The Management of Patients with Gender Disorders

Sexual Deviation: Paraphilias

“…In some cases, homosexual transsexuals may initiate hormone intake (estrogens for males and testosterone for females) to acquire some cross-gender secondary sex characteristics. In a biological male, regular estrogen intake leads to a redistribution of body fat, a reduction in facial and body hair, and mild to moderate breast enlargement (Steiner, 1985). A percentage of transsexuals will seek sex reassignment surgery (some extreme cases of autocastration have been reported in transsexuals).…”

“…Surgical sex reassignment is generally more effective for males than for females. The creation of an artificial penis is difficult and often unsatisfactory (see Steiner, 1985). For males, surgery entails removing the penis and testes and creating a vagina and breast augmentation.…”

Transvestites and transsexuals: toward a theory of cross-gender behavior

“…The insistence upon gender transformation is believed to be transient in the secondary transsexual with stress factors playing a part in the timing of the gender-change demands. It is said that when a 2-year test period of living in the opposite gender role is required, as called for in the standards of the Harry Benjamin International Gender Dysphoria Association (1985), many of these men will abandon their belief that such a change is imperative (Steiner, 1985b).…”

“…Whether this circumvention of professionals is actually in the best interest of persons having gender difficulties remains to be seen. For a discussion of the clinical management of transsexuals, see Steiner (1985b). Another practice for avoidance of professionals by transsexual applicants for gender reassignment is through virtually complete reliance upon other transsexuals as counselors.…”

“…The diversity of activity reported and the duration of a typical cross dressing session calls into question the familiar characterization of transvestism (found in many textbooks) as primarily a sexual excitant. Steiner (1985b) has expressed her opinion that this explanation is too simplistic. Little has been previously reported concerning what TVs say they do during a typical session or how long they spend doing it.…”