The reasons for this requirement have been given as clinical judgement, a need for the individual to experience the new gender role before making irreversible hormonal changes, and concern about some of the effects of hormones and the medical risks involved in their administration. In a few cases (not necessarily at the facilities we have mentioned), this criterion seems to have been set up as a roadblock, with the idea that those who want sex reassignment badly enough will persevere, no matter what the obstacle.





Advisory



It is our position that the psychological and social effects which occur as a result
of preparing for and beginning a period of full-time cross-living are in most cases
potentially far more disruptive than the lingering effects or physical dangers of
a short period on hormones. We believe that requiring a mandatory period of real-life
test before initiation of hormonal therapy can be and often is harmful, and should
not be a universal requirement or even the usual rule. While we agree that the individual
should have some experience in the new gender role, we urge practitioners who adhere
to this practice of global requirement of full-time cross-living before hormones
to change it. [1] [2]





Discussion



Hormones are not without danger, and some of their effects, like breast development
in the genetic male and hirsutism and voice- deepening in the genetic female, are
indeed irreversible. [3] Hormones should not be administered except
in accordance with the Standards of Care of the Harry Benjamin International Gender
Dysphoria Association, Inc.; that is, the individual should be in therapy and have
been given a diagnosis of gender dysphoria by a clinical behavioral scientist. Before
hormonal therapy is initiated, care should be taken to rule out other conditions
which can masquerade as transsexualism.



Real-life test does not occur in a vacuum. Friends and family must be informed, marriages
must be dissolved, and accommodations must be made at work–if the individual is
fortunate enough to keep his or her position. No only the primary client, but others
are affected: parents, children, husbands and wives, neighbors, employers, co-workers.



The result of failed hormonal therapy is at worst some physical characteristics which
run counter to type and which may be difficult for the individual to explain. The
results of a failed real-life test is a life in shambles. Family, friends, and employers
cannot be un-told about transsexualism, marriages and family life are unlikely to
be resumed, and lost employment is unlikely to be regained. A non-passable appearance,
which is likely if the individual has not been on hormone for a significant period,
can be highly stigmatizing, and can place the individual in physical danger in this
era of hate crimes. Furthermore, a failed real-life test can result in a high potential
for self-destructive behavior, including suicide.



A stigmatizing appearance is not necessary a contraindication for sex reasignment,
but it is certainly a disadvantage, an done which can be lessened by the provision
of hormonal therapy prior to actually changing gender roles. The individual who has
had such treatment is more likely to be viable–and therefore successful–when the
role of choice is assumed.



Globally denying needed medical treatment, including hormonal therapy, in persons
diagnosed as transsexual, or making it contingent on the individual structuring his
or her lifestyle according to the demands of the caregiver or clinic, is in our opinion
needlessly obstructionistic, a holdover from the days of less sophisticated treatment.



We believe that although conservatism is usually given as a reason for requiring
cross-living before initiation of hormonal therapy, it is not in reality a conservative
approach, except from the purely medical standpoint of the effect hormones have on
the body–a narrow viewpoint in light of the profound and largely irreversible social
changes that real-life test requires.



Notes



[1] Administration of small doses of estrogens has proved to be a
useful tool in differential diagnosis. Male transvestic fetishists on a regimen of
estrogens or progesterone are likely to show reduced desire for sex reassignment.



[2] Procedures such as orchidectomy, hysterectomy, or sex reassignment
surgery should not be performed before the individual is living successfully in the
gender of choice. This is in accordance with the HBIGDA Standards of Care. We support
the Standards of Care.



[3] Hormonal therapy in genetic females has more profound and irreversible
effects than in genetic males, and more precautions are in general indicated, but
this advisory applies to both genetic males and genetic females.





Position Statement

Originally Released in 1992

© 1997, 1999, The American Educational Gender Information
Service, Inc., All Rights Reserved

Webmistress, Gwendolyn Ann Smith