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Once, twice, three times a 'ladyboy': A case of transsexualism

Summer vacation is upon us, oh my readers. Conjured images appear of transoceanic flights, bleached Thai beach sand and sensual massages often concluded with the legendary 'happy ending'. Many of these 'happy endings' however have ended in a 'not-so-happy surprise' when the patron discovers his coy mistress to be a smiling mister.

Anecdotes like these a far from uncommon in Thailand and describes a flourishing culture referred to by the locals as 'kathoeys' or 'ladyboys'. The tropical getaway is believed to be home to the highest population of transsexuals in the world, boasting the highest rate of gender reassignment surgeries performed[1] .

Introducing Dr Jekyll

The DSM-V's diagnostic term for transsexualism is 'Gender Dysphoria', in which the individual feels pervasively disconnected with his/her body and desires to be a member of the opposite sex. This originates from the individual's feelings of incongruity between his/her gender identity and their sexual identity.

Manifestations of such a disconnect may range from adopting clothing and mannerisms of the opposite sex, to attempts at 'correcting' ego-dystonic feelings through more permanent and irreversible means such as hormone replacement therapy and surgical enhancement.

Becoming Ms Hyde

Guidelines for 'safe' transition to the fairer sex (or not so fair in the case of a trans-locating woman), have been set by the World Professional Association of Transgender Health (WPATH), an international body concerned with the understanding and treatment of gender dysphoria. Once the diagnosis of transsexualism has been made, the individual then follows three further phases.

The first phase of physical treatment relates to hormonal reconstitution, which occurs after a three month period of rigorous psychological therapy and proven mental stability. Transmen (biologically born women becoming men) are given androgens such as testosterone, while transwomen (biologically born men becoming women) are administered oestrogen and progesterone, as well as testosterone-blocking agents.

Second, an individual is required to undergo a Real-Life Test, consisting of a 12-month period of successful hormone therapy and immersion into life as the desired gender. This includes maintaining a part-time or full-time job as their 'significant other' self as well as legally changing their name to one of the opposite sex.

The final phase of gender translocation involves contacting a gender reassignment team consisting of a gynecologist, urologist, plastic surgeon or general surgeon, by recommendation of the hormone administering physician in conjunction with a mental health care professional.

Transmen usually undergo removal of the testes and penis, with surgical construction of a vagina, labia and clitoris.

Transwomen are subject to removal of the uterus, ovaries and vagina, followed by the artificial construction of a penis, scrotum along with matching prosthetic testicles.

Further, either sex may choose to have adipose reshaping, facial bone reconstruction as well as vocal cord surgery or voice training.

Is it worth going out on a limb?

While there is an ongoing debate as to whether the process shows an improvement in quality of life when weighed against the cost and potential physical and psychological side effects of the treatment, the rate of regret post-operatively is relatively low.

This however, is not the case in Iran, where gender reassignment is forced upon the individual through societal and institutional pressure. With gender reassignment being promoted and even partially funded by the government in an attempt to "eradicate homosexuality", more transgender operations are performed in Iran than in any other country bar Thailand. This leads to large populations suffering with the regret and emotional scarring of the ordeal, especially since many would not have chosen operative treatment if given a choice[1] .

One notable and outspoken advocate for transgender rights is transmale writer and musician, Chaz Bono (born Chastity Sun Bono), the only child of American entertainers Sonny Bono and Cher. Along with organisations like WPATH, he strives to increase the understanding and fair treatment of transgender individuals across the world, ensuring that everyone has a fair shot at their own 'happy ending'.

[1] Iran's 'diagnosed transsexuals' by Vanessa Barford, BBC News

About Chamendran Naidoo

Chamendran Naidoo works as a General Practitioner in the SA Navy. His interests include fine surgery as well as approaching the patient as a whole in a Bio-Psycho-Social manner. He is passionate about the immersion of medicine into everyday life which he actively manages via social media fronts. Chamendran is also a co-presenter on SABC3's Dr Mol Show. Email Chamendran on moc.liamtoh@nardnemahc and follow him on Twitter at @Chamendran.

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