Gender Identity Disorder

How Gender Identity Disorder can be treated?

Hello friends, I am Dr. Anubhav Gupta. I am a consultant plastic surgeon working at Sir Ganga Ram Hospital, New Delhi. Today, I am going to talk about a condition which has increasingly become more frequent in our practice and that is Gender Identity Disorder.

Gender Identity Disorder is a condition where in a person has incongruency between his sex and gender. Let me explain it to you, a person whose phenotypic and genotypic condition is male, his sex is also male. For example, a person who is having external genitalia, penis, beard, etc that is his phenotype, that is his sex and that is also a genotypic test as gene XY, so that will be his sex. But, gender is what a person feels about himself. For example, a male who is having phenotype and genotype sex as male but he feels he is a female then that is the gender of that person. What a person feels about himself is called his gender. So, when there is an imbalance between the sex and the gender of a person, it is called Gender Identity Disorder.

Basically, it is not what is wrong about them, it is why they feel about this. There is something which is hardwired into their brain, that they don’t have a feeling of equilibrium with their sex. It is not a disease; it is the way they think. There are certain neurohormonal factors which at the time of development have been said to cause this condition but there are no researchers that conclude the cause of this condition.
Yes, the government of India has now recognized the third gender that is transgendered. People who are not in congruence with their sex have been recognized as legal by the government of India.
See, when these patients come us, basically there are now well-described guidelines. When the patient first, comes to me, I first tell them what the exact condition that they have is and I send the person to a psychiatrist for evaluation. We have to be sure whether they have Gender Identity Disorder before we go for the surgery. So, the psychiatrist starts his treatment, basically takes counseling sessions and he tries to ascertain whether this person is actually having gender identity disorder.

Now, the recommendations are that permanent gender surgery, that is the change of gender surgeries like penectomy and vagina creation and penile creation, these are gender surgeries and are permanent in nature, should not be done before 1-year certification by the psychiatrist has been given. But, other surgeries like face surgery, and breast surgery, can be done after 3 months of psychiatric evaluation. So, this is what we follow. Once a psychiatrist has seen and he certifies that this person has gender identity disorder, we start doing the facial surgeries, and once a period of 1 year has passed, in the meantime we also send him to an endocrinologist who counsels them about hormonal therapy and we further encourage them to cross dress and live in the society as the gender of which they feel they want to stay.

So, once these things fall into place then we move into surgery. And, before surgery, we also need a certification from another psychiatrist just to counter and confirm what the first psychiatrist has felt. So we have certification from two psychiatrists and after a period of one year, we can proceed to Permanent Gender Surgery. Before we do that gender surgery we also need to take an affidavit in the court of law in which the person who is undergoing the surgery and the surgeon, they understand the fact that it is a permanent surgery and the person who is undergoing surgery will not be able to procreate or reproduce in the future, and the patients, when they understand these factors are then counseled and then the surgery is done.

In male to female patients, the initial surgeries, we start with the face surgery, such as Genioplasty and Rhinoplasty. Then, these patients, if they require breasts, we go for a breast augmentation by implants. There are two types of implants; if the chest is having enough space, we can go for a silicone implant and sometimes the chest of males are very tight, then we have to use an expander implant. So these are the common surgeries. Then there is the genital surgery which is a permanent surgery where we do a penile disassembly surgery and we use the penile skin to create a new vagina and we do an orchiectomy at the same time and so we do a gender surgery.

In the female to male also, we start with the face, rhinoplasty, brow lift, genioplasty, McSteamy is done, and these are the initial surgeries. Mastectomy is done where the male chest is created. And, finally after one year of treatment, we go for a creation of a new phallus, we create a penis by the process of radial artery forearm flap, wherein we take the skin from the hand and we create a penis. After that, we can do testicular implants in the labia majora to create testicles. And later on, this surgery is successful of the penile reconstruction by radial artery forearm flap and the patient is having sensation till the tip of the penis. Then we do a final erectile implant which can even cause the erection.

If you have any further queries regarding this topic, you can contact me on Lybrate.