Transsexualism: A review of etiology, diagnosis and treatment

Transsexualism is considered to be the extreme end of the spectrum of gende r identity disorders characterized by, among other things, a pursuit of sex reassignment surgery (SRS). The origins of transsexualism are still largel y unclear. A first indication of anatomic brain differences between transse xuals and nontranssexuals has been found. Also, certain parental (rearing) factors seem to be associated with transsexualism. Some contradictory findi ngs regarding etiology, psychopathology and success of SRS seem to be relat ed to the fact that certain subtypes of transsexuals follow different devel opmental routes. The observations that psychotherapy is not helpful in alte ring a crystallized cross-gender identity and that certain transsexuals do not show severe psychopathology has led clinicians to adopt sex reassignmen t as a treatment option. In many countries, transsexuals are now treated ac cording to the Standards of Care of the Harry Benjamin International Gender Dysphoria Association, a professional organization in the field of transse xualism. Research on postoperative functioning of transsexuals does not all ow for unequivocal conclusions, but there is little doubt that sex reassign ment substantially alleviates the suffering of transsexuals. However, SRS i s no panacea. Psychotherapy may be needed to help transsexuals in adapting to the new situation or in dealing with issues that could not be addressed before treatment. (C) 1999 Elsevier Science Inc.