Even today, very large numbers of desperate young transsexuals in India and Bangladesh run away from home to join the "Hijra" caste. To become Hijra, these teens voluntarily undergo fully emasculating surgeries under primitive conditions, just as they would have in ancient times, with only opium as an anesthetic. Most undergo the surgery in their teens shortly after the onset of puberty, with results as seen in photo below. By being castrated just early enough, many avoid the development of male secondary sex characteristics (except for the breaking and lowering of the voice), and their bodies can remain permanently soft, childlike and girly.
Transsexualism has profound implications for our conceptions of gender categories. Some cases of transsexualism have received great publicity. In 1952, George Jorgensen, a retired Marine, went to Denmark to have his genitals surgically altered to resemble those of a female. George changed his name to Christine, went public, and became the first highly publicized case of a transsexual who underwent sex reassignment surgery (SRS).
A variety of medical and surgical options are available, and although some transpeople proceed through all the stages to eventual surgery, many do not. For many, treatment officially begins with psychotherapy, which helps explore options, establish realistic life goals, and identify points of conflict that have been interfering with life happiness.
The clinician should have known the patient for at least three months in a therapeutic relationship before making a recommendation for hormonal reassignment and six months before making a recommendation for surgical reassignment. Prior to sex reassignment surgery, the patient should have lived full-time in the social role of the other sex for at least 12 months.
In 1973, the gay rights movement succeeded in removing homosexuality from the American Psychiatric Association's Diagnostic and Statistical Manual (DSM). At the same time, transsexuals were moving in the opposite direction, and, in 1980, transsexualism was added to the DSM, providing a means to obtain access to hormone therapy, reassignment surgery, and other treatments. (Transsexualism was later incorporated into the controversial designation 'Gender Identity Disorder.' The entry is under revision for the next version of the DSM, to be published in 2013.)
Without first meeting eligibility requirements, the patient and the therapist should not request hormones or surgery. An example of an eligibility requirement is: a person must live full time in the preferred gender for twelve months prior to genital reconstructive surgery. To meet this criterion, the professional needs to document that the real life experience has occurred for this duration.
Finally, the survey explored overall satisfaction and eventual regrets. Results revealed that 131 patients (94%) were satisfied with their new sexual status and did not regret having undergone their surgery, while 8 patients (6%) were dissatisfied with results and regretted the surgery.
As a whole, the data on SRS and hormones demonstrate that the vast majority of this sample would not have been represented had the research design only included transgender individuals presenting at clinics seeking medical intervention. This highlights the importance of alternate research strategies, and suggests that online research methodology may be particular well suited to capture a wider range of transgender identifying individuals.
On the other hand, there are some significant disadvantages to SRS, even for persons committed to SR. Genital surgery is expensive: $7000 to $24,000 for MFs, and up to $50,000 or more in the case of FMs. Although vaginoplasty for MFs has become very sophisticated, there is really no satisfactory phalloplasty procedure for FMs.
As noted earlier, reduction mammoplasty (chest reconstruction) for FMs, and facial feminization surgery for MFs are often of greater practical importance than genital surgery in the daily life of transsexual persons. This is because the former procedures are often essential to permit passing in the desired gender role in ordinary social interactions.