THE BLANK POINT—what is transsexualism?Study Guide

Miscellaneous Thoughts


The diagnosis and medical treatment of the transsexual, along with the social adaptation, should be planned out and taken step by step. The entire process of changeover may cost $20,000 — a formidable challenge — and I have known some to have spent in excess of $50,000. However, if one has a liberal group health insurance policy (particularly effective with a supportive employer), out-of-pocket expenses may be less than $10,000.


Sarah Shaker



Sarah writes of the costs for the male-to-female change process. Just as the surgical procedures differ for female-to-males, so do the costs. A writer in a publication for female-to-males shared his cost information:

$400 — initial evaluation by Gender Dysphoria Program

$34 — binder for breasts (pre-surgical cross-living)

$312 — annual cost of delatestryl [hormones] — depotestostrerone or generics may cost less

$200 — annual cost estimate for physician visits and blood tests

$100 — prosthetic penis to wear under clothing (not for sex)

$4,242 — "top" surgery (outpatient bi-lateral mastectomy [breast removal]): operating room, surgeon, anesthesiologist

$4,250 — annual cost estimate for psychotherapy (50 sessions)

$500 — estimated cost to augment wardrobe (size changes/neck and shoulders bigger, hips smaller)

$10,038 — expenses during the first year — 3 weeks on disability

$200 — annual cost estimate for physician and blood tests

$312 — annual cost for delatestryl

$4,700 — plastic surgeon's fee for genitoplasty (makes clitoris into penis, puts tissue expanders in labia for scrotum)

$1,385 — anesthesiologist's fee for 5.5 hours of surgery (combined genitoplasty and total abdominal hysterectomy)

$3,000 — OB/GYN surgeon's fee for hysterectomy

$500 — plastic surgeon's fee for mastectomy scar revision

$11,000 — operating room and hospitalization (4 day stay because of hysterectomy — not required for genitoplasty alone)

$300 — pre-op lab work and post-op pathology

$4,250 — annual estimated cost for psychotherapy

$500 — buy a decent business suit and serious shoes

$26,147 — expenses during second year — 8 weeks on disability

$ n/c — series of office visits over 3-4 months to fill expanders in scrotum to stretch skin for testicles

$1,150 — surgeon's fee to remove expanders and replace with silicon testicles

$725 — operating room fee

$200 — annual cost estimate for physician visits and blood tests

$312 — annual cost for delatestryl

$136 — Superior Court filing fee: Name and Birth Certificate change

$80 — required publication of Order to Show Cause (Court)

$25 — fees for copies of judge's decree & birth certificate

$4,250 — annual cost estimate of psychotherapy

$6,878 — expenses during third year — 2 weeks on disability

$43,063 — total cost of transformation — 1988/1989/1990

$2,700 — annual maintenance costs: post-transformation physician visits, testosterone, psychotherapy

Richard writes in this study guide about the process of transition being more dramatic for the male-to-female transsexual. If this is so, I feel that society is the cause.

"Sissy" is a more loaded term than "tomboy." If a girl chooses to express her inner male identity by adopting the interests and clothes of a boy, said girl is a "tomboy." But should a boy attempt to do the same and adopt the manners, dress and activities associated with being a girl, it's a matter of great concern.

Ours is a male, or rather, a man dominated society. When a female emulates the dominant group, all is well. But to reject being part of the dominant group is like an Englishman going native — it's unpardonable.


Transsexualism deals with the issue of gender identity that is in opposition to one's sexual anatomy — independent of one's sexual desires. Historically, it has been documented in cultures dating back to early civilizations.

Transsexualism can be traced back to the earliest recollections of childhood. Though normal in anatomy (it is rare that a transsexual is born with characteristics of both sexes), the child feels different from other children. It may be (as in my case) with an ambivalence about being a boy or a girl. Or, as with other cases, there is a strong feeling early in life that he or she was born into the wrong body. This imbalance predates puberty, and some scientists have even traced it back to the early stages of fetal development. The manifestation of sexual desires does not occur at this early stage of a child's development, so the term transsexualism should not be associated with one's sexual attraction to a male or a female…

The medical procedures of a change in sex may take several years, so the process may be thought of as a metamorphosis.

Sarah Shaker

It takes a special courage to even attempt living in the opposite gender-role. One must deal with potential loss of family, friends, livelihood, career. Transition means putting oneself in the control of the medical establishment — there are risks in taking hormones, along with all that can go wrong with surgery. In some states it means entering legal limbo (try living with identification in the wrong gender). Especially in the early stages there is the danger of discovery. Being "read" or discovered is emotionally painful, and it can also mean harassment, often of a physical nature. There is the reality of relationships. To inform a lover is to risk rejection. To not inform is to live in fear of discovery.


Professionals trained in the counseling and treatment of transsexuals are a limited resource. However, the Harry Benjamin International Gender Dyshoria Association (1515 El Camino Real, Palo Alto, CA 94306, (415) 326-4645) is an umbrella organization well-equipped to provide referrals throughout the United States and internationally. Established standards of care and procedure are continually updated by HBIGDA. University-based medical centers may be a good source to contact, too.

Sarah Shaker

I wish that society and the medical establishment were not prone to equate gender and sexuality. People usually confuse sex and gender. But people also confuse sexuality and gender.

There are exclusively homosexual men and women; there are exclusively heterosexual men and women; and there is every permutation between. So it is with transsexuals. My gender is not bound up with my sexuality. When I lived as a man, I was attracted to men; as a woman I am attracted to men… But this is true only for myself. Another person who goes from living as a man to living as a woman may not be sexually attracted to men.

Sexuality and gender are not rigid among transsexuals. People fail to relate the wide range of sexuality among the population at large to transsexuals.


The transvestite has a passion for the clothing and accessories of the opposite sex that is a gratification unto itself, to be played with until the physical and emotional urgency and the resultant pleasures have been realized. The transvestite might fantasize similarly to a transsexual while "dressed up," but in reality the transvestite is secure in his or her gender and sex. There isn't a desire to alter physical characteristics or otherwise fully adapt to the lifestyle of the opposite sex.

Sarah Shaker

Athena sprang full-grown from the forehead of Zeus: Is this history's first recorded image of transsexual desire? And Hera, jealous of Zeus's achievement with Athena, parthenogenetically birthed Hephaestus, the outcast whose passionate soul is driven to create beauty out of pain. These archetypes, these tales of non-biological birth do not exist for nothing.

In Greek mythology the Theban seer Tiresias was a well-known transsexual; that is, he was transformed into a woman and in later life was restored to his original form. Because of his knowledge of both masculine and feminine psyches and experience, Zeus asked him to settle an argument between himself and Hera over whether men or women "more deeply enjoyed the pleasures of love. He voted nine to one in favor of women." If there were no societal need for the transgendered psyche, these myths would not exist. And all archetypes are rooted in actual human experience.

In China the male diety Guanyin changed sex and evolved into the goddess of mercy. There are many popular tales of Guanyin's adventures [and traditionally, she's the most popular Chinese god]. It is fitting that mercy should be the province of the transgendered, because the power of the transformation teaches compassion to the transformed. How did these ancient people know this?