Diagnosis of Gender Identity Issues

The gender reassignment process begins long before surgery. There are five steps to the process: diagnostic assessment, psychotherapy, real-life experience, hormone therapy and surgery.

A transsexual begins by consulting a mental health professional who performs sessions of psychotherapy and formulates a diagnosis. To become a candidate for gender reassignment surgery, an individual must first be diagnosed with Gender Identity Disorder (GID). GIDs, including transsexualism, are considered mental disorders. The International Classification of Diseases-10 (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) consider transsexualism a GID.

Neil Van Der Merwe
Pornchai Kittiwongsakul/AFP/Getty Images
Neil Van Der Merwe of South Africa sits on a hospital bed during preparations for a sex change operation at a hospital in Bangkok, Thailand. Van Der Merwe has lived
as a man for the past five years.

The DSM-IV breaks GIDs into several types: Gender Identity Disorder of Childhood, Gender Identity Disorder of Adolescence or Adulthood and Gender Identity Disorder Not Otherwise Specified.

A Landmark Birth
Check out the Discovery Health's Pregnant Man Show to learn about a female to male gender reassignment.

­Additionally, the ICD-10 provides five diagnosis types for GIDs:

  1. Transsexualism
  2. Dual-role Transvestism
  3. Gender Identity Disorder of Childhood
  4. Other Gender Identity Disorders
  5. Unspecified Gender Identity Disorder

According to the ICD-10, transsexuals are diagnosed when they have a desire to live as and be accepted as a member of the opposite sex, along with the desire to transform their bodies with gender reassignment surgery and hormone therapy. The transsexual identity must be persistent for at least two years and the desire for gender change cannot be a symptom of another disorder or a chromosomal abnormality.

­Patients are diagnosed with dual-role transvestism when they have no desire for a permanent change to the opposite sex. Unspecified and Other GID diagnoses are often used to describe an intersex condition -- when an individual is born with ambiguous genitalia. Ambiguous genitalia is a rare birth defect where a child's genitals are not clearly male or female either because they are unformed, deformed or include aspects of both male and female genitalia.

Prospective candidates for gender reassignment surgery must work with a mental health professional for diagnosis. However, the mental health professional additionally provides counsel about treatment options and implications as well as therapy and education for the individual, his or her family and employers.

The Price of Identity­
The entire gender reassignment process is extremely expensive. Costs vary depending on where patients have the surgery, if they choose to have additional elective surgeries and if they are covered by health insurance. Male to female gender reassignment surgery costs roughly $37,000 while female to male surgery costs about $77,000 [source: SF Gate] Choosing surgery outside of the United States sometimes means cheaper associated costs -- facilities in Thailand often charge less than $10,000 [source: Seattle Times].

­After a diagnosis, there are three phases left to complete in the process:

  1. Hormone therapy
  2. Real-Life Experience, also known as the Real-Life Test
  3. Surgery to change genitalia and other sex characteristics

For some transmen (biologically born females transitioning to males), the phases may begin with hormone therapy but breast augmentation surgery to remove the breasts may come before the Real-Life Experience.

Now that we know how the diagnosis of gender identity disorders works, let's find out about treatment. Look at the next page to learn about hormone therapy, the Real-Life Experience and surgery