Transgender people may express their gender identity in a variety of ways. For some, simply dressing in the clothing of their chosen gender is enough, but for others, realigning their physical body to conform to their mind's view is an important step. The path to this change can be difficult and costly, and the impact of hormones and surgery can take their toll. But for many, reaching the goal is worth this burden, and they begin the journey of transition. Hormones and surgery -- Sexual Reassignment Surgery (SRS) -- are the two tools used to effect gender change. Becoming a Female Male-to-female (MTF) transgender individuals use estrogen to become more feminine, and it can be effective in reducing body hair, increasing breast size, reducing penis size and changing the distribution of body fat, resulting in a body that looks more female. Hormone treatment does not affect facial hair, however, and expensive and often painful electrolysis may be needed to achieve a smooth complexion. Sexual Reassignment Surgery can be very effective for MTF individuals. Vaginoplasty is used to remove the testes and the scrotum is converted into a labia. The penis is essentially turned inside out to create a vagina. Surgery can also be used to change other features, such as augmenting breast size with implants, reducing the size of the Adam's Apple, and changing facial features to make them more feminine. Becoming a Male Female-to-male (FTM) transgendered individuals use the hormone testosterone to masculinize their bodies. It results in a lowered voice, greater sex drive, the growth of body and facial hair, and the end of menstruation. Interestingly, male pattern baldness can also result. Sexual reassignment surgery for FTM individuals is much more difficult, and is often undertaken in a series of steps. Breast removal, although often quite traumatic to the body, is the most common procedure. Some individuals choose to create male genitals, as well, through one of two approaches. Metaoidioplasty is a procedure whereby connective tissue around the clitoris is cut to increase its length and sensitivity. This typically results in a somewhat smaller penis, between two and three inches in length, but is often preferred due to the fact that nerves are intact and sensitivity is maintained. Phalloplastic surgery is a procedure used to construct a penis, using flesh removed from another part of the body, often the thigh or arm. Using current methods, a penis of about ten or more inches is constructed, and through tissue shrinkage, it ultimately becomes half that size. A penis constructed in this manner has no nerves, and although bigger, is often viewed as less satisfying than the first approach. Hysterectomies and vaginectomies are also sometimes chosen by FTMs. Neither of these affect certain body characteristics, however. MTFs do not have periods, do not have ovaries or a uteris, and cannot give birth. The Journey If you have come to the conclusion that you are transgender, and you wish to change your physical gender, you're going to have to deal with a ridiculous morass of legal and procedural regulations. The path to sexual reassignment is a difficult one, and one has to navigate what can only be described as Byzantine and frankly offensive reviews. The guidelines most often applied is called "The Standards of Care for Gender Identity Disorders" and was developed by the Harry Benjamin International Gender Dysphoria Association. It is often identified as The Harry Benjamin Standards of Care (HBSC). Using these tests, doctors and psychiatrists attempt to determine if someone is transsexual and whether or not their psychological and emotional makeup makes them suitable for sexual reassignment. A standard questionnaire is also used as part of this process. Hormones can be prescribed by all medical doctors and psychiatrists, but SRS should only be performed by experienced surgeons with the very specific expertise in this type of surgery. Insurance Coverage Most insurance companies refuse to provide coverage for sexual reassignment surgery, viewing the operation as elective and cosmetic. Hormone therapy can be expensive, and surgery can run as much as $150,000. A good source of information for this surgery is The Gender Identity Center of Colorado. OutProud acknowledges, with grateful thanks, the following organizations and articles which provided the foundation for this document: The International Foundation for Gender Education, TGNet Arizona.

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