On May 6th, 2010, almost half a year after Chastity Bono (Cher's daughter) underwent sexual reassignment surgery, she was legally granted a change in designation of sex and a name change to Chaz Bono.According to Perez Hilton, Warren Beatty's wanted sex reassignment surgery this past June, and rumors have been flying for a while now that R&B star Ciara underwent a sex-change. Even when you Google image search "transgender", pictures of Tyra Banks and the pregnant man who apppeared on Oprah show up. Why are we so fascinated with sex reassignment therapy and surgery?

According to Wikipedia, sex reassignment therapy is " an umbrella term for all medical procedures regarding sex reassignment of both transgendered and intersexual people". Although many people's attentions are drawn to the surgery alone, the therapy process can include psychological diagnosis and treatment, hormone therapy, multiple surgeries, and changing of gender roles, names, and legal sex.

SurgeryEncyclopedia suggests two main reasons why people desire to undergo sex reassignment therapy or more specifically, sex reassignment surgery:

  • Newborns with intersex deformities must early on be assigned to one sex or the other. These deformities represent intermediate stages between the primordial female genitals and the change into male genitals caused by male hormone stimulation.
  • Both men and women occasionally believe they are physically a different sex than they are mentally and emotionally. This dissonance is so profound that they are willing to be surgically altered.
Dan to Dawn

Psychological Diagnosis/Treatment

Many people desiring sex reassignment therapy are diagnosed as having gender identity disorderand often times, the diagnosis is required to be eligible for the surgery. They also have a tendency to have depression and/or anxiety, and have a higher suicide rate when untreated than the general population. The DSM-IV warns that Gender Identity Disorder may be comorbid with schizophrenia and other psychological disorders. This disorder is inherently controversial, with many people petitioning to have Gender Identity Disorder removed from the DSM-IV, as it promotes the view that transsexualism is a disease. Also, many feel that this issue is biological, not psychological and thus should not require a psychological diagnosis for permission to undergo therapy.
Aside from psychological therapy, there are internal processes that are suggested by the Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders
1.Acceptance of personal homosexual or bisexual fantasies and behaviors (orientation) as being completely distinct from gender role aspirations.2.Acceptance of the need to maintain a job, provide for the emotional needs of children, honor a spousal commitment, and to not distress a family member as currently having a higher priority than the personal wish for constant cross-gender expression. (This doesn't mean that you can't do what you want; just that you should realize that your decisions affect a lot more people than merely yourself.)3.Integration of male and female gender awareness into daily living.4.Identification of the triggers for increased cross-gender yearnings and effectively attend to them; for instance, develop better self-protective, self-assertive, and vocational skills to advance at work and resolve interpersonal struggles to strengthen key relationships. 5.Seeking spiritual comfort.

Hormone Replacement Therapy

The Harry Benjamin International Gender Dysphoria Association's standards of Care for Gender Identity Disorders (linked above) also has a list of criteria adopted by many physicians that ought to be met before one begins hormone therapy:

  1. The patient must be of legal age (at least 18 years old).
  2. The patient must have demonstrable knowledge of what hormones can medically do and not do, and be aware of their social benefits and risks.
  3. Either:
    • A documented real life experience should be undertaken for at least three months prior to the administration of hormones.
    • A period of psychotherapy of a duration specified by the mental health professional after the initial evaluation (usually a minimum of three months) should be undertaken.
The Association also provides "Readiness Criteria." This means that they are not requirements per se, but are judgment calls to be made by the patient's doctor
  1. The patient has had further consolidation of gender identity during the real-life experience or psychotherapy.
  2. The patient has made some progress in mastering other identified problems leading to improving or continuing stable mental health. This basically implies an absence of mental problems such as sociopathy, substance abuse, psychosis, or suicidal tendencies.
  3. Hormones are likely to be taken in a responsible manner.

Hormone therapy helps to change the secondary sex characteristics, eg: breasts, facial hair, menstruation, etc. Some of the changes are irreversible, such as enlarged breasts, stretch marks, deepening of the voice, facial and body hair growth, and male pattern baldness. Male-to-female patients can undergo therapy through estrogens, progerstogens, anti-androgens, and GnRh agonists. Female-to-Male patients can receive testosterone therapy through injection, transdermal patches and gels, pellets, pills and buccal forms, and receive non-testosteronal treatments such as GnRH agents, progestin, and other supplements. Hormone therapy has many dangerous side effects, such as increased blood clotting, thinning of the skin, increase in LDL cholesterol, Polycystic Ovary Syndrome, effects on other prescription drugs, sleep apnea, Polycythemia, and liver damage.

Sex Reassignment Surgery

According to the Harry Benjamin Association, there are more requirements to receive this surgery: 1) Legal age of majority in the patient's nation (18 in the United States).
2) Twelve months of continuous hormonal therapy for those without a medical contraindication.
3) Twelve months of successful continuous full-time real life experience. Periods of returning to the original gender may indicate ambivalence about proceeding and should not be used to fulfill this criterion.If required by the mental health professional, regular responsible participation in psychotherapy throughout the real life experience at a frequency determined by the mental health professional. Psychotherapy is not always required; only if the doctor feels that it is.
4) Demonstrable knowledge of the cost, required lengths of hospitalizations, likely complications, and post surgical rehabilitation requirements of various surgical approaches.
5) Awareness of several different competent surgeons. Hey, this is a time when you shouldn't hesitate in getting a second opinion.
Once meeting these requirements, trans males (female to male) and trans females (male to female) undergo very different processes. Trans males may have chest reconstruction surgery in order to present more as a female and likewise, trans females may undergo breast augmentation in the same manner that women who want to enlarge their breasts do (through implants).Trans males may choose to have a hysterectomy (removal of the uterus), and also remove the fallopian tubes, ovaries, and cervix. They may do this because of dissatisfaction with having inner female body parts (even though hormones usually stop menstruation), or also to reduce their risk for cancer of these areas, which hormones can increase risk for. They may also undergo Metoidioplasty, which is the process of enlarging the clitoris through androgen therapy, or choose Phalloplasty, which constructs a penis using grafts from other areas of the body and an erectile prosthetic. Trans males may also undergo cosmetic surgery in order to appear more feminine. Common areas of concern include: cheek and jaw bones, the nose, and the Adam's apple. Some estimates of the cost of surgery for trans males exceed $50,000, not including hormone therapy. Trans females continue the process after chest reconstruction with Vaginoplasty, which inverts the penis to make a vagina and uses the scrotum to form labia. You can read about the steps of vaginoplasty here. Although trans women can choose to undergo surgery to have a vagina, there are currently no methods to construct a uterus or ovaries, meaning the woman cannot bear children or menstruate. This procedure is estimated to cost between $7,000 and $24,000.


Thailand and health facilities

Phuket Plastic Surgery Clinic and Yanhee hospital are two facilities in Thailand that perform gender reassignment surgery and other cosmetic surgeries. These hospitals make the gender reassignment surgery as comfortable as possible. The process of gender reassignment surgery is treated like a retreat. Gender reassignment surgery is popular in Thailand due to the cheaper prices and the surgeons there (particularly male to female surgeons) are highly reputable. However, surgery in Thailand is illegal without psychiatric consent, and the individual cannot legally change their sex designation in the US if they had surgery outside of the US. This is a video about sexual reassignment therapy in Thailand. Here are the prices from Phuket Plastic Surgery Clinic for gender reassignment surgery: These do not include the Hormone therapy the person must go through. You can find the price list from Yanhee general hospital here.

Gender Reassignment Surgery
Full GRS with scrotal skin graft US$ 10,000
Full GRS with additional skin graft US$ 11,500
Secondary Colon Vaginoplasty without additional
skin graft US$ 9,000
Secondary Colon Vaginoplasty with additional
skin graft US$ 10,500
Cosmetic Labiaplasty and Urethroplasty US$ 2,000
These charges are fully inclusive of surgeon’s fee, anesthesia, operation costs and hospitalization. Transportation between the airport, hotel and hospital are also included. No deposit is required
The fee does not include Hotel and International telephone call charges.

Post GRS Revision Procedures
Full Thickness Skin Graft Vaginoplasty US$ 5,500
Full thickness Skin graft Vaginoplasty with
Tummy Tuck US$ 7,500
Rectosigmoid Colon Vaginoplasty US$ 9,000
Labiaplasty US$ 1,200 – 2,500
Urethroplasty US$ 1,200
These charges are fully inclusive of surgeon’s fee, anesthesia, operation costs and hospitalization. Transportation between the airport, hotel and hospital are also included. No deposit is required
The fee does not include Hotel and International telephone call charges.

Facial Feminization Surgery
Frontal Bone Shave and Remodel, with Eyebrow Lift US$ 6000
(includes 3 days hospitalization and all fees)
Upper Eyelid Surgery (Upper Blepharoplasty) US$ 700 - 1,500
(price dependent on type of anesthesia)
Lower Eyelid Surgery (Lower Blepharoplasty) US$ 700 - 1,500
(price dependent on type of anesthesia)
Nose reduction (Reduction Rhinoplasty),
Nasal Tip Surgery US$ 2,000 - 4,500
(includes 1-3 days hospitalization and all fees)
Cheek Implants US$ 2,500
(includes 1 day hospitalization and all fees)
Chin Advancement, Implant or Shaving US$ 1,500 - 4,000
(includes 1-2 days hospitalization and all fees)

Miscellaneous Facts

  • According to Wikipedia, in 1979, when Paul McHugh became chairperson of the psychiatric department at Johns Hopkins, he ordered the department to conduct follow-up evaluations on as many of their former transsexual patients as possible. When the follow-ups were performed, they found that most of the patients stated that they were happy as members of their target sex, but that their overall level of psychological functioning had not improved. McHugh reasoned that to perform physical gender reassignment was to "cooperate with a mental illness rather than try to cure it." At that time, Johns Hopkins closed its gender clinic and has not performed any sex reassignment surgeries since then.
  • Trans females often experience narrowing of the new vagina and have to have dilation done to correct it.
  • Trans males can often experience dysfunction of the penis.
  • Since the number of trans surgeries are so few, it is hard to find reliable statistics on the number of occurences, fatalities, and rejected petitions for therapy.According to there are approximately 100 to 500 sexual reassignment surgeries done in the U.S. annually.
  • Check out a transexual diary: A detailed account of someone's journey as a transgender.
  • This is a link for some legal issues surrounding sex reassignment change.

Sex reassignment therapy
Sex reassignment surgery
Gender Identity Disorder
Harry Benjamin's International Gender Dysphoria Association's Standards of Care
Trans female hormone therapy
Trans male hormone therapy
Trans female sex reassignment surgery
Trans male sex reassignment surgery
Sex reassignment in Thailand
So you wanna get a sex change?