Treatment. Being transsexual has the benefit of having a very structured management tool: The Standards of Care for Gender Identity Disorder. I will provide the link at the end of this post for anyone who wishes to read it, and will intersperse some of my commentary with either excerpts or citations. In MY treatment of those with GID, this is the manual, with some variation, that I follow. One thing of note to be aware of. The entire process from diagnosis of GID to completion of sex-reassignment-surgery can take YEARS and usually does. Other practitioners may vary in their time-frame, but I move very conservatively with this issue as I want to be certain. Also, not every person goes through all the stages, even if they ARE transsexual. Some may choose to stop at any stage.
There are 5 elements of clinical work: diagnostic assessment, psychotherapy, real-life experience, hormone therapy, and surgical therapy. There are several practitioners that might be involved in the treatment team: mental health clinician, physician prescribing hormone therapy (HT), and the surgeon performing the sex-reassignment surgery (SRS). The mental health professional is, generally the team "leader". It is this individual's responsibility to assess and diagnose GID, to identify the individual as being transsexual, to indicate the readiness of any of the major stages and any minor stages that fall within the major ones, to determine and treat any co-morbid psychological issues, and to assist in educating family members.
There is a specific structure for treatment, and this structure also depends on the age of the individual. For example, it is NOT recommended that any non-reversible physical treatments be performed on a child under the age of 16, and NO treatments may be performed on a minor without parental consent. There are, however, some universal conditions.
Firstly, during the assessment stage, the mental health practitioner needs to take a complete history, family history, assess for co-morbid psychological disorders, and determine whether these are the cause of the individual's gender distress or whether these are separate or caused BY the gender distress. In general, a diagnosis of GID should not be given in less than 3 months.
At the point that the diagnosis of GID is given, the individual is considered, though not confirmed as transsexual. Transsexuality is NOT the diagnosis, but a state of being; Gender Identity Disorder is the diagnosis. Consider that a mental disorder is classified as a psychological state that causes
distress. The transsexuality is not causing the distress, but rather the conflict between ones anatomical gender and the symptoms of GID that are inconsistent with this. Alleviating the symptoms of GID is the goal NOT cure. It then behooves the mental health practitioner to assist the individual in either ways to manage this diagnosis or to assist the individual towards moving towards some sort of intervention.
Once the individual is considered transsexual, the treatment of the GID takes on an additional piece. Along with continued care for the distress surrounding the GID and any co-morbid issues, assessing readiness level for moving forward with interventions is done. This is done in conjunction with the individual. For example, an individual who may want to start discussing their transsexuality with friends would work around this, discussing the "whys", "hows", "whos", "whens", and the ramifications of these decisions. The stability of the individual and descriptions of their specific circumstances are taken into consideration when determining the readiness of any step such as this. I know that I tend to err on the side of caution and conservatism, making sure the individual is ready.
After the identification of transsexualism has been confirmed, much of the work not only focuses on the psychological issues surrounding GID, but also ways for the individual to begin transitioning to their perceived sex. Things often start simply, with minor attire or hygiene changes, name and pronoun alterations (often starting with individuals or small groups), and can progress to more widespread alterations towards the perceived gender. Again, all of these changes are made with a readiness assessment, agreed upon by both the individual and the mental health practitioner, based on that individual's situation.
As the individual moves through some of these transitions, the next stage is either the "real life" experience or hormone replacement therapy (HRT). The "real life experience" requires the individual to live as the perceived gender for at least 6 months, preferably a year. If this is successful, and there are specific criteria that need to be met, then the individual is
confirmed as transsexual; if not, then the consideration is revoked and other issues that may have already presented are further explored. This is one reason why I, though others disagree, NEVER recommend any physical interventions until the "real life experience" has been completed and deemed a success. This is the true test, as identified by the guidelines, to confirm transsexuality. I do not believe in providing physically intervening treatment for something that is not an issue.
If transsexuality is confirmed, HRT and SRS can then be performed, again, according to the Standards guidelines, along with the readiness assessment of the mental health practitioner, and now at least one or two medical practitioners. And, of course, with the desires of the individual. Some individuals choose to do neither HRT or SRS, some only HRT. It depends on the individual.
The guidelines that I have been discussing are mostly taken from the following link:
http://www.wpath.org/Documents2/socv6.pdf
Though much of the work I do follows these guidelines, I certainly use my own training and experiences in psychotherapuetic treatment, along with interventions to assist the individual deal with psychological issues that go along with GID, such as depression and anxiety.
Please feel free to ask any questions.