Medical requirements and consequences of sex reassignment surgery.

Prior to considering surgical reassignment, the key issue for the surgeon is to establish beyond reasonable doubt that the gender dysphoria or transsexual feeling is genuine and that surgical reassignment will be beneficial. For this he will need the expertise of a reputable behavioural scientist. To determine whether the patient is physically fit for surgery, the surgeon may lean on the expertise of an endocrinologist with substantial personal experience in the field of hormonal treatment of transsexuals. Sex reassignment for M-->F transsexuals may be completed in one operation, leading to acceptable cosmetic and functional results, provided the surgery and postoperative treatment are performed with a high degree of expertise. Present generation operative techniques for phalloplasty in F-->M transsexuals still do not meet all requirements. The term 'one-stage phalloplasty' is deceiving. Genital reassignment surgery in F-->M transsexuals can seldom be achieved in one stage. Prior to any form of this kind of surgery, this should be made clear to the patient. F-->M and M-->F transsexuals will become irreversibly infertile by the orchiectomy and the oöphoro-hysterectomy usually performed on them. Diagnosis of, and counselling and treatment for, gender dysphoria should be restricted to reputable gender teams. These teams should exchange information.