It is interesting that an article on transsexuality is considered suited for listing on the cover of the first issue of a new women's magazine, launched on the UK market by a German publisher. This can safely be presumed to indicate that there is considerable interest in the subject amongst their target audience.

Sex change report: the ultimate plastic surgery?

"Quickie" ops mean that transsexuals are sometimes ill-prepared to deal with their new identity. A sex change is a long and complex procedure involving months of counselling before surgery can take place. [BAD INFORMATION WARNING]

How must it feel to grow up in the body of the wrong gender? It's virtually impossible to imagine, but for the one in 10,000 people with transgender issues, it's a fact of life. Medical advances mean sex-change procedures are now much more sophisticated than they were, although the operations involved to change male to female and female to male are clearly still incredibly major.

The support network that exists for transsexuals at least makes life a little easier. "The trouble is," says Janett Scott, spokesperson for support group, the Beaumont Society, "that a person can have a sex-change operation privately for as little as £4,500, so they don't always have the right amount of psychological counselling to prepare themselves." [BAD INFORMATION WARNING]

Under the NHS, there's a comprehensive process of therapy and counselling that a person must go through before the health service gives the go-ahead for the Final operation (to alter genitals). First, the GP has to refer the person to a consultant psychiatrist, which can take up to a year. The psychiatrist then refers the patient to one of the UK's gender consultancy clinics for further counselling and assessment. During this time, the person has to prove they can survive as a member of the opposite sex (earn a living, support themselves in full-time education or do voluntary part-time work). Once the psychiatrist is happy that the patient is mentally prepared and physically fit, sex-change procedures can begin. [BAD INFORMATION WARNING]

Private health follows different guidelines, whereby someone could essentially have a "fast track" sex change, living as a member of the opposite sex for just a year beforehand. "In reality, it is more likely to be two to five years," says consultant psychiatrist Dr Russell Read.

"Meanwhile," says Janett Scott, "it's only via a detailed assessment and therapy programme that someone with gender issues can truly come to terms with the implications of a sex change. Someone prepared to have the procedure in Thailand can have a sex change, a nose job and a holiday thrown in for the same price!"

The Beaumont Society: www.beaumontsociety.org.uk

Nick's story

22-year-old Nick, formerly Lianne, is halfway through a sex-change procedure and, because of more flexible laws in the rest of Europe, will soon be able to live life as a man.

"Even as a little girl I hated skirts and dresses," says Nick, who moved to Berlin from Hong Kong as a small child. She was a pretty girl but was always a bit of a tomboy, and as she grew older she became further and further removed from those around her. When she reached puberty her problems really began. "At high school, sports lessons were single sex and it was a nightmare. I would never get changed in front of the others and always had my sports clothes on underneath my school clothes."

When her breasts began to develop, Lianne couldn't look at herself in the mirror. By the age of 16, she was certain she wasn't a girl. "I had no one to turn to, as my family were never close and they wouldn't have understood."

A year later Lianne couldn't bear it any longer and left home to live in a shared flat, calling herself Nick. "There I had the peace to come to terms with my situation."

Surfing the Internet, Nick discovered a transsexual group in Berlin and went to see them. "It was a great relief. Suddenly here were so many other people who felt like me. They gave me support and recommended doctors for me to see."

Having found a psychologist, it wasn't long before Nick started hormone treatment, and for the last year and a half has been receiving testosterone injections. Every day they make him a bit more of a man. "I noticed the first changes after about two months," says Nick. "My throat became sore and my voice got deeper."

There were physical changes too. He began to put on weight and his muscles got stronger. "My feet have even grown and now I have to shave every three days." Now Nick is facing the second hurdle: breast removal. He has all the necessary psychological certification and just needs the go­ahead from his medical insurance. Meanwhile, every morning he binds his breasts, "which luckily haven't grown very big", tightly with a bandage.

After the breast op, Nick will undergo the most major operation - to have his ovaries and uterus removed. A piece of skin taken from under his arm will be used to make a penis and the surgeon will form testicles from the labia. It's an incredible thing to have to deal with and, not surprisingly Nick is terrified about it. But, despite everything, he is determined to have the operation, which will legally make him a man. Then he will be free to change his birth certificate, which means he can marry a woman if he chooses to.

Since living as a man, Nick has already had a relationship with a woman. "I first fell for someone two years ago," he says. "I spent a lot of time in chat rooms, and of course presented myself as a boy. I met someone and we chatted for hours. There was something between us from the first moment."

After a while she wanted to get to know him in person, so when they next chatted Nick told her the truth. But they never met, as she couldn't handle Nick's transsexuality. "It made me sad that she didn't give me a chance, but I don't hold it against her."

Things are easier with his friends. "The few really good friends I have like me for who I am," he says, although most people are shocked. "Even my mother can't deal with it. Recently we bumped into one of my mother's friends and she introduced me as her daughter, which caused a lot of confusion, She just can't come to terms with the fact that I was born in the wrong body."

As for his father, he broke off contact with the family long ago. But this no longer worries Nick. Since deciding to live as a man, his self-confidence has grown, though there are still problems of course. He can't play football yet - "what would happen in the showers?" - but by next summer he should be able to join a team and even go swimming. "I've already bought my trunks!" he smiles.

UK versus Europe

One of the biggest hurdles facing transsexuals in the UK is that they cannot legally change their birth certificates and therefore marry. Everywhere else in Europe and the Commonwealth, they can. The British Government believes that a transsexual marriage is the same as a same-sex marriage, which is also illegal in the UK. [BAD INFORMATION WARNING] It's possible to change a passport into a new identity, but your birth certificate will always stay the same. Of course, there is a great deal of controversy about this, especially as the UK's laws continue to shift to be more in line with the rest of Europe. Read Nick's story and let us know how you feel about this difficult issue. Write to us at Amber magazine, 16-19 Southampton Place, London WC1A 2AJ.

Those Warnings...

As Nick's story, reproduced from a German magazine, makes clear, but the British editors, misled by the Beaumont Society clearly fail to comprehend, transsexuality is not about changing one's identity. It is about permanently matching one's body and the way one is perceived by others to one's existing gender identity.
    Although good counselling might help some transsexual people overcome the results of experiencing years of prejudice, pain and loss (of childhoods, families, the ability to reproduce), or cope with the misdirected supposed psychiatry, and long delays in treatment, in fact there is little counselling available. So most manage without.
    Some adapt quickly and seamlessly to the life that hormonal and surgical assistance makes available, with little other help, perhaps just information on how to change identity documents. The only regret usually expressed is that it was not done earlier.
    In many cases more than enough thought has been given, far too much delay experienced, no further delay is required, and the concept of treatment being "quickie" is quite foreign, and unhelpful.
    The exclusively "heterosexual male" transgenderists (cross-dressers) of the Beaumont Society, assuming a more or less female identity for the occasional outing, but keen to maintain their male bodies, roles, earning capacities and privileges, and wishing to reassure their wives that there is no further intention that would threaten their marriages, are very different place, and evidently have no understanding of transsexuality. It seems however that their leaders often imagine their members to be tempted to follow transsexual treatment and so, thinking it will protect them, and their families, invent propaganda as a deterrent, careless of how it affects transsexual people.
    In an example of astoundingly bad journalism, Amber here has the UK organisation "for heterosexual male transvestites" (similar to the US group Tri-ESS) provide the only input on the situation for both female-to-male and male-to-female transsexuals. That's rather like having the Evangelical Alliance exclusively provide information on Sikhism or Buddhism. Decent journalists should be able to spot that, but Amber failed that test.
    Given this opportunity, cross-dresser "Janett Scott" provides "her" usual spiel intended to promote it being more difficult for people to get medical help for transsexuality, implying access is too easy, too quick, and that tragedies result. None of which are true. We are lucky not to have been treated to "her" other common claims of sex reassignment surgery never providing an ability to be sexually fulfilled, and of high rates of suicide following that surgery, which are equally untrue - as follow-up by responsible surgeons has amply demonstrated.
    The international "standard of care" for transsexuality states that one year is an entirely adequate period of assessment prior to surgery, and many people have been allowed surgery much sooner, with no noticeable link to any regrets.
    The comprehensive web sites of Thai reassignment surgeons (some of the best in the world) warn that no one should consider a surgical visit to be anything like a holiday.

National Health Service

Most NHS assessment in England depends more on delay to supposedly help in weeding out applicants than insight into the transsexual syndrome. Illegally long waits for appointments are common. Deliberate lies to patients, and poor hormonal prescribing so that results are disappointing, are common. Respect for patients and for medical confidentiality are almost unknown. At most centres there is little or no "counselling", only the forcing of already suffering people through an irrelevant and prolonged obstacle course by psychiatrists or psychologists with no experience of the condition themselves, little training about it, and some weird theories.
     Whilst some NHS surgeons are the best in the country, others are unreliable, with poor resulting appearance and frequent problems with vital functions resulting. Unfortunately patients are usually denied a choice of surgeon. The private route offers better treatment in every respect, a fact recognised by several NHS districts who pay for patients to be privately treated, for the whole or part of the process. For example, private, individual hospital rooms are far more suitable for sex reassignment surgery patients, providing complete privacy for the questions, discussions, and treatments of an utterly intimate nature, providing greater protection from infections (which can be disastrous following genital micro-surgery), for quiet during the days of discomfort and confinement to bed, private telephones to enable communications with friends and families at what is a crucial point in patient's lives, and televisions to help with the passing of the 7 or so days confined to bed. A shared ward, with curtains alone for privacy, as is almost inevitable in NHS hospitals, is far less suitable.

Legal Misinformation

Amber magazine, appearing on newsagents' shelves in February 2003, manages to be two months out of date on the main topic of a major feature. Before Christmas 2002 the UK government at last issued a policy change promising legal changes required to implement a European Court of Human Rights judgement of July 2002. Laws were promised to allow new birth certificates, privacy and marriage, amongst other reforms, for example of the law on rape. It was made clear that transsexuality is not seen as a mental illness. Further suggestions are invited. Unfortunately the legislation will take many months, if not years to draft and pass into law.