Supporting The Families Of Adults experiencing Gender Discomfort and Transsexualism
By Bernard Reed
Issues To Be Faced
It is helpful for trans people and their families to look realistically at the daunting range of issues to be dealt with during the transition process:
- Psychiatric assessment to confirm the diagnosis
- Understanding a vast amount of new information about gender identity and
transsexualism
- Obtaining funds for treatment, NHS or private
- Carefully informing all who need to know
- Undergoing the real life experience that is a mandatory precursor to surgical treatment, which requires living in the new gender role full-time
- Handling relationships
- Maintaining access to own children
- Certificate of gender confirmation treatment for use if challenged in using toilets or other gender-segregated facilities.
- Statutory declaration of new identity to use in obtaining new documents
- Medication
- Employment
- Pension provisions
- Entitlement to state benefits
- Entertainment and social activities
- Media intrusion
- Transphobic crime
- Legal support to deal with extreme problems
- Crisis, even rape, support
- Counselling
- Artificial body parts
- Clothing, footwear and wigs
- Behaviour and deportment
- Cosmetics
- Hair removal
- Speech therapy
- Surgery: genitals, gonads, breast, trachea, face
The list of documents and records that the trans person has to change is also very long:
- Driving licence
- Passport
- Degrees and other qualifications
- GP and other doctors
- Other medical services e.g. Dentist, Optician
- Tax and National Insurance
- Personnel records at work
- Pension records
- Benefits Agency
- Job Centre
- Bank and Building Society
- Personal and household insurance policies
- Mortgage
- H.P. Agreements
- Credit cards
- Utilities: Gas, Electricity, Water, Phone
- Council Tax
- Electoral Roll
- Club memberships
- Birth certificate, after grant of a gender recognition certificate, (commencing 2005)
- ID Cards (commencing whenever the proposed new legislation comes into effect)
In this complex and changing situation, the inevitable stress, for trans people and their families, severely inhibits communication, making it even harder for all of them to sustain an effective relationship.
Very often, the importance of surgery is given exaggerated importance, by trans people and their families, in comparison with the many other factors above that have to be dealt with successfully to ensure a happy life for the trans person. However, for most trans people, surgery is essential and it is very expensive. Many trans people cannot afford private treatment. The NHS makes only limited funds available for this treatment. Funding priorities are set locally by the strategic health authorities and primary care trusts. Waiting lists for surgery, or indeed for other medical treatment can be long.
Families, as well as trans people, need to be aware of the main surgical options:
a - MtF (Trans Woman):
- orchidectomy - removal of testicles
- penectomy - removal of penis
- vaginaplasty - creation of vagina
- clitoroplasty - creation of clitoris
- mammoplasty - breast enlargement
- tracheal shave - reduction of Adam's apple
- facial feminising - especially reshaping the nose and chin
b - FtM (Trans Man):
- mastectomy - removal of breasts
- hysterectomy - removal of uterus
- oopherectomy - removal of ovaries
- metoidioplasty - creation of micro-penis, using the clitoris
- phalloplasty - creation of penis, with or without urethra
- penile implant - making erection possible
Hormone treatment is likely to affect the trans person's libido (sex-drive). In trans women (MtF), the effect of the hormones (anti-androgens and estrogens) is likely to reduce libido. In trans men (FtM), it is likely to be increased by the hormones (testosterone). Both trans women and trans men can experience orgasm post-operatively.
