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In 1952 a 27-year-old, former WWII-era GI from New York named George Jorgensen traveled to Denmark, and returned to the U. In time, she became a trailblazer in seeking those gender reassignment surgeries as these procedures, now known as gender realignment (reconstruction, affirmation or confirmation) surgeries, wouldn't begin in the U. A person living with this an internal conflict may develop anxiety and depression, and go on to be diagnosed with gender dysphoria, formally known as gender identity disorder (GID). Jorgensen, who had described herself as a woman trapped in a man's body, was one of the first to transition from the male to female gender through a process involving hormone therapy and surgical procedures [source: Hadjimatheou]. Gender identity struggles usually begin in early childhood but descriptions of feeling like a man trapped inside a woman's body, or vice versa, have been identified in and reported by people of all ages.The discussion pertains to both classical intersex patients born with ambiguous genitalia and to female-assigned 46, XY individuals with such nonhormonal genital abnormalities as penile agenesis, cloacal exstrophy of the bladder, and postnatal penile ablatio or traumatic loss of the penis, which may occur, for instance, after a circumcision accident.
THE current intense debate of the management of patients with intersexuality and related conditions focuses on three major issues: 1) the assignment of gender; 2) the indication for genital surgery; and 3) the disclosure of medical information to the patient.
For instance, in recently published guidelines for intersex management, Diamond and Sigmundson (1, 2) emphasized the growing evidence of prenatal androgen effects on the sexual differentiation of the brain and made strong recommendations for assigning to the male gender all 46, XY patients of the following categories: genital trauma (leading to loss of the penis), micropenis, androgen insensitivity (AIS) of Quigley (3) stages 2 and 3, hypospadias, 5α-reductase deficiency (5α-RD), and 17β-hydroxysteroid dehydrogenase (HSD) deficiency.
Human research has made it likely that prenatal sex hormones influence, but do not by themselves fully determine, the development of gender-role behavior (22), and there is a large body of evidence in support of marked effects of social and psychological factors on normal human gender development (23).
It is the evidence from long-term follow-up of intersex patients themselves, however, that will be the final arbiter of the adequacy of a given management policy, and this evidence is extremely limited, especially in the case of male pseudohermaphroditism.
Similar observations were reported by Rösler and Kohn (20) on the syndrome of 17β-HSD deficiency.
Critics ( questioned, however, whether direct sex-hormone effects on the brain could be the sole or even the major mechanism underlying this late gender change; it seemed likely that other psychosocial and psychological mechanisms also contributed.
Being transgender also isn't about anatomy or sexual orientation; it's about internally identifying with a gender status — which could be masculine, feminine, agender or gender fluid — that is different than the one culturally assigned to you based upon your physical characteristics.
While some people may never publicly acknowledge their transgender status, others may decide to live as their desired gender — and that could mean changing how they express their gender through transitioning.
Around the middle of the 20th century, reviews of the existing literature (9) and studies of intersex patients at Johns Hopkins Hospital (Baltimore, MD) by Money (10) led to the conclusion that, in most cases, the gender assigned in infancy will be the one the patient stays with into adulthood, regardless of the status of the standard biological indicators of sex.
As a consequence, the Hopkins group (11) replaced the then prevalent “true-sex policy” by an“ optimal-gender policy” (12), which bases the assignment and reassignment of gender on the expected optimal outcome in terms of psychosexual, reproductive, and overall psychologic/psychiatric functioning.