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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