How to Change Sex

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The most important thing : don't do it unless you have to. Think of the impact on others around you, your parents, your partner, and especially your children.
  1. First, make sure you can't live the way you are, and that this feeling has lasted at least 2 years.
  2. Now, be prepared to do a lot of research. You must demonstrate at all stages to experts that you know the consequences of your actions, the long-term health risks, the effects and possible side-effects of the medications you will be taking. Read the Transsexual Road Map (http://www.tsroadmap.com/), and  TransGender Health Care (http://www.transgendercare.com) literature on the web. By all means join the many Yahoo groups such as Trans-Surgery to benefit from the experience of others. You're not alone : 1 in 2500 people in the US are transsexual.
  3. If you have any children, then if they are of age 0-4, or 5-11, you can proceed now. If age 5, leave it a while, there's gender consolidation issues happening for them, and they must come first. If your children are in their teens, try to delay until they're 20, as although it won't damage them, they may wish to never see you again.
  4. Now see a Primary Healthcare Provider. You may need to see more than one, many know nothing about Transsexuality, or Benjamin's Syndrome as it's often called. You'll need a series of blood tests to provide a baseline of your liver, thyroid, and adrenal functions.
  5. They will refer you to a Gender Specialist, a psychologist or psychiatrist specialising in this area, who will review you for 3 months or longer, to make sure that a Diagnosis of Gender Identity Disorder is appropriate.
  6. They will in turn refer you to an Endocrinologist, who will, with the specialist's written consent, prescribe a course of gender-changing hormones. You will need regular blood tests every 3 months to monitor your liver, adrenal, thyroid, parathyroid, pituitary and pancreatic functions.
  7. Investigate, and if necessary, have performed any necessary surgery that will improve your appearance to a socially acceptable level. For guys, that means reduction mammoplasty, and for girls, facial feminisation surgery. "The works" with Dr Oosterhaut in San Francisco can cost upwards of $40,000, so you better start saving. Spiegel in Boston and Suporn in Thailand may be a little less costly, and are equally good.
  8. When your appearance is such that you can "pass" as your target gender, due to natural appearance, hormonally-induced-changes, and surgical modification, start a 1-year "Real Life Experience" living in your target gender. That means at work, at home, 24/7, and no breaks, even if your mother dies and your father wants to see you in your old gender at the funeral, unless you get permission from your Gender Specialist. Be prepared to lose your job, your marriage, your career. Most do.
  9. After the year is over, obtain two confirming letters : one from your Gender Specialist, another from a Doctoral or Post-Doctoral psychiatric specialist. Not one, but two specialist psychiatrists must be convinced that you are sane enough to undergo surgery, yet have Benjamin's Syndrome, which is currently (2006) listed as a psychiatric disorder in the DSM-IV. It is the only "psychiatric disorder" curable by surgery.
  10. Investigate surgical options: Search on "Gender Reassignment Surgery" and "Sex Reassignment Surgery". Currently the top surgeons in the field are in Canada (Massard), the US (Bowers), and Thailand (Sanguan, Suporn and others), but there are many others who have adequate expertise. Make sure the exact technique they use is appropriate for your anatomy. Guys may wish to forego this : the hormones work very well for them, but the surgical reconstruction techniques are still not very good.
  11. Have the surgery. You can now start the real task - living as you were always meant to by your brain's morphology, something that was set in the first trimester of conception.
  12. Consider changing your whole identity, your career, and never seeing any of your friends and family again, starting all over not as a "transsexual" but just as a normal guy or gal. Many, perhaps most, do this. Some don't, and 10-20% of people have their marriage survive, and their family accept the outward appearance change. For you can never "change sex", you can only get your body aligned with your mind.
This sequence follows Version 6 of the Harry Benjamin International Dysphoria Association Standards of Care. In some jurisdictions (the UK and Australia for example) , the  "Real Life Experience" may be 2 years not one as they use an earlier version, and in Canada and the UK,  people may be forced to engage in the RLE before hormones are prescribed, and consequently face violence and ridicule. Many such "DIY" the hormones over the Internet, and travel to Thailand where the rules are less strict for their surgery. Taking Hormones without medical monitoring is extremely dangerous for those over 30, so if you must "DIY", get your primary health care provider to monitor your health.
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