ABSTRACT
The concept of medicalized sex change did not depend on the later invention of synthetic hormones or the development of elaborate surgical techniques. Ablative surgical procedures such as orchiectomy or hysterectomy have long been performed for sex change purposes before the term ‘trans-sexual’ was introduced into the scientific literature in 1923. It was in 1931 that a complete staged genital reassignment procedure in a male-to-female trans-sexual (MF-TS) was reported in a medical journal. 2 In 1966 the influential book by Harry Benjamin, The Transsexual Phenomenon , brought genital sex reassignment surgery to a scientific level and made the medical societies aware of potential benefits of this type of surgery. It took another 14 years before the first standards of care were published in 1997, under the auspices of the Harry Benjamin International Gender Dysphoria Association (HBIGDA). These standards have been continuously updated, and the sixth version was published in 2001. 3 Recently, the HBIGDA changed its name to the World Professional Association for Transgender Health (WPATH), and the latest standards of care for trans-sexual patients were published in 2001. 3
These standards should be seen as an international interdisciplinary recommendation, which must be brought into context with national forensic and medical recommendations for the individual patient. Prevalence data for gender identity disorders vary with the survey methods used in various countries and have been reported as 1 in 2900 in Singapore and 1 in 36,000 in Germany. Gender identity disorders seem to affect more biological males than females with a sex ratio in various reports being about three males to every female.
