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Sex reassignment therapy is an umbrella term for all medical procedures regarding gender reassignment of both transgender and intersexual people. Sometimes it is also called gender reassignment, even though many people consider this term inaccurate, as it alters physical sexual characteristics to be more in line with the individual's psychological/social gender identity, rather than vice versa as is implied by the term "gender reassignment".
Sex reassignment therapy consists of hormone replacement therapy (HRT), various surgical procedures (see below), and epilation for transwomen, that is permanent hair removal on the face and body is accomplished with electrolysis or laser hair removal.
Transsexual people who go through sex reassignment therapy usually change their social gender roles, legal names, and legal sex designation, in addition to undergoing the medical procedures discussed in this article. The entire process of change from one gender presentation to another is known as transition.
Sex reassignment surgery is the most common term for what would be more accurately described as genital reassignment surgery or genital reconstruction surgery. This refers to the procedures used to make male genitals in to female genitals and vice versa. Sex reassignment surgery, or SRS, can also refer to any surgical procedures which will reshape a male body into a body with a female appearance or vice versa.
The requirements for hormone replacement therapy vary greatly; often, at least a certain period of psychological counseling is required, as is a period of living in the desired gender role, if possible, to ensure that they can psychologically function in that life-role.
Generally speaking, physicians who perform sex-reassignment surgery require the patient to live as the members of their target gender in all possible ways for at least a year ("cross-live"), prior to the start of surgery, in order to assure that they can psychologically function in that life-role. This period is sometimes called the Real Life Test (RLT); it is part of a battery of requirements. Other frequent requirements are regular psychological counseling and letters of recommendation for this surgery.
Most US professionals who provide services to transsexual women and men follow the controversial Standards of Care for Gender Identity Disorders put forth by the Harry Benjamin International Gender Dysphoria Association. Outside the USA, many other SOCs, protocols, and guidelines exist, although the Harry Benjamin SOCs are certainly the best known. A significant and growing political movement exists, pushing to redefine the SOC, asserting that they do not acknowledge the rights of self-determination and control over one's body, and that they expect (and even in many ways require) a monolithic transsexual experience, when in reality there are as many different ways of being transsexual as there are transsexual people. In opposition to this movement is a group of transsexual persons and caregivers who assert that the SOC are in place to protect others from "making a mistake" and causing irreversible changes to their bodies that will later be regretted -- though few post-operative transsexuals believe that sexual reassignment surgery was a mistake for them.
Although the overwhelming majority of individuals who undergo sex reassignment express happiness in living as members of their target sex, some believe that sex reassignment is ineffective as a treatment for transsexuality, or that it is unnatural and/or immoral.
Many religious conservatives believe that physical sex reassignment is morally wrong, and cite evidence that transsexuality can be cured spiritually or psychologically. However, evidence suggests that current psychological treatments for transsexuality are highly ineffective.
Although it is undeniably offensive to transsexual women and men, some people consider transsexuals to be members of the physical sex assigned to them at birth, even after they have completed all aspects of transition and sex reassignment. Their reasoning is often based in the facts that sex chromosomes cannot be changed with the procedures currently available. It has also been argued that transsexuals do not have reproductive organs and that the procedures merely create a facsimile of the desired genitals by mutilating the genitals they were born with. Many other people believe that an individual's sex is determined by factors such as gender presentation, gender identity, external genitalia, and sex hormones; and therefore, they consider transsexuals to be true members of their target sex. They often point to ordinary women and men who were either born without certain reproductive organs, or had them removed, as well as the existence of people whose sex chromosomes do not match their physical sex and gender identity, such as women with Complete Androgen Insensitivity Syndrome.
In 1967, John Money, a prominent sexologist at Johns Hopkins Hospital, recommended that David Reimer, a boy who had lost his penis during a botched circumcision, be sexually reassigned and raised as a girl. Despite being raised as a girl from the age of 18 months, Reimer was never happy as a girl, and when he learned of his sex reassignment, he immediately reverted to living as a male. Money never reported on the negative outcome of Reimer's case, but in 1997, Reimer went public with the story himself. His case, as well as several cases of intersexed infants with conditions such as cloacal exstrophy who have been reassigned and raised as females, suggest that gender identity is innate and immutable.
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 claimed to be 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. Many people have criticized McHugh's conclusion, often stating their belief that the purpose of gender reassignment is to make transsexual people happy and content with their bodies, not to improve their psychological functioning.
Many medical textbooks state that "significant psychological problems often persist after surgical and hormonal sex reassignment." However, research that has been done on transsexuality has been incomplete when compared to studies done on various other conditions, such as Down syndrome, Cerebral palsy, and autism. However, many people, especially transsexual people, feel that sex reassignment is a highly effective treatment for transsexuality, and that there are higher priorities for medical researchers. This is especially true of those who feel that mainstream medical professionals who research transsexuality are attempting to find ways to cure the condition psychologically; many transsexual people feel that physical sex reassignment is a far better treatment for their gender dysphoria than any psychological treatment or other treatment to "change the mind to match the body" rather than vice versa, ever would be.
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