The necessity of sex reassignment operations and the legal implications for people who wish to change their sex has come under discussion in the community recently. With more than 20 years of experience in dealing with transsexual patients, I can offer an insight into the kinds of people they are and what their pre-surgery journey involves.
First of all, transsexuals are physically fit adults of sound mind. The only major mental distress they suffer is an incongruence between mind and body. They feel they should belong to the opposite sex.
Typically, they cannot accept the sexual characteristics of their bodies - for a born male, a penis, testes and a prominent Adam's apple. Similarly, a born female is distressed by her sizeable nipples, breasts and menses. Furthermore, they want to gain the sexual characteristics of the opposite sex: a vagina for a born male; a penis for a born female.
This is a very unusual condition. Over the past 30 years, only about 100 people have had sex reassignment surgery in Hong Kong.
During adolescence or later adulthood, transsexuals usually try modifying their hairstyles, clothing and lifestyles to better suit their state of mind. But this does not always provide relief, so some seek medical help.
A general practitioner is the first stop - from here the patient is referred to a psychiatrist to assess their mental condition.
One important task is to distinguish the condition from other psychiatric diseases, which require very different treatments. After the diagnosis is established, the patient is referred to a clinical psychologist for assessment.
If their mental condition persists, sex hormones of the opposite sex are prescribed. Taking these induces changes in the patient's body as well as their psychology. Those satisfied with the change can continue with this course and do not need more aggressive treatment.
However, those who are still not satisfied can ask for surgery to make major body changes. Before they are allowed to undergo surgery, they are required to demonstrate they can live comfortably in the social role of the opposite sex. This is the so-called real-life experience. It should cover all settings of life such as going to work or school and visiting family or friends.
In other words, they should be psychologically and socially well prepared before contemplating irreversible sex reassignment surgery.
The core part of sex reassignment surgery consists of removing the patient's original sex organs and constructing organs mimicking those of the opposite sex. For a born male, the penis and testes are removed and a vagina is constructed; for a born female the ovaries and uterus are removed and a penis is constructed.
None of my patients has regretted having the surgery. Nearly all are happy with their new assigned sex.
After surgery, they are granted a new identity card bearing the new sex and lead normal lives afterwards. Their main concern is the physical change; the change in status on the card is a secondary gain.
In conclusion, sex reassignment surgery is an effective, long-lasting solution for people with an unusual mental condition. Everything we do is in their best interests.
Dr Yuen Wai-cheung is consultant surgeon of Ruttonjee and Tang Shiu Kin hospitals