Theories and Therapy
This section contains information dealing with the theories
behind transsexuality and psychological aspects of treatment "and stuff
like that".
There is always new research being performed, and everything of
late has been very good news for the transsexual, in that it all points to the
fact that we are not mentally ill because of this, and that it is a medical
condition and not a "lifestyle choice".
Here is information from a medical paper abstract on Medline,
which is a followup to a 1995
paper on brain research:
"Title: Symptom profiles of
gender dysphoric patients of transsexual type compared to patients with personality
disorders and healthy adults.
(Acta Psychiatr Scand 2000 Oct;102(4):276-81, 0001-690X,
Haraldsen IR; Dahl AA, University of
OBJECTIVE: Gender dysphoric patients of
transsexual type (TS) have been considered to have severe psychopathology.
However, these notions have a weak empirical documentation. METHOD: TS patients
(n = 86), patients with personality disorder (PD, n = 98) and adult healthy
controls (HC, n = 1068) were compared by means of the Symptom Checklist 90
(SCL-90). All patients were diagnosed by structured interviews (Axis I, II and
V of DSM-III-R/IV). PD patients were further characterized according to the
LEAD-standard. RESULTS: TS patients scored significantly lower than PD patients
on the Global Symptom Index and all SCL-90 subscales. Although the TS group
generally scored slightly higher than the HC group, all scores were within the
normal range. CONCLUSION: TS patients selected for sex reassignment showed a
relatively low level of self-rated psychopathology before and after treatment.
This finding casts doubt on the view that transsexualism is a severe mental
disorder."
The 1995
research paper by Zhou has graphs and charts that show clearly the brain
differences. The year 2000 research should be available through this link: http://jcem.endojournals.org/cgi/content/full/85/5/2034.
Other references:
Evidence that local changes in hormonal concentrations can lead
to large changes in brain development and structure, which would of necessity
have some impact on brain function (e.g., behaviour): Lustig, R.H. "Sex
Hormonal Modulation of Neural Development in Vitro: Implications for Brain Sex
Differentiation"
A concordant pair of monozygotic twins, both transsexual
(possibility of this happening by chance: about 1 in 900,000,000), and the
presence of transsexualism in all ethnic groups despite wide cultural diversity:
Tsur, H., Borenstein, A., & Seidman, D. S. (1991).
"Transsexualism." Lancet, 338, 945-946.
Preliminary evidence for a causal effect of both estrogen and
testosterone on pattern of cognitive ability has been obtained from studies of
transsexuals selected for hormone therapy. A rapid shift has been described
from the female to the male pattern of cognitive abilities in female-to-male
transsexuals treated with testosterone. Compared with their performance just
before treatment began, they showed deterioration in verbal and improvement in
spatial abilities: Van Goozen, S.H.M., Cohen-Kettenis, P.T., Gooren, L.J.G.,
de Poll, N.E. (1994). "Activating effects of androgens on cognitive
performance: Causal evidence in a group of female-to-male transsexuals."
Neuropsychologia, 32, 1153-1157.
In a subsequent study, it was found that male-to-female
transsexuals treated with antiandrogens and estrogen showed the reverse
changes. These findings support a causal effect of gonadal steroids on the brain
functions that underlie sexually dimorphic cognitive abilities: Van Goozen,
S.H.M., Cohen-Kettenis, P.T., Gooren, L.J.G.,
Yes, being TS is NOT a severe mental disorder, Thank
you! Yes, there are still others that will argue the other way, and I just have
to believe that their observations aren't objective, and that it's not a
scientific conclusion as the above abstract describes.
Will SRS help
me? Will I regret it?
Well, that depends.
Even with all the "safeguards" in place to prevent
this, there are people who are really cross-dressers that fantasize of being
female, that for whatever life reason fake their way through the system and severely
regret having SRS. Many of these people
realize it immediately after the surgery, just as they wake up, and now know
they made a huge, permanent mistake. For me it's hard to image going that far,
to go through the pain and joy of transition, to NOT know beforehand - that
this isn't something you should do - even at the last moment. But yet it
happens, even today.
I believe that it's important that your general mental state is
good before you go into transition. If you have mental baggage going
into this, it may greatly hamper your ability to handle transition and surgery.
That's not to say that you should avoid transition because your life isn't
perfect, or that you won't be able to handle it, but getting rid of as much of
that baggage beforehand as you can will improve your chances of success. No
one's life is perfect, ever.
If you are going through a divorce, dissatisfied with your
life, your job, whatever, and feeling that your life is crumbling around you,
then that is probably NOT the time to start transition. These other issues not
only just give you that much more to worry about at a time when you really don't
need more problems, they may also cloud your judgment and make it difficult to
see the issues related to transition that you need to handle effectively. You
need to be able to connect with your feelings, and you don't want life problems
to make you believe you are TS when in actuality you are not.
The belief that SRS will solve all your problems is a false
one. The grass is, as you know, always greener on the other side. SRS may solve
some problems, and create others, and that is something you should be prepared
for. Having a supportive therapist, family and friends helps greatly, but I
know that isn't always the case. The purpose of transition and SRS is to
improve your life, after all, and you should be very certain that it will. SRS
should not be used as an escape from the problems in life that we all have, but
rather as something to remove the gender problem from your life.
Here is some advice to help improve satisfaction with SRS, from
a group that studied a number of SRS patients that were severely dissatisfied
with the results:
"1. the criteria of indication for the operation of the
transsexuals should be observed thoroughly, especially the psychotherapeutic
accompaniment before the operation during at least 1 year; 2. the question of
emotional stability, of frustration tolerance and of the danger of an outbreak
of psychosis are to be examined carefully; 3. the professional and social
integration before and after the operation is of central importance."
So, first it's important that you do the Real Life Test. You
need to ensure that you can survive in the real world, that in seeking gender
congruity that you don't destroy the remainder of the life that you have
built. That said, SRS may be the right
thing for you, despite the fact that the life you knew is gone. Just be prepared.
Second, get your act together before and during transition, and
get help after SRS if you need it.
“Doing it yourself”, as many do, may mean that you are doing it for the
wrong reasons.
Here is some info from and abstract on www.medscape.com on surgical result
satisfaction:
“The reported sex and surgery satisfactions of 28
postoperative male-to-female transsexual patients.
(Arch Sex Behav 1999 Feb;28(1):71-89; 0004-0002; Rehman J;
Lazer S; Benet AE; Schaefer LC; Melman A; Department of Urology, Montifiore
Medical Center/Albert Einstein College of Medicine, Bronx, New York 10467,
USA.)
From 1980 to July 1997 sixty-one male-to-female gender
transformation surgeries were performed at our university center by one author
(A.M.). Data were collected from patients who had surgery up to 1994 (n = 47)
to obtain a minimum follow-up of 3 years; 28 patients were contacted. A mail
questionnaire was supplemented by personal interviews with 11 patients and
telephone interviews with remaining patients to obtain and clarify additional
information. Physical and functional results of surgery were judged to be good,
with few patients requiring additional corrective surgery. General satisfaction
was expressed over the quality of cosmetic (normal appearing genitalia) and
functional (ability to perceive orgasm) results. Follow-up showed satisfied who
believed they had normal appearing genitalia and the ability to experience
orgasm. Most patients were able to return to their jobs and live a more
satisfactory social and personal life. One significant outcome was the
importance of proper preparation of patients for surgery and especially the
need for additional postoperative psychotherapy. None of the patients regretted
having had surgery. However, some were, to a degree, disappointed because of
difficulties experienced postoperatively in adjusting satisfactorily as women
both in their relationships with men and in living their lives generally as
women. Findings of this study make a strong case for making a change in the
Harry Benjamin Standards of Care to include a period of postoperative
psychotherapy.”
You should want to do this the best way you can, and work to
get the best results, both mentally and physically.
Being TS is like being between a rock and a hard place, that's
for sure, and the force that drives you is strong and immutable. It never goes away, and at some point it may
drive you to the point where you have to transition, no matter what the
cost to you, or the life you lead. Just
make sure, absolutely, that you are doing it for the right reasons. Make sure that when you move towards SRS that
it isn’t because you are running from something else.
Only you can know if you are truly a transsexual, no one
else. Only you can decide if this is
something you must do, no one else. SRS
was the right thing to do for me, but that may not be the case for you. That
said, the satisfaction rate, as I understand it, is very high. I have yet to meet anyone in 3D that was not
happy they did it, but that’s not a scientific study. I’ve only seen one Internet site where the
author said that she wished there was some other way she could have handled the
problem, but again, not a very scientific study. I have had one friend de-transition prior to
SRS because of severe family problems, and so far ‘he’ is happy. There are two people I know that were there
when someone awoke from surgery, and that person knew at that moment that they
made a huge mistake.
Psychiatric Aspects of Sex Reassignment
Surgery
Abstracts
from the Endocrine Society
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