In the minds of the general public, and unfortunately, in the minds of many professionals
involved in the medical and psychological treatment of persons with gender identity
issues, the inevitable result of sex reassignment procedures (hormonal feminization
or masculinization, electrolysis, breast augmentation or reduction, resocialization,
establishment of new legal identity) is or should be masculinizing or feminizing
genital surgery (Sex Reassignment Surgery, or SRS). However, SRS is neither wanted
nor needed by a significant percentage of persons who have established or plan to
establish cross-gender roles nor is SRS ever achieved by the majority of persons
who desire it.



Consumer advocacy organizations like AEGIS and the International Foundation for Gender
Education have long argued that SRS should be a choice and not a requirement for
transsexual persons. In The Diagnostic and Statistical Manual of Mental Disorders,
4th Edition (DSM-IV), the American Psychiatric Association (APA) took an important
conceptual step forward by dropping the category Transsexualism (302.50) in favor
of a single diagnostic category for all persons with gender identity issues (Gender
Identity Disorders, 302.85). Thus, the APA no longer clinically distinguishes those
transgendered persons who desire SRS from those who do not. A number of articles
in professional journals and several texts currently in press, including Current
Concepts in Transgender Identity: Toward a New Synthesis (Garland Publishers) and
Recommended Guidelines for Transgender Care (Sullivan Press) reflect this sensibility.



SRS is intrusive, irreversible, and expensive, and has the usual risks of any surgical
procedure. It should never be required of those who do not want it, or are not sure
they want it. It should not be a requirement in order to establish a legal identity,
live in a particular gender role, or obtain medical or psychological treatments.
In particular, the lack of a stated desire for SRS should not be used as a reason
to deny hormonal therapy, electrolysis, breast reduction or enlargement, other masculinizing
or feminizing plastic surgeries, or other procedures usually considered part of sex
reassignment. In fact, to force such a drastic and irreversible procedure as SRS
on another human being, for whatever reason, is clearly unethical.



SRS is a valuable tool which provides great relief to many persons living in cross-gender
roles. Many transsexual persons consider it essential for their psychological well-being,
and a number of studies indicate that the procedure has a high success rate. This
advisory should not be interpreted as an argument that SRS is not sometimes necessary.
It is an essential part of treatment for many transsexual persons. However, it should
never, for any reason, be forced upon those who do not want it.





January, 1995

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