The transition process

Even though it is sometimes called a sex change it is important to see it more as a process than a change that happen a certain day. People seem to be very focused on the sex reassignment surgery and usually think of that as the actual sex change. In some ways it is of course but there not only other medical aspects of change (like the effect of hormones) but also the mental and social parts.

Usually after a long time of thinking about how you feel about yourself you decide that something needs to be done.It just does not work anymore and you long for a life where you can be yourself and finally be able to see your reflection in the mirror and think “yes that is me”. The point is that everything starts with the you and your need to do something to change the situation. In Sweden transsexuality is a health condition where the treatment is covered by the social security system and there is a law passed in 1972 that permits people to have sex reassignment surgery and changed legal status as woman or man.

Phase 0
The first step is to get a referral to a specialist team for transsexual patients. That means going to the local psychiatric clinic and tell them that you are transsexual and that you need treatment for that. Usually, you only need to go there once or twice before they agree to send you to the specialist team but sometimes the local clinics are not that knowledgable about transsexuality and they try to stall the process. Unfortunately it is them much up to the patient to be strong and argue your case which can be hard because it is not uncommon to feel very vulnerable at that time. Another option is to find a psychiatrist right away who is prepared to oversee the whole transition process by himself/herself but without being a part of one of the specialist teams.

After that there is generally a waiting time between 3-6 months and sometimes even longer depending on the current situation at the hospital.

Phase 1 – Examination
The process starts when seeing the psychiatrist for the first time and thus first phase generally lasts about a year. That person is the one overseeing the whole process and sending you off to other specialists along the way. The first thing that happens is that you meet this psychiatrist for 3-4 times. During these meetings you talk about every aspect of your life and you can explain how you feel and how you came to the conclusion of starting this process.

After that comes some traditional physical examination together with a lot of different blood tests and sometimes even checking for your composition of chromosomes.

Another part of the examination by the team is seeing a welfare officer that tries to map you social life like family, friends, relatives, collegues and so on. That person also offer assistance if the patient have trouble with their economy or housing.

In order to establish the personality profile a number of psychological evalutations is also done by a psychologist. That includes IQ-tests of various kinds and a personality profile.

Finally, you get to see another psychiatrist that will provide a second-opinion about your and your transition.

After that the team gathers together for a conference and decide together whether or not the diagnosis transsexuality is valid.

Phase 2 – Treatment
During this second year the actual treatments is started and that means that the transition process is coming into a new “mode”. The evalutations are over and now everybody tries to support you and your way to start living your life in your “new” gender role. Several things are being done during this period:

– Seeing a speech therapist in order to work on your voice
– Hormone replacement therapy starts after doing some hormone level tests.
– Name change
– Beard removal for transsexual women using laser or electrolysis.

Sometime during this period it is common to start you Real Life Experience-period. That usually coincides with name change and starting hormone replacement therapy. That period is the a way to find a way to a new normal life and see if the patient seem to handle tha

If everything goes well the application for a new legal status as man/woman is sent to the National Health Board and that is also a request for approval for the sex reassignment surgery. The patient is usually summoned to the board for a short interview and then they decision is made and the patient gets a certificate with a new social security number (personnummer in Swedish).

After that the patient is put on a waiting list for surgery and that means that the surgery can take place 2 year and maybe 3-4 months after meeting the psychiatrist for the first time. The surgery for male-to-females is done with a proven method that usually renders very good results. The visual appearance is similar to a genetic woman and usually the “feeling” is good and it possible to have an orgasm. The patient spend around two weeks at the hospital after the surgery and is then on sick-leave for another 6-8 weeks.

Later on during the third year it is also possible to have breast enlargement surgery if the effect of the hormones is deemed to limited.

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