There are 4 phases of gender transition after a diagnosis of Gender Identity Disorder has been made. Information on these phases, which can help assess a person’s readiness for gender reassignment surgery, is provided below.
There are 4 phases of gender transition after a diagnosis of Gender Identity Disorder has been made:
- real life experience in the desired role
- hormones of the desired gender
- surgery to change genitalia and other sexual characteristics
- post-transition monitoring.
It is important to note that not everyone with Gender Identity Disorder will need or desire all these elements of transitioning. Similarly, it is also important to understand there is a difference between eligibility for a phase and readiness to undertake it.
Real life experience
This phase is assisted and assessed by the psychiatrist and psychologist.
Living and working full time for at least 2 years as a woman/man.
Demonstrating further consolidation of the evolving female/male gender identity with consequent improving mental health.
This phase is assisted and assessed by the endocrinologist and GP.
Eligibility – for people over 18 years old
- Demonstrating knowledge of what hormones can and cannot do, as well as their risks and benefits.
- Documented real-life experience of more than 3 months and/or counselling for at least 3 months.
Readiness – consolidation of gender identity during real life experience
- Progress in mastering other identified mental health issues.
- Will take hormones in a responsible manner.
The maximum physical response to hormones may take up to 2 years of continued use, and the degree of effect obtained varies widely from person to person. Medically unmonitored hormone therapy is dangerous and can jeopardise or preclude transitioning surgery as can self harming and mutilation.
For some people hormone therapy is adequate for social functioning and surgical intervention becomes unnecessary.
It may be of use to talk about sperm banking with the endocrinologist or GP prior to undertaking hormone therapy.
Transitioning in general and surgery in particular, has profound personal, social and medical consequences that need very serious consideration. These impact on all aspects of life – family, vocational, interpersonal, educational, economic and legal. Therefore surgery is only undertaken after comprehensive multidisciplinary evaluation.
A person’s suitability for Gender Reassignment Surgery can be assessed using the internationally accepted World Professional Association for Transgender Health’s Standards of Care.
These standards are minimum requirements and therefore it is also important to be mindful of other factors not related to gender identity that may preclude surgery (for example co-existing medical conditions or surgical risk). Similarly, although someone may be eligible to be considered for Gender Reassignment Surgery, both non-medical and medical considerations may impact on their suitability for surgery beyond what is described below.
The journey towards Gender Reassignment Surgery is complex. The decision to offer surgery is by consensus and just undertaking the pre-requisites for surgery does not necessarily mean an operation will be offered.
This phase is assessed and performed by the anaesthetist and surgeons.
Eligibility – for people over 18 years old
- More than 12 months of continuous hormonal treatment .
- More than 2 years of successful and continuous real life experience as a woman/man.
- 2 psychiatric reports by senior psychiatrists with some experience in this field, 1 of which is by an evaluating (not treating) doctor.
- 1 psychologist’s report by a senior psychologist or social worker with experience in this field.
- Demonstrated progress in transitioning including consolidation of gender identity, dealing with work, family and interpersonal issues as well as significant improvement/stability in mental health
- No other medical conditions that constitute a surgical or anaesthetic risk
- Able to have a full understanding of the procedure with its risks and expected outcomes to allow for the most informed consent.
A limited amount of funding is available from the Special high cost treatment pool.
Postoperative follow-up is one of the factors associated with a good outcome and therefore the ability and readiness of someone to commit to this forms part of their evaluation.
After surgery the person is asked to:
- stay in regular touch with a doctor for the ongoing prescribing of hormonal therapy
- be monitored for possible conditions consequent to the medical and surgical interventions
- continue with normal screening (eg, for prostate cancer)
- be open to further mental health input that would assist with any problems adjusting after operation.
Follow-up is helpful to the person, but it also improves the understanding of the limits and benefits of this type of surgery so as to enable the best possible counselling and assessment of others who might follow.