upon others for help in surmounting his problems.  Indeed,
          if it becomes  apparent that we  are not meeting  our friends  at
          least half  way, by  showing initiative  and courage  on our  own
          behalf, their inclination to be of help may quickly diminish.

               "Why  me?"  is the  question  so  often asked  by  people in
          trouble.   Perhaps it is  a question  which at  first one  cannot
          avoid asking.   But nothing is more certain than that no one hold
          the  key to the  inequities of human  fortunes -- why  some of us
          suffer  material  want  while others  are  over-endowed  with the
          world's good, why  some have a  greater share of physical  beauty
          and others less.  WE must all ultimately acknowledge the futility
          of  such  questions,   accept  our   circumstances,  and  go   on
          energetically from  there, doing  the best  we can  with what  we
          have, without a  chip on our  shoulder that just turns  potential
          new friends off.

               Whatever our religious beliefs, or lack of them, the Book of
          Job  tells  the story  that  for  as  long as  Job  persisted  in
          lamenting his fate, his troubles, which  at first seemed so great
          they could grow  no worse, grew greater  still.  when at  last he
          came to  the end  of lamentation,  and accepted  himself and  his
          circumstances, he found in himself the strength to rebuild a life
          that had seemed ruined beyond repair.

               Although other people can help us, as we can help them, each
          one  of  us must  learn  to  look  inward,  to discover  his  own
          resources and to  depend primarily upon  them.   Those of us  who
          enjoy  a faith  in  God, or  in  a  reality that  transcends  the
          personal, may  find  strength  in  this  belief;  but  even  this
          orientation may not be  one of utter dependency.   Most religious
          philosophies embody the awareness that  "God helps those who help
          themselves."

               How  we  regard  ourselves  suggests  to others  what  their
          attitude toward us  should be.   If the  transsexual persists  in
          thinking of himself  as essentially  crippled, in  a physical  or
          emotional sense,  it is probably  that this  feeling will  infect
          others in their reactions to him.  If, on the other hand, he more
          realistically  regards himself  as  an individual  with  problems
          which can be remedied, and  actively applies himself to obtaining
          the help  which  is available  to  him, this  constructive  self-
          acceptance  will  stimulate  in  other   people  an  enthusiastic
          response that will reinforce his own efforts.  

               negative thought  patterns can  be as  damaging as  negative
          actions  to the  person who  indulges in them.   Learn  to divert
          yourself  from the  self-destructive  mental  repetition of  your
          problems by turning your attention  to some constructive activity
          the  moment  you become  aware that  your  thoughts are  taking a
          negative turn.  Arrange to meet a friend or pick up a  good book.
          Learn some simple handicraft, like crewel work, for example, with
          which  you  can  quickly occupy  yourself  at  difficult moments.
          There can be  unusual gratification in using  your own misfortune
          to help you grow in compassion toward others who may be even less
          fortunate than you.

               Make a virtue of the common necessity of working at a job to
          discharge your medical and living expenses.   During the hours in
          which you apply yourself to your work,  you will generally be too
          busy to drift into negative thoughts.  Remember that no matte how
          humble the work you do, it  produces a product or serves a  need,
          and the salary you earn each day carries you closer to your goal.

               In  summary:    Your  personal  program  should  be  one  of
          constructive thought reinforces with constructive action.

          PREPARING OTHERS

               One  important  way in  which you  can  smooth the  path for
          yourself is to carefully prepare those  with whom you are closely
          associated for  the changes to come in your  life.  Except in the
          case of those friends  and relatives you are fairly  certain will
          be  inclined  to  support your  decision,  it  would  be wise  to
          postpone discussions until you are well along in the trial period
          and you  and your counselor are  in agreement that you  have made
          the right choice.

               It  cannot be too strongly  stressed that it  is in your own
          best  interests  to  approach others  with  the  utmost  tact and
          forethought  when  the  time  comes  to  talk  over  your  plans.
          Professionals who have worked with transsexuals can cite numerous
          instances  in which families and employers  have been shocked and
          alienated on seeing a familiar person abruptly appear before them
          in unfamiliar guise, when  at least in some cases,  a sensitively
          prepared discussion before he appeared  in cross-dress would have
          kept a family united, or saved a job.

               There  are   families  which,  when   carefully  approached,
          surprised their son or daughter by being far more sympathetic and
          helpful than could have  been anticipated.  Similarly, it  is not
          uncommon for  a transsexual to be  accepted in his old  job after
          surgery, or assisted by his boss in finding new employment, after
          a frank private conversation about his  plans.  Many schools will
          readmit a student, correcting his records so that they carry only
          his new name  and sex, or help  him to gain admission  to another
          school  with  no   loss  of   scholastic  credit,  upon   tactful
          application to the appropriate officials.

               If you are  married, and especially  if there are  children,
          the situation  is in  some ways  more  sensitive.   You are  then
          concerned with the person or persons with whom your life has been
          most  intimately related.  Reactions  will vary, according to the
          quality of the relationship with spouses and children.  A husband
          or wife probably will not taken completely by surprise, but he or
          she  may  need some  professional  assistance in  reorienting his
          life.   You  will no doubt  choose to  obtain a divorce,  and the
          surgeon will require this before undertaking surgery.

               Where  children  are  concerned,  one  should  proceed  with
          delicacy  and care.    It may  be  advisable to  postpone  a full
          discussion of the  facts of your  situation, if the children  are
          adolescent or  of pre-school age.   A  child in grade  school, by
          which time gender identity is well  established is less likely to
          be disturbed.  However, you will  want to consider the likelihood
          that  he will discuss  the matter with  his peers, who  may react
          adversely or make  your private concerns common  knowledge in the
          community.  A counselor should be used to help assess the child's
          readiness to hear the truth, and his or her reaction later.

               The child's  age and  maturity should  be carefully  weighed
          before  deciding  whether or  how  fully  to take  him  into your
          confidence, and one or two meetings with a professional counselor
          may greatly assist  you to  fulfill this parental  responsibility
          with intelligence as well  as love.  When you separate  from your
          spouse, and  if the children  remain with him/her,  remember that
          they  will  continue to  need  assurances, through  your letters,
          phone  calls and  visits,  of your  continuing interest  in their
          activities and their welfare.

               To sum up, it stands to reason that you will be serving your
          own  best interests by  considering the  feelings of  others, and
          not,  through  thoughtlessness  or   a  self-defeating  defiance,
          risking severed relations  with those people  who may be of  real
          help to you if they are approached with tact and care. 2

          MAKiNG IT OFFICIAL 3

               When   the  probability  of   sex  reassignment  surgery  is
                              

               2    When talking over  your plans  with family or  friends,
          you  may find  it  helpful to  offer  them a  copy  of The  Janus
          Information Facility booklet:  INFORMATION  FOR THE FAMILY OF THE
          TRANSSEXUAL/

               3    Throughout this  section, the  services of  an attorney
          are frequently  recommended.   If funds  are limited, your  local
          Legal Aid Society may provide assistance for a token fee.   While
          it is true that in delicate  situations, and sometimes in dealing
          with bureaucratic officials, the intervention of a lawyer may  be
          helpful, many  of these procedures can be successfully handled on
          your own.  The Janus  INformation Facility booklet, LEGAL ASPECTS
          OF TRANSSEXUALISM, treats in full detail the matters discussed in
          this section, and is available on  request to you, your attorney,
          and concerned governmental and social agencies.
          imminent,  you  will want  to  begin  to establish  a  new public
          identity.    There  are  a number  of  legal  and  administrative
          processes which  you may  use to  your advantage  and to  prevent
          harassment,  both  during  the  preoperative  period  and   after
          surgery.

               You may not  be aware that under  the common law you  have a
          legal right to call yourself by any name you wish, provided there
          is no intent  to defraud or of prejudice to others.  If your name
          applies to either sex  (e.f. Chris, Leslie), it may  be advisable
          to  continue to  use it.   Otherwise,  it would  be expedient  to
          select a name with the same first initial.

               You may use  your new name when applying  for a library card
          and  museum  memberships,  when establishing  a  bank  account or
          applying for credit cards:   all useful items  of identification.
          Many of these  procedures may be handled through the  mails.  For
          example, you may open a new bank account  without closing out the
          account under your  original name, and conduct the transaction by
          mail.   Then, at a later date, you  may write a check to your new
          account from the old one, withdrawing  all funds and thus closing
          the account.   In opening  a checking  account, a friend  or your
          attorney can provide a credit reference.

               During the transition period, when mail  will be arriving in
          the names  of both sexes,  it might be  advisable to rent  a Post
          Office  box in order to avoid embarrassment.   Once your new name
          is firmly established,  you can revert  to receiving mail in  the
          usual way.

               There are  several safeguards you may take  to avoid running
          afoul of the  law.  The first precaution is to favor conservative
          rather  than  flamboyant dress,  so  that  you will  not  attract
          unfavorable notice.  Second,  you may obtain from  your physician
          or counselor a letter to the effect that he is treating you for a
          transsexual condition,  and that  you are  cross-dressing on  his
          recommendation.

               The counselor may supply to you an  identification car which
          includes the following data:  your counselor's name, address  and
          phone number, and  the information that  he is treating you  as a
          prerequisite to sex  reassignment surgery;  a statement that  you
          are required to  live in the  gender of choice  for 12 months  or
          longer prior to surgery; your height,  weight, eye color, and the
          date of  birth; and  that additional information,  if needed,  is
          available from him.  Your name (both of them)  and address should
          be included.

               It is  advisable to  provide yourself  with whatever  record
          changes and documents  are available to  you;  this will  enhance
          your sense  of comfort and security in the  new gender role.  The
          letter from your treating counselor and a court order for a legal
          change  of  name  are  the  most  helpful  of   those  obtainable
          preoperatively,  as  the  new  birth  certificate will  be  after
          surgery is completed.   The methods  for securing these  official
          documents, which can  be useful in  helping you to acquire  still
          other documents, will be discussed in  detail below.  Whether you
          are  applying  for  new  documents   of  identity  or  requesting
          correction of those  you already hold,  you can help yourself  by
          being neither over-aggressive nor apologetic.   Remember that you
          are within your  rights in  making use of  these procedures,  and
          that  an attitude  of  quiet self-confidence  will  get the  best
          results.

          LEGAL PETITION FOR CHANGE OF NAME

               As previously noted,  a change of  name by court decree  may
          not be necessary in most cases.  In general, because of the costs
          and  the possible  loss of  privacy, it  might  be wise  to avoid
          litigation.    In some  situations,  however, as  for  example in
          claiming a legacy,  a prior change of name by court decree may be
          a convenience, if not a necessity.

               Several  different methods have been successfully pursued by
          transsexuals in petitioning for  a change of name.   Some involve
          legal  help, and  others  may  be  accomplished directly  by  the
          individual himself.  Some of thee procedures  known to us will be
          outlined below.  It should be borne in mind that the venue of the
          court  and  the  attitude  of  the presiding  officer  are  often
          decisive factors  in the success of  your petition.   It would be
          advisable,  therefore, to inform yourself about these to the best
          of your ability before choosing your method of application.

               A postoperative  transsexual  employing the  services of  an
          attorney  will  find  that the  following  procedure  is commonly
          successful.  Request that  your physician send to the  attorney a
          letter  confirming   that  sex  reassignment  surgery   has  been
          performed, recommending  the change  of name  which will  reflect
          your changed anatomical status, and further stating that the name
          change  is vital  to your  health  and well-being.   This  is the
          essential document in your attorney's  presentation to the court.
          If  the  court  then determines  that  there  is  no evidence  or
          intention of fraud, your petition should be granted.

               It should be  noted that  the court's decree  in granting  a
          change of name is not accepted as legal proof of a change of sex.
          However, possession of a court order  for a change of name  often
          assists in the  process of changing sex status, as  well as name,
          on the birth certificate.   This is much more easily  achieved by
          the postoperative  transsexual, because of  the medical documents
          he presents,  but some  preoperative transsexuals,  on presenting
          the court decree  of name  change, also have  been successful  in
          having sex  status altered  on  the birth  certificate.   Usually
          however, sex status cannot be changed until after surgery.

               In  some  states, the  following  simple procedure  has been
          followed  with  good  results  by  both  pre-  and  postoperative
          transsexuals.  Application  for a change of  name is made,  for a
          fee, and appropriate  forms are filed  with the Clerks Office  of
          the local Probate, Surrogate, or  Superior Court, no other action
          being required.

               When  changing  your name,  it  is advisable,  for practical
          reasons, to retain the last name unchanged.

          IN CASE OF ARREST

               If you are  taken into custody for cross-dressing or another
          complaint related to  transsexualism, remember  that you are  not
          obliged to supply an information  other than your name,  address,
          date of birth, and social security  number.  Other questions need
          not be  answered without  the presence  of an  attorney, and  you
          would be well-advised to volunteer  no further information.  Even
          seemingly innocent remarks  may later  be used against  you.   Be
          sure that the data you supply  (name, address, etc.) is truthful.
          Giving false information is grounds for prosecution on the charge
          of obstructing an officer.

               The arresting officer must inform you of your constitutional
          rights  to  remain  silent  during  interrogation.    Information
          obtained without the issuance of a warning cannot legally be used
          against you.

               Do not wait until the time  of trial before requesting legal
          aid.    You  are  entitled  to   call  an  attorney  even  before
          preliminary questioning (i.e.,  name, address, etc.) begins,  and
          it is  recommended that you  do so.   Once the intake  process is
          under way, the  authorities have the  right to check your  record
          and  you may find it  helpful to consult  with an attorney before
          supplying  any  information.   He  can  also  provide substantial
          assistance  during   the  pre-trial   hearing  in   the  District
          Attorney's office, when he  may be successful in having  the case
          dismissed or the charges against you reduced.

               A lawyer  also will be helpful if you have been subjected to
          police brutality during the  arrest or while in custody.  We know
          of several such actions which  have been successfully filed,  and
          damages  collected,  on  the  attorney's  petition  for  a  trial
          judgement.

               If you should  be held in custody  pending trial, or  if the
          trial  judgement whether for a complaint  related or unrelated to
          transsexualism,  goes   against  you,   an  extended   period  of
          confinement raises problems  of evaluation  and treatment.   Most
          prisons  and  jails will  not  start  or initiate  counseling  or
          hormones if  you were not already  on them before  going to jail.
          Only  some  jails will  let  you  continue hormones  if  you were
          already  on  them,  and  very  few   jails  will  help  with  any
          arrangements leading toward  surgery.  Most jails  will house you
          in  a  single  (solitary)  cell  in  the mal  or  female  section
          depending  on whether  you  have any  bodily  changes from  prior
          hormone therapy or  surgery, and how long you have been living in
          the current  gender  role.   Sometimes,  however,  they  put  you
          wherever they  want to and  you may be highly  vulnerable to gang
          rape if housed in a male dormitory!

          MILITARY SERVICES

               To date, and to our fullest knowledge, the military services
          are consistent in their policy of disqualifying transsexuals from
          enlistment, refusing requests for transfer  from men's to women's
          and women's to men's branches of service, and are discharging, on
          medical or psychiatric grounds, known transsexuals.    A male-to-
          female  transsexual  who is  contemplating  or has  undergone sex
          reassignment surgery usually will have no difficulty in obtaining
          an exemption from  her draft board if she  presents a letter from
          her  physician explaining  that  she is  being  treated for  this
          condition.    Some  draft  boards  may require,  in  addition,  a
          physical examination.   If  you are  asked to  appear before  the
          board  more than once,  you may wish to  enlist legal aid against
          possible harassment.

               If,  while you  are a  member  of the  forces,  you reach  a
          decision to undergo treatment preparatory to surgery, it would be
          advisable first to complete your term  of service if possible, in
          order  to  avoid a  prejudiced  discharge,  and so  that  you may
          qualify  fully  for  the  veterans   benefits  you  have  earned.
          Transsexuals  who have served in the  military prior to treatment
          and surgery do not forfeit G.I.  Bill or other veterans benefits.
          You  will  qualify under  your  new  name and  sex,  all military
          records and discharge papers being adjusted accordingly, when you
          submit papers attesting to a legal change of name and your new or
          amended birth certificate.

               Veteran's  Administration Hospitals  have  not yet  provided
          preoperative  treatment  or performed  sex  reassignment surgery.
          However,  in  several  cases  known  to  us,  they  have  offered
          extensive  postoperative  care,   including  corrective   surgery
          related to sex reassignment, when required.

          EMPLOYMENT AND EDUCATION

               Medical   costs    for   sex   reassignment    therapy   are
          considerable4.   Unless you  have substantial  private means,  it
          will be necessary to  continue earning prior to surgery,  and you
          will want to give careful thought  to your vocational plans after
          surgery is  completed.   In some  cases, where  your employer  is
          sympathetic and the work you do is appropriate to your new gender
                              

               4    This    includes:        hormone    therapy    (pre-and
          postoperatively),  physical  and  psychiatric  examinations,  and
          tests, surgery, and  related therapies such as  electrolysis, and
          attorney fees (plan on about  $10,000 altogether).  Transcription
          note:   This is now said  to be up to  at least $30,000, today in
          1988).
          role, this will not present a problem,  since you may continue to
          work in the same job or field of work.  Others, however, may find
          it essential to plan for vocational training in a new field.   If
          financial  assistance  is needed  for  this, there  are sometimes
          funds available from  public sources  to which you  may apply  on
          your physicians recommendation.

               Your employer may agree  to discharge you from your  job, so
          that you can qualify  to collect unemployment insurance.   If you
          judge that it  will be necessary to  resign your job  should your
          plans  become  known,  be  certain  to  draw all  sick  leave  or
          sabbatical  benefits  that  have accrued  to  you,  applying them
          toward the period of cross-gender testing,  when you may be short
          of funds.

               If  you are a licensed member of  a trade or profession, you
          may apply directly to  the appropriate state agency to  have your
          name  corrected on the  licensing documents.   However, since the
          officials   concerned    may   not    be   well-informed    about
          transsexualism, it may be advisable  to make your request through
          a skilled legal intermediary.   Petitions for correction of  work
          licenses usually are routinely granted  by trade associations and
          the  accrediting  boards  of most  professions.    School boards,
          however,  then  to  regard  returning  postoperative  transsexual
          teachers with honest if misinformed concern about endangerment of
          the morals of their students.   They may be more likely to  alter
          the license  and reassign  the transsexual teacher  to duties  in
          another school, if they are approached by a skilled attorney.

               An attorney can be helpful, too, in  presenting your request
          for job recommendations  to former  employers, if you  anticipate
          any  difficulty  in  obtaining  them  in  your new  name.    Most
          employers, if approached  in this way,  will be cooperative.   If
          you fail to get  their cooperation, and alternative, if  you wish
          to  stay  in  the same  line  of  work,  is  to  apply  for  jobs
          subordinate to  the one  you formerly held,  with the  confidence
          that  your  skills will  soon earn  you  the promotion.   Another
          possibility  would be  to explain  your situation  honestly to  a
          prospective employer, if you judge that he may be sympathetic.

               If you have no  trade or profession, these problems  ill not
          arise.   You  may find  it easiest to  begin with  some unskilled
          occupation for which recommendations are not needed, or for which
          a personal  recommendation will do:   for example,  factory work,
          waiting tables.   Most taxicab companies  will hire both men  and
          women  drivers  who have  passed  the  test  for  a  chauffeurs's
          license.  It  would not be  advisable to apply  for a job with  a
          large  company,   most  of   which   require  complete   physical
          examinations of new employees.

               It would also be practical to attend a secretarial school to
          study typing, and, if  time and money allows, shorthand.   Second
          hand bookshops frequently  stock copies of texts  on speedwriting
          (which  otherwise are  obtainable only  through registration  for
          courses in schools which teach  this simplified shorthand method)
          which you  can then study on your own at home.  There is always a
          demand  for  men  and  women  with  these skills,  and  temporary
          agencies generally require only that you pass their typing and/or
          stenography tests, without asking for recommendations from former
          employers.

               When you  are ready, you may decide  to return to school for
          preparation for a more rewarding job.  If you already have earned
          a  college  degree,  or  wish  to  continue  your  studies,  most
          universities and  colleges will  be cooperative  in changing  the
          name and sex designations on the  transcript of a former student.
          In this instance,  too, the assistance  of an attorney or  social
          worker can be helpful  in insuring a receptive hearing,  although
          direct negotiations with the Dean  of Students may be successful,
          if tactfully undertaken.

               The  federal government  makes  grants to  state  vocational
          rehabilitation agencies  "to help  them to  serve persons with  a
          physical  or mental  disability who  need help  in obtaining  and
          holding an appropriate job, and (the  grant) is based on (1)  the
          presence of a  physical or mental  disability; (2) a  substantial
          handicap  to  employment;  (3)  reasonable  expectation  that  on
          completion of services, the  disabled person can be engaged  in a
          gainful occupation.

               "Services  include  evaluation of  rehabilitation potential,
          counseling  and  guidance,  personal  and vocational  adjustment,
          training, maintenance, physical restoration, placement, follow-up
          and other services."

               A  letter  from  your  physician,  addressed  to  the  State
          Department  of Vocational  Rehabilitation, should  accompany your
          application for aid.   Although  transsexualism is  not always  a
          recognized disability  category,  several  states  have  provided
          assistance  to  transsexuals  under the  category  of psychiatric
          disability.   The kind  and degree  of help you  may obtain  will
          depend upon several  constantly changing factors:    the policies
          of your  local Vocational Rehabilitation  Office; the individuals
          who administer them;  and the  funds available at  the time  your
          application is made.

               This, "physical restoration" may, according  to the time and
          place  of   application,   include  courses   in   grooming   and
          electrolysis  for  the  male-to-female transsexual;  and  plastic
          surgery.   It should be  stressed that,  in general,  and at  the
          present  time,   most  of   the  state   offices  of   Vocational
          Rehabilitation    have   no   clear   policy   with   regard   to
          transsexualism, and many  offer little or  no help with  medical-
          related therapies.  But, since this is a relatively new field for
          governmental consideration,  and the situation  is in a  state of
          flux,  this  is  clearly  a  case of  "noting  ventured,  nothing
          gained."   Do not count on receiving funds for medical help, but,
          by all means, give it a try.   At this time, assistance with fees
          for vocational training  would seem to  be somewhat more  readily
          available from this source.

          MEDICAL HELP

          FINANCING MEDICAL CARE:  INSURANCE

               If you, like most  people, do not enjoy a  large independent
          income, it will be necessary for you to finance your expenses for
          medical care and  recuperation with your own earnings or savings,
          or possibly through  a bank loan, if  you are able to  offer some
          collateral.   Even  surgeons who  are testing  new techniques  in
          transsexual surgery  require  full  payment  for  their  patients
          (usually in  advance).  There is no private foundation, including
          us,  that  offers  financial  assistance   for  this  purpose  to
          transsexuals.   For those  who qualify  for veterans'  benefits,,
          Veterans Administration Hospitals  usually provide  postoperative
          care  only.  A  good health  insurance policy  can be  your major
          source  of assistance, but there  are several important points of
          procedure on which you and your surgeon should be informed before
          you sign the  contract and before he  applies to the  company for
          reimbursement of fees.

               Before  signing   the  contract   for  insurance,   read  it
          carefully.   Some  companies  specifically exclude  treatment for
          transsexualism or related  conditions from their coverage.   Most
          policies stipulate a twelve month waiting period before providing
          benefits  for  conditions which  have  been diagnosed  before you
          contract for coverage.   Therefore, you are well advised  to wait
          until  after  you  have  signed the  policy  before  consulting a
          physician  for diagnosis and treatment.  Be sure to apply for and
          sign  the insurance  contract  with your  original  name and  sex
          (i.e.,  that  which  appeared  on  the  first,  unamended,  birth
          certificate):  if you  fail to do so, coverage may  be terminated
          on grounds of fraud.   For your fullest protection,  re-read this
          paragraph carefully, to  be sure you thoroughly  understand these
          three important points.

               After you have made a careful choice  of insurance policies,
          have undergone preparatory treatment, and  are ready for surgery,
          it is important  that your  surgeon be advised  of the  following
          information,  so  that  you  and  he  stand the  best  chance  of
          benefitting  fully  from  your insurance  coverage.    Claims for
          health  insurance  should  probably  not  define  the  prescribed
          treatment  simply  as  "transsexual  surgery,"  or  as  "cosmetic
          surgery":  applications  for  help  under  these  categories  are
          consistently rejected.  Best results  have been obtained when the
          condition     (transsexualism)     is     presented     as     "a
          neuroendocrinological  or  psychohormonal  disorder,"  absolutely
          requiring  and  responsive  to surgical  and  hormonal treatment.
          Another effective classification is "gender dysphoria."

               Some  health  insurance policies  state  that the  holder is
          covered only  for "necessary  treatment of an  injury or  disease
          process."    In such  a  case,  the  physician  should  represent
          transsexualism  as  "a  distinct,  medically  definable   disease
          entity, for which treatment is required."   In every instance, it
          is advisable for you and your  physician to examine carefully the
          wording of your policy, for indications as to how he should frame
          his diagnosis.

               Recently, some  insurance companies have become more liberal
          in  providing coverage for  preoperative evaluation  (medical and
          psychiatric), sex  reassignment surgery,  related therapies,  and
          hospital costs.  While few companies allow benefits for all these
          phases,  there  is  a  distinct  and  encouraging trend  in  this
          direction.   In general, it has  been found that coverage is more
          generously allowed on group than on individual policies, but this
          is not invariably the case.

               If you leave the employment of  a company which has provided
          you with group insurance, and which does not exclude benefits for
          treatment of transsexualism,  it would  be advisable to  maintain
          the policy on an individual basis.  (Although individual policies
          rarely  have as liberal  and extensive  coverage as  the original
          group policy had.)

          CHOOSING A PHYSICIAN

               Until  quite  recently,  the   gender  identity  clinics  of
          university hospitals  offered the  only  facilities for  complete
          therapy, including sex reassignment surgery, for the transsexual.
          Fees at some  of these clinics are high, and the number of people
          applying   for  help  far   exceeds  the   number  that   can  be
          accommodated.   fortunately, alternative  means of  treatment are
          now available.   At the  present time, many  endocrinologists and
          internists  are   accepting  transsexual  patients   for  hormone
          therapy, and many  surgeons associated with private hospitals now
          perform sex reassignment operations.

               For  obvious reasons, it is  advisable to choose a physician
          who  has had  considerable experience  in treating  transsexuals.
          Since  hormone  therapy  precedes surgery,  you  should  visit an
          endocrinologist or  internist.  At the appropriate  time, he will
          refer you to a  surgeon who has performed other  sex reassignment
          operations.  In choosing your surgeon,  assure yourself as far as
          possible that he will  be interested in vigorously  pursuing your
          insurance claim.

               However, before you are  in a position to seek  surgery, and
          even   hormones,   it    is   advisable    that   you   seek    a
          psychiatrist/psychologic  evaluation.   The Standards of  Care of
          the  Harry  Benjamin International  Gender  Dysphoria Association
          require a  psychologic/psychiatric  recommendation,  based  on  a
          complete   psychologic  evaluation,   before   hormones  can   be
          prescribed,  and  also  require   that  before  sex  reassignment
          surgery, you must be recommended for such surgery by at least two
          psychologists or psychiatrists  (one must be a  psychiatrist), at
          least one of whom  has known you  for at least  six months.   The
          purpose  of  these  visits  is  not  to dissuade  you  from  your
          decision.  It is simply a precautionary measure.

               Even  though  this  is a  required  part  of  the prescribed
          treatment,  you   may  decide   independently,   as  have   other
          transsexuals, that some sessions of supportive counseling with an
          understanding therapist will be helpful to you during the periods
          of  transition before or  immediately following surgery.   If you
          are experiencing any  problems with your employer or your family,
          they may be more receptive to  learning about your situation from
          a counselor.   This the kind of  service most physicians are  too
          busy  to provide.    The counselor  also  can  help you  to  gain
          perspective  on  your  situation  and  provide support  and  good
          advice.   He may  be the  objective friend  you can  use in  your
          corner in times of stress.

          MEDICAL TREATMENT FOR MINORS

               For medical as  well as  legal reasons, surgeons  will   not
          perform  the sex reassignment  operation upon a  minor.  However,
          hormone therapy preparatory  to surgery is obtainable  in certain
          instances.   It helps  to have  your  parents' authorization  for
          treatment, but this is  not always required.  Some  states regard
          the teenager who  is living away from home  and providing his own
          support as an "emancipated" minor, and in these states physicians
          may cite this  doctrine to  justify treating a  minor at his  own
          request.

               Many states recently have lowered  the age of majority  from
          twenty-one  to  eighteen,  and  some  legislatures  have  enacted
          statutes  specifically enabling  minors  under eighteen  to elect
          medical care.   The tendency even in states  with no such laws on
          the  books  is  for the  courts  to  be  increasingly liberal  in
          interpreting common-law principles.   The urgency and  gravity of
          the  case, the age  and maturity of  the minor, and  the doctor's
          prior knowledge of  his medical history are all carefully weighed
          in such cases.

               In the past,  physicians have exercised caution  in treating
          minors without  parental  assent  because  they  feared  criminal
          prosecution.   Yet  it would  appear that there  is not  a single
          recorded instance of a  doctor's being penalized for  treating in
          confidence  a minor  over  fourteen years  age, when  no surgical
          procedure  was involved.   With the increasing  liberality of the
          law  and the interpretation of the  law, the prospect is that the
          physician's professional  judgement and  the minor's  request for
          help soon may be  the only requirements for treatment  of younger
          patients.

          HORMONE THERAPY5

               Your  physician  will prescribe  hormones  for at  least six
          months before referring you  to a surgeon.  The  physical changes
          they bring  about may enhance  your confidence socially,  and you
          may find their  calmative effect emotionally beneficial.   Should
          you decide at some point during this trial  period not to proceed
          with surgery, discontinuance of  hormones will gradually  reverse
          some  of  the  physical alterations.    What  are  some of  these
          changes?

          Male-to-Female Transsexuals

               You may  notice that  the skin  takes on  a softer  texture.
          There may  be some increase in hair growth on the scalp, although
          this is less  common.   After a time,  muscular development  will
          diminish somewhat, and there will be a more feminine distribution
          of fatty tissue: for example, more  pronounced hips.  The breasts
          will  gradually increase to proportions  comparable to those of a
          girl in the late  teens.  Larger breasts may  be achieved through
          breast implants, at a later date.6

               Hormone therapy will  not feminize your voice,  but remember
          that there are women whose  extremely husky voices are considered
          to  be  both attractive  and  feminine:   Lauren  Bacall, Marlene
          Dietrich, and the  late Tallulah  Bankhead are notable  examples.
          Speech  therapists  who  work  with  male-to-female  transsexuals
          concentrate  not  only on  raising  the pitch  and  resonance and
          softening the quality  of the voice;  they point out that the use
          of a more feminine vocabulary,  more careful articulation, and  a
          greater range  of inflection  (rise and  fall) of  the voice  all
          contribute to a  more feminine impression.  You may work on these
          points yourself, with  the help  of a mirror  (to practice  freer
          facial  movement)  and a  tape recorder.   If you  feel you  need
          professional  help,  there  are  speech   therapists  in  private
          practice, and associated with speech therapy centers in hospitals
          and  universities, who provide  special instruction  for male-to-
                          

               5Some physicians may adopt practices  which differ in degree
          or kind from those outlined here.  This section, and  those which
          follow, are intended to give you a general impression of the most
          commonly followed course of treatment.

               6    Silicone implants,  the internal placement  of plastic-
          like bags containing  silicone jelly, is  the approved method  of
          augmenting  breast  size.    There  are  serious  health  hazards
          associated with injections  of liquid silicone directly  into the
          breast tissue: it is extremely difficult  to detect cancer in the
          area when the  breasts have  been augmented by  this method;  and
          there  is the danger  that the injected fluid  will move to other
          parts of the body, causing medical complications.  The F.D.A. has
          denied approval to  the use of  silicone injections, and you  are
          strongly advised against them.

          female transsexuals with voice problems.7

               Hormones   will  not   appreciably   reduce  beard   growth.
          Electrolysis of  the beard is an essential  complement to hormone
          therapy.

               You may notice a  decrease in libido (sexual  desire), after
          following a program  of hormone  therapy for some  months.   Most
          male-to-female  transsexuals  consider  this  to  be   a  helpful
          modification in adapting to the new role.  Also, sperm production
          may decrease and your fertility (even if you later stop hormones)
          may be permanently impaired.

          With few exceptions,  transsexuals are  required to use  hormones
          throughout  their  lives  postoperatively,  in  order  to  ensure
          maintenance   of   hormone-stimulated  development   of  physical
          characteristics of  the gender of  choice, and for  other health-
          related  reasons.   However,  since  the  long  range effects  of
          hormone therapy are not fully known at this time, it is important
          That you visit  your physician  conscientiously every six  months
          after surgery.  He can then check on your general health  and any
          possible harmful side effects,  providing any required  treatment
          or adjustment of hormone dosage according to his findings.

          ELECTROLYSIS

               A course of electrolysis  of the beard requires from  one to
          two years of completion8   Before recommending the male-to-female
          transsexual  for  surgery,  his  physician  will  expect  him  to
          complete  at  least half  of  this  process.   There  are several
          important reasons for this recommendation.

               If, after surgery,  when you are now  anatomically female in
          all other respects, there  is still noticeable evidence  of beard
          growth, you are very likely to  suffer from feelings of confusion
          as to your present  gender.  Your  confusion may be reflected  in
          the  response  you  receive from  others,  thus  compounding your
          difficulties.    Many  physicians  experienced  in  working  with
          transsexuals  have  noted  that serious  psychological  conflicts
                              

               7    A helpful  tip offered  by one  of these  therapists is
          that the transsexual,  when introducing herself on  the telephone
          (as, for example, in  making an appointment for a  job interview)
          should begin the  conversation by saying  "This is  Miss X."   In
          that way, should she  still need some practice in  feminizing her
          voice and if the  person on the other end of the  line is in some
          doubt as  to her  sex, this  assertion usually  will resolve  the
          equation in her favor.

               8    Electrolysis  does  not  permanently   discourage  hair
          growth.  After the major work has been done, it will be necessary
          to see  your electrologist  at infrequent  intervals to  maintain
          beardlessness.

          block the successful  adjustment of those  patients who have  not
          undergone adequate electrolysis, and who, in their opinion, would
          otherwise have done well.

               It  is  true that  a certain  amount  of time,  expense, and
          discomfort is associated with electrolysis.  But it would be most
          unwise to seriously jeopardize your chances  for a fulfilling new
          life by neglecting  to attend to  this important aspect of  total
          therapy.

               You  are  strongly  advised against  purchasing  one  of the
          electrolysis machines available on the market for self-use.  This
          is an operation which requires long and careful training.   If it
          is clumsily employed, there  is a distinct danger of  scarring at
          the site.   For this reason, one should  also take care to choose
          an experienced professional operator.

               If you do not at first have the money or  the time to see an
          electrologist,  there  are  various  commercially  available  wax
          preparations which  you can use  at home for  hair removal.   You
          will find  that this  process must be  employed every one  to two
          weeks, depending upon heaviness of beard growth.

          SURGERY

               Some surgeons prefer to perform  the operative procedure for
          the male-to-female  transsexual in  two stages.   Other  surgeons
          will complete the work in a single  process.  The male organs are
          removed and labia, a clitoris  and a vagina are constructed.   If
          surgery  is  performed  in  two  stages (castration  and  vaginal
          construction) by two different surgeons, it is important that the
          two surgeons  consult each  together before  the  first stage  is
          undertaken, in order  to avoid some possible  complications which
          may occur if the  second stage is too long delayed.   If cosmetic
          surgery,  such  as breast  implants  or nasal  reconstruction, is
          desired, this is  undertaken at a  later date after full  healing
          from the initial surgery.

               The degree of possible sexual  pleasure after surgery cannot
          accurately be predicted.   For some, the capacity for  orgasm may
          be lost, but many others report that they are now experiencing it
          for the first time.

               In the preferred  method of  surgery for the  male-to-female
          transsexual,  sensitive genital tissue is used to line the vagina
          and to  create a  clitoris, thus  preserving a  degree of  erotic
          sensation, and in some cases providing  a small amount of natural
          lubrication  during  intercourse.   However,  when  there  is not
          enough penile skin available to completely line the vagina,  skin
          grafts from other parts of the body may be used.

               There is at present no technique  for the transplantation of
          reproductive organs.  Therefore, following surgery, both male-to-
          female  and female-to-male  transsexuals  are  sterile.   Married
          transsexuals have adopted children  through social agencies,  and
          the  wives  of  female-to-male transsexuals  may  choose  to bear
          children through donor insemination.

               The  final results  of any  surgery cannot be  guaranteed by
          anyone.  Scarring, infections, necrosis,  loss of skin grafts and
          disfigurement are always  possible, but  hopefully occur not  too
          frequently.  You should be absolutely sure that  before receiving
          hormones  or surgery  your doctor  explains  all of  the possible
          risks to you in words you  understand.  If you don't  understand,
          ASK -- its your body, and happiness, at stake!

          POSTOPERATIVE CARE

               It   is  essential   that  the   male-to-female  transsexual
          conscientiously follow her  surgeon's instruction  on the use  of
          the vaginal form9.  This is a device designed to keep the vaginal
          passage open during the period following surgery.  During surgery
          the vagina  is packed with gauze.   When healing is well advanced
          the  gauze is removed, and  you will be  instructed to insert and
          keep the vaginal form in place for most of each day for the first
          few days of use.  After this period, your surgeon will advise you
          to insert  the form several times a day for one or two hours at a
          time for the  next several months or  so.  Your surgeon  also may
          show you how to  lubricate and stretch the vaginal  passage twice
          daily, another important factor in postoperative care.

               To repeat:  these practices which  will be explained in some
          detail by your physician, should be followed faithfully.  Failure
          to  do so could result in closing  up of the vaginal passage.  Be
          sure to see  your physician without  delay if, after your  return
          from the hospital, your temperature should become elevated, or if
          you  should  experience  unusual discomfort  or  swelling  in the
          surgical area or difficulty in urination.

               You will be cautioned by your doctor not to use the  vaginal
          passage  for intercourse for a  period of time following surgery.
          If  you  ignore this  restriction,  there  is a  serious  risk of
          infection or rupturing of the sutures.

               When your surgeon tells  you that intercourse may be  safely
          engaged in, he  will also recommend the  most favorable positions
          which your new  internal structure allows.   He will also  advise
          you to urinate and empty the  bowels before intercourse, in order
          to provide the maximum  space in the vaginal passage  for comfort
          and facility when the penis is penetrating the vaginal canal.

               Certain easy-to-follow, common sense precepts of health care
          should be observed postoperatively by both the male-to-female and
          female-to-male transsexual.   Adequate rest  is important, and  a
                              

               9    Some newer  surgical techniques eliminate  the need for
          the vaginal form.

          premature return to  work may be ill-advised.  The male-to-female
          transsexual should avoid prolonged standing immediately following
          surgery, and prolonged sitting may at first be uncomfortable.  It
          is important to keep  the weight stable, and especially  to avoid
          any weight gain, so as not to overburden the surgical area.

          MARRIAGE

               The  question of whether  a postoperative transsexual should
          disclose  to  a prospective  mate that  he  or she  has undergone
          surgery  is   primarily  an  ethical   one,  but  it   has  legal
          implications as well.   Failure to  discuss this matter may  give
          valid grounds for annulment or divorce,  in that the marriage may
          be considered to have  been entered into fraudulently.   This can
          affect  later   alimony,  support   payments,  and  division   of
          "community property."

               The precedent of  impotency, which  is accepted grounds  for
          divorce in some states,  can be invoked by the wife  of a female-
          to-male  transsexual.     In   the  case   of  a   male-to-female
          transsexual, if the transsexual discloses to her husband prior to
          marriage that she cannot bear children, theoretically her options
          are  open as  to  whether she  also  must reveal  that  she is  a
          transsexual,  although  presumably  if  she  does  so  her  legal
          position is stronger in the event of divorce proceedings.

               Having  discussed  these   problematical  legal  aspects  of
          marriages entered into  by transsexuals, it  is important to  add
          that many transsexuals have without publicity contracted enduring
          and successful  marriages which  are accepted  without notice  or
          comment  by other  members of the  community.   Furthermore, they
          have brought their own  children into the marriage, have  adopted
          children, or, in the case of the female-to-male transsexuals, the
          wife has borne children by means of artificial insemination.

          CAUTIONARY REMARKS

               It  is likely,  as  well as  understandable,  that prior  to
          surgery, while subject to inner  stress and limitations of  outer
          circumstances and opportunities, you may have been impeded in the
          development of your potentials  for living a full and  fulfilling
          life.    Your interests  may well  have  been restricted  by your
          problems, your energies  exhausted by them.   If your whole  life
          until then has  been centered on  the goal of achieving  surgery,
          once it is  achieved you  may be unpleasantly  surprised to  find
          yourself in a predicament comparable to that of the newly retired
          man  who  had  devoted  himself exclusively  to  his  job,  never
          cultivating  any  outside   interests,  and  now   finds  himself
          depressed and at a loss, his life seemingly at a standstill.

               Now that your life-long problem has been resolved, and after
          the initial euphoria, you may unexpectedly find yourself facing a
          void.  The obvious answer  is to fill it, and without delay.   In
          this situation, some transsexuals find that they benefit from the
          counseling  and support of a  sympathetic therapist.  Others will
          begin  independently   to   investigate  their   world  and   its
          possibilities.  You  will learn to apply  newly-released energies
          to the development of your talents, and to the exploration of the
          broader range  of social  relationships and  career opportunities
          now open to you, perhaps for the first time.  If, before surgery,
          the single area  of gender identity  comprised the whole of  your
          self-knowledge  and  occupied all  your  attention, there  can be
          intense pleasure  and release  in discovering yourself  now as  a
          total human being.

     Another common  stumbling block experienced  by transsexuals  can be the
excessive and  unrealistic expectations, cherished for  many years  perhaps, of 
what life  will be  like after  surgery.  Surgery  indeed  can solve  your one 
major  problem, but  if you  anticipate that it will magically solve all problems,
you are due  for a disappointment.  Life will certainly be more rewarding now.

     You  will be more  comfortable, more at ease with you.   You can  begin to 
take  advantage of  many  opportunities  for self-  development and career
advancement that were not available to you  in the  past.   But  the postoperative 
transsexual must  realize  that he has this in common with  every other human
being, that he  too must meet the  challenge of all the common  difficulties that 
arise in any life:   the occasionally troubled relationships, the  possible  job 
 frustrations,  the   temporary  depressions   and  setbacks.

     Now that  you  have  been relieved  of  your  one  consuming problem, you may
discover in  it one positive aspect that can  be  uniquely  enriching.   Having 
lived  the life,  however hindered  preoperatively, of both sexes, you can  enjoy
a rare capacity for  immediate empathy with  people of  both sexes, for 
understanding  intimately their points of view and feelings.  Where other people 
may  exercise  intelligence, imagination  and  sympathy in  their  human
relationships, you  have the additional resource  of direct  experience of "both
sides" of life.  If you use this asses, allow  the old burdens to  fall away,
confront life with  new curiosity,  realism, courage and  determination, you can
discover,  like many  transsexuals before you, the unexpected joys of a true
rebirth, a more hopeful and better-prepared second chance.

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