From He to She



For one in 10,000 of the population, a hormonal imbalance in the uterus about six to nine weeks after conception is where it all starts. A study from the Netherlands examined the brains of straight and gay men, women and male-to-female transsexuals. They looked at part of the hypothalmus, an area of the brain that is affected by sex hormones during its development, and discovered that while the brains of straight and gay men were the same, the transsexual-to-female brains were almost identical to the brains of women.

However, knowing that the way you feel is due to a quirk of nature doesn’t make life any easier, especially when puberty kicks in and your body starts to head off down a route that is diametrically opposed to the way you want to go.

“I have people turning up who are on the point of suicide,” says Fran Springfield, specialist gender identity counsellor, “and self mutilation is not uncommon.” But, in a strange way, these are the lucky ones – they’ve recognised their situation and have taken the first step. Others are not so lucky. “Many transsexuals go through periods when they attempt to suppress or deny their condition. Some choose hobbies or jobs that are hyper-masculine in order to try to prove that they are not transsexual.”

Transsexuals can be found in all walks of life: Springfield has even had former SAS members come to her for help. Some transsexual-to-females who visit are in the 40s or 50s, have married and have children. Having made the initial contact the patient is now ready to embark on the journey from transsexual-to-female.


STEP ONE: Counselling

“Clients undergo many hours of counselling to determine that they are really transsexual and to rule out other psychiatric problems,” says Springfield. The only specialist nurse gender counsellor in the country, she has worked in the gender field for ten years, and is a member of the Harry Benjamin International Gender Dysphoria Association, an organisation which governs the treatment of transsexuals. The client is then referred to a psychiatrist for further evaluation.

STEP TWO: Hormone Treatment

Transsexual-to-females are given oestrogen which prompts them to develop breasts and a smaller waist. They will see more fat on their hips and smoother skin along with a reduction of body hair and loss of libido. Hormones do not usually stop beard growth which has to be removed by electrolysis. It can take up to 1,000 hours of electrolysis at £35 per hour to remove a full beard. Hormones do not alter voice pitch either, although speech therapy can help in that respect.

STEP THREE : Changing gender role

Patients will have to live in their new gender role for at least 12 months before an operation can be performed. During this time, all documents relating to the client are changed – driving license, National Insurance, everything except birth certificate. The patient must also come out at work – following the case of P vs Cornwall Council in the European Court in April 1996, transsexuals are now protected against discrimination in the workplace. A Home Office working party is expected to report in 2000/2001 on changing the birth certificates of post-operative transsexuals to reflect their new gender identity.

“The real life experience is important,” says Springfield. The 12-month period is a duration laid down by Harry Benjamin, who actually coined the term transsexual and, on a quite unrelated point, lived to be 102 years old. During this time transsexuals are checked up on to make sure that they are not cheating.



STEP FOUR : Counselling and Referral.

Psychiatric examination follows more counselling to rule out delusion in the patient. After all, there will be no going back after the operation.

STEP FIVE : Surgery

It’s not only the end results that are good, there are also very few complications following the 4-5 hour operation. The patient is out of hospital in ten days and can be back at work in three months. The risk of prolapse is small and usually only occurs if patients have sex too soon after surgery or if the surgery is poor. Satisfaction rates with good surgery are 100 per cent. “The patient has got they body they always wanted,” says Springfield. “To see patients going from desperation to complete satisfaction makes the job very rewarding.”

Following surgery cases, 40 per cent of transsexual-to-females live as heterosexual women, 40 per cent are lesbian and 20 per cent pursue a bisexual lifestyle.

“Transsexuals are ordinary people who’ve gone through an extraordinary experience,” says Springfield. “Many live their lives without anyone knowing their background. You have probably met some without even knowing.”

You can contact Fran Springfield at

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