Gender Dysphoria

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The following are standards from the Gender Dysphoria Program at the entry level. It was written by the Directors: Jude Patton, Joanna Clark and William Heard, Ph.D. (This letter was written in the early 1980,s)

Psychological Evaluation

The psychological evaluation is to help rule out secondary diagnoses, especially depression, thought disorder, intellectual impairment, and / or psychopathic character disorders. Such conditions do not necessarily rule out sex reassignment surgery, but they may necessitate delayed entry into the program while themselves being treated.

Applicants accepted into the program are required to undergo a minimum of three (3) psychological evaluations. These evaluations are scheduled as follows: one (1)at the time of entry into the program, (2) sex months after entry into the program, and (3) within thirty days of scheduled genital sex reassignment surgery. A forth psychological evaluation may be required for clients requesting breast reduction or augmentation surgery separate from and prior to genital surgery.

Psychological evaluations are conducted by a licensed clinical psychologist, experienced in the management and treatment of gender dysphoria syndrome.

Psychiatric Evaluation

Like the psychological evaluation, the psychiatric evaluation is designed to help rule out secondary diagnoses of depression, thought disorder, intellectual impairment, and / or psychopathology. As stated previously, such conditions do not necessarily rule out sex reassignment surgery, but they may necessitate delayed entry into the program while themselves being treated.

Applicants accepted into the program are required to undergo a minimum of three (3) psychiatric evaluations. These evaluations are scheduled as follows: one (1)at the time of entry into the program, (2) sex months after entry into the program, and (3) within thirty days of scheduled genital sex reassignment surgery.

A forth psychiatric evaluation may be required for clients requesting breast reduction or augmentation surgery separate from genital surgery.

Psychiatric evaluations are conducted by a licensed clinical psychologist, experienced in the management and treatment of gender dysphoria syndrome.

Psychometric Evaluation

Psychometric testing is a integral part of the evaluation process. Consequently, the applicant will be required to complete the Minnesota Multiphase Personality Inventory (MMPI), the Tennessee Self Concept Scale (TSCS), and the Bem Sex Role Inventory (BSRI). The MMPI, TSCS and BSRI will be administered at the time of admittance into the program and within thirty days of scheduled genital sex reassignment surgery.

Medical Evaluation

Following acceptance into the program, and attendance at the prescribed six group counseling sessions during the first three months of participation, the patient will be provided a letter of introduction which will permit the patient to proceed with the medical evaluation and initiation of hormonal sex reassignment.

You should be aware that standard laboratory test are for the most part non-contributory to the diagnosis of transsexualism. They are necessary, however, to rule out possible contraindications to hormone therapy and / or risks of surgery. For example, estrogen and testosterone raise lipids presenting possibility of heart attack. As such, the following are considered significant contraindications to estrogen and / or androgen therapy:

We refer to a board certified physician in internal medicine and endocrinology, experienced in the treatment of transsexuals, who cooperates with our gender dysphoria program.

His initial medical examination includes comprehensive history and physical examination, electro - cardiogram, chest X - ray, appropriate endocrine and routine blood tests, as well as urinalysis. He spends considerable time during this examination in carefully evaluating each patient, medically and endocrinologically, to insure safety of receiving hormones. He has proven to be most exacting and careful in his follow-up of patients in order to avoid any deleterious or disastrous side effects relation to hormone administration. Consequently, should you elect to participate in the program, you will be required to return at periodic intervals for proper monitoring in order to insure that no unwanted side effects should occur.

Real Life Test

It has been proven that the diagnosis of transsexualism is best confirmed by the one- to two-year real-life test. This test allow the rehabilitative effect of sex reassignment to be observed and recorded as it occurs.

It requires that you become rehabilitated hormonally, socially, vocationally, and interpersonally in the sex of reassignment prior to the irrevocable step of surgery.

The real-life test allow you to experience what it means to be treated day in, day out, as a member of the opposite sex. This experience is imperative to complement the solipsistic, inner conviction and imagery of being a member of the opposite sex.

You are free to initiate the real-life test at your discretion. However, it should be noted that the one- to -two-year requirement does not begin until full-time cross-gender living has begun. The patient should consider all of the social, interpersonal, and vocational consequences of the real-life test prior to initiation. Rejection by loved ones and loss of employment are not uncommon occurrences. Therefore, careful planning is required before taking the major step.

Sex Reassignment

Sex reassignment surgery is a highly complex procedure and should not be taken lightly. As the number of surgical sex reassignment procedures have increased, so have the reports of complication. Very often these complications are quite severe, rendering the patient incapable of functioning in the opposite role. In many cases, these complications have incapacitated the patient to the extent that they have had to give up jobs and seek repeated and prolonged medical care to rectify these problems. Consequently, the staff of the gender dysphoria program cannot overemphasize the importance of using care in the selection of a surgeon and / or surgical team to perform the procedure.