Factors which influence Individuals'
Decisions when considering Female-to-Male Genital Reconstructive Surgery
[Abstract] Full Text [PDF]
Abstract
This research examined the factors, which
influenced the decisions of people who had considered female-to-male
genital reconstructive surgery. The sample consisted of 27 people who
had been born as female and had male gender identities. Subjects were
recruited from a support group for female-to-male transsexuals (FTMs) in
New York City and from participants at a conference for female-to-male
transsexuals in San Francisco. A questionnaire was designed to explore
subject demographics and surgical decision-making. Respondents rated
contact with other FTMs and information from within the FTM community as
the most important sources influencing their decision. Lack of money and
inadequate medical technology were the most frequent obstacles to
implementing their choice. Results illustrate the growing influence of
community and peer support services. Results also challenge the
expectation that FTMs will request genital reconstructive surgery (phalloplasty
in particular) and identify some of the numerous reasons why FTMs may
not undergo such surgery.
Factors Which Influence
Individual’s Decisions
When Considering Female-To-Male Genital Reconstructive Surgery
A transsexual or transgendered
person usually makes decisions regarding sex reassignment surgery (SRS)
with the support of his or her health care providers. For several
decades providers have been the primary source of information about the
gender transition process. Today, due to the growing educational
opportunities available outside of the clinical setting, contact with
professionals may be only a small portion of an individual’s
preparation for gender transition. The internet has transformed
people’s ability to share information and peer support groups and
information networks are widely accessible. In many major cities in the
United States specialty bookstores have "transgender" sections
which include biographies, textbooks, and information on hormonal
regimens and surgical procedures. This study is the first to look at
where female-to-male transsexuals (FTMs) in the United States get
information about SRS and how they weight the different information
sources.
Research into SRS has generally focused
on psychosocial functioning and satisfaction with surgical results (Barraett,
1998; Mate-Kole, Freschi, & Robin, 1990;). Research into
postsurgical outcome has found that people who are emotionally healthy,
who have more social support, who will more easily "pass" in
their chosen gender, and people with good surgical results, are most
satisfied with life after surgery (Bodlund and Kullgrem, 1996; Ross and
Need, 1989). Follow-up studies to assess people’s satisfaction with
their surgical results have included variables such as genital size,
genital appearance, and excretory and sexual functioning (Kockett &
Fahrner, 1988). The literature on sex reassignment surgery generally
looks at who went for surgery and how that surgery changed their life.
The goal of most such research is to assess the effectiveness of SRS as
a treatment for gender identity disorders (GID) and to minimize
postsurgical regrets (Kuiper & Cohen-Kettenis, 1998, Pfaefflin &
Junge 1998). It is only recently that FTMs have a number of surgical
options. It is also a recent development that information regarding
these options is available from a number of sources.
The relationship between gender
identity and the request for surgery
Transsexual people have historically
been defined by their requests for surgery. Harry Benjamin’s 1966 Sex
Orientation Scale (Benjamin, 1966) describes seven categories of sex and
gender roles. This scale includes diagnostic criteria for three types of
transvestites and three types of transsexuals. The two categories of
"true transsexual" are reserved for those who request surgery.
How do these categories reflect the experiences of FTMs today?
Benjamin’s original scale was intended to refer to Male-to-Female
transsexuals but has been applied to both MTFs and FTMs. At the time he
had seen only 20 FTMs and of their surgical concerns he wrote:
They long for a penis, yet mostly
understand realistically that the plastic operation of creating a
useful organ would be a complicated, difficult, highly uncertain,
and most expensive procedure. Only one of my twenty patients had the
operation performed in several stages, but the final result is still
questionable. (p. 150)
Benjamin understood the gap between FTM
desire and the reality of surgical choices. He did not see this same
phenomenon among MTFs, but Schaefer and Wheeler addressed it in their
1988 paper "The Nonsurgical True Transsexual". Schaefer and
Wheeler wrote the following:
It is our belief that the concept of
gender emanates from one’s mental perception, … being perceived
authentically in the preferred gender has little to do with the set
of genital organs one may have. We say it is not genitals that make
a MF TS but the feelings of wanting to be a woman and the total
inner (as well as outer) identification with women. Transsexualism
is much less an issue of sex than it is of gender, and perhaps much
more of an issue of identity. (p. 7)
Kuiper and Cohen-Kettenis (1988) looked
at the therapeutic effect of sex reassignment surgery in a study of 141
Dutch transsexuals. Their sample included 25 FTMs.
… 21 had undergone mastectomy,
hysterectomy, and oophorectomy, and 4 had had penoplasty. In view of
the grave risk of complications and the often-disappointing results,
penoplasty is likely to be omitted in the remaining FMs. This means
that medical treatment can be regarded as completed in a total of 25
FMs. (p. 442)
The current limitations of sex
reassignment surgery for FTMs require that we reconsider how surgery is
used to determine gender status. In Devor’s 1997 book FTM
Female-To-Male Transsexuals in Society, she interviewed 39 FTMs and
found:
These participants had done research
into the surgical outcomes available to them. They had seen articles
in professional books and journals or spoken with other transsexual
men who had gone before them. They learned that phalloplasties were
extremely costly, involved multiple surgeries spanning a number of
years, and produced phalluses which were cosmetically questionable,
generally oversized, awkward for intercourse, and probably unusable
for urination. (p. 406)
FTM Options for physical transition
A thorough discussion of surgical
options is beyond the scope of this paper. However, it is important, for
the purposes of this research that the reader understands the options
available to FTMs and the risks and costs involved. Desire for surgery
and requests for surgery have often been considered diagnostic of the
degree of GID. Medical practitioners and mental health professionals who
work with this population should be aware of the current advances in
hormonal and surgical treatments. For a more complete discussion please
consult the medical literature (Hage, JJ. 1996; Hage et al. 1993; Kirk,
1997; Sengezer and Sadove; 1993). Hormonal and surgical options
available to FTMs, and expected outcome of transition, differ notably
from those for Male-to-Female transsexuals (MTFs). FTMs are truly
transformed through the use of hormones. The effects of testosterone:
deepening of voice, growth of body and facial hair, changes in skin
texture, reduction in subcutaneous fat, redistribution of fat, and
frequently, male pattern baldness, result in a distinctly male
appearance. Though FTMs are often smaller than other men in a given
ethnic group, the cultural norms for men are flexible enough to allow
for men of their size. FTMs are not generally perceived as being visibly
different from other men.
In addition to taking hormones, some
FTMs elect to have some combination of liposuction, mastectomy and/or
chest reconstruction/contouring. This surgery can create a chest
passable enough so the man can comfortably take his shirt off at the
beach or locker room (though there are often considerable scars). In
many ways an FTM can function socially as a man without any genital
reconstructive surgery.
Many FTMs will chose to have to have
their female reproductive organs removed (ovaries, uterus, and/or
vagina) and may have more masculine genitals constructed. Options for
genital reconstruction for FTMs currently fall into two types;
phalloplasty and metoidioplasty. Phalloplasty refers to a variety of
different operations which attempt the construction of a full-size
phallus. Virtually all of these operations take the tissue for the
phallus from other parts of the body (forearm, abdomen or leg).
Phalloplasty is associated with a large number of complications
including urethral fissures, tissue necrosis, neuropathy, and scarring
of the donor sight. The procedure is extremely costly. Multiple
operations are usually necessary both because phalloplasty may be done
in many stages and because complications requiring follow-up
intervention are the norm. There are a limited number of surgeons who
can perform this surgery, so individuals must frequently travel long
distances for both the initial and follow up procedures. Depending on
the type of phalloplasty, individuals may chose options such as standing
urination, ability to achieve an erection, penile sensation, penile
length, and testicular implants. Different phalloplasty techniques are
more or less adequate in these areas. Cosmetic results vary widely.
There is not yet a phalloplasty which can provide a fully functioning
and completely authentic-appearing phallus. All phalloplasty methods
involve major cost, compromises, sacrifices and risks.
Complications in sex reassignment
surgery (SRS) have many repercussions. Ross and Need (1989) examined the
relationship between the adequacy of surgical results and postoperative
psychopathology in 14 male-to-female transsexuals selected for the
absence of preoperative psychopathology. The researchers found that the
best predictor of postoperative psychopathology was poor surgical
results. Tsoi (1992, 1993) studied transsexuals in Singapore. He found
that five years after genital reconstructive surgery (GRS) only 39% of
FTMs were satisfied with the results of their phalloplasty. In spite of
disappointing surgical results, most people are more satisfied with life
after surgery and very few have regrets (Lundstrom, Pauly, and Walinder,
1984; Kuiper and Cohen-Kettenis, 1998). Barrett (1998) studied 40
postoperative phalloplasty patients and found that they were more
satisfied with the appearance of their genitals than were a comparable
preoperative sample. Green and Fleming (1990) found overall satisfactory
postoperative results for 97% of FTMs.
Metoidioplasty is a less costly
alternative to phalloplasty. Metoidioplasty refers to a variety of
operations, which utilize the individual’s existing genital tissue to
create a more male appearance. The clitoris, which has been greatly
enlarged by androgenizing hormones, is "freed" so that it is
more prominent and may even be capable of limited penetration. The
urethra may be extended to enable standing urination. The labia majora
may be used to create scrotum and may receive testicular implants. The
outcome most closely resembles a very small penis or "microphallus."
Metoidioplasty is considerably less expensive and is associated with
fewer complications than phalloplasty. However, as with phalloplasty,
the individual does not have a phallus that functions in every way like
a mature naturally-occurring penis. In spite of the limitations of the
available surgery, there are individuals who benefit from the
procedures. This research attempted to explore why FTMs chose to have,
or not have surgery and the process they go through over time to make
that decision.
Method
Participants
Subjects were female-bodied individuals
who were socialized as female but had male gender identities. All had
considered genital reconstructive surgery to assume a more male
appearance. Subjects were recruited from a peer support/social group for
FTMs in New York City and from The First FTM Conference of the Americas
held in San Francisco in August of 1995.
Measures
A questionnaire was designed to assess
what surgical procedures subjects had considered and which major factors
guided their decisions. The questionnaire included multiple choice
questions, rating scales, and open-ended questions. Demographic
questions included: age, gender identity, gender presentation, sexual
preference, and relationships status. With specific regard to surgical
decision-making, subjects were asked if they had ever considered
undergoing genital reconstructive surgery and what decisions they had
made. They were asked how they learned about surgical options and then
rated the sources of information in terms of which had most influenced
their opinions. The instrument was reviewed by two FTMs who were not
included in the research and by one psychologist who had expertise in
survey design and decision-making research.
Procedure
This was an exploratory,
non-randomized, non-clinical study. People who had attended the New York
City support group were called on the telephone and asked if they would
consider filling out a questionnaire. It was considered indiscreet to
send such a questionnaire without explicit permission. Sixteen former
support group attendees were contacted and all agreed to have the
questionnaire mailed to them. One hundred questionnaires were given to
people at the conference. Some conference attendees were approached by
the researcher and were asked if they would be willing to participate.
Other individuals picked up questionnaires on a table that displayed
flyers, information, and research opportunities. Questionnaires included
a self-addressed stamped envelope and a brief cover letter stating the
basic nature of the research and assuring confidentiality. They were
also asked to include their name and telephone number if they would be
willing to be interviewed in the future.
Results
Respondents: A total of 27
completed questionnaires were returned, a response rate of roughly 23%.
Nineteen people included their name and telephone number with
invitations to call and notes of encouragement for the project. There
are at least two likely reasons for the small response rate. People may
have been somewhat confused by the cover letter which addressed
"people who have considered having surgery, whether they decided to
or not". Many people who had surgery seemed to think that this did
not apply to them, and those who were not having surgery thought that it
did not apply to them either. Another factor in the response rate from
the conference may be individuals’ basic resistance to being studied.
At several forums at the conference participants expressed resentment
that they were commonly "treated like guinea pigs".
Age and gender identity. The
majority of respondents identified exclusively as male (n=19). Because
of their cross-gender identity these 19 were termed the
"transsexual" group. Twelve of those subjects were presenting
as male 100% of the time, 3 were presenting as male 75% of the time and
the other four were at an earlier stage of transition (presenting as
male from 0 to 50% of the time). Ages ranged from 21-50 with a mean of
37. The remainder of the sample (n= 8) did not identify exclusively as
male. They had unconventional gender identities or were at a stage of
gender transition at which they felt they were between genders. Because
of their non-traditional or gender-blended identities these individuals
were termed "transgendered". Three people in this group said
that they identified as "both male and female", three
identified as "neither male nor female". The other two
subjects identified as "lesbian" and as "butch dyke,
queer, transgendered". Of those people who considered themselves
"neither" one was presenting as male 100% of the time (and had
undergone mastectomy and male chest reconstruction), one was presenting
as male 75% of the time, and the third reported presenting as male 25%
of the time. Of those identified as "both male and female"
only one presented as male as much as 25% of the time. Because
female-to-male transsexuals are generally defined by their male
identification, only the 19 individuals who identified exclusively as
male were included in the analysis of results below. Due to the small
sample size it was not possible to analyze the statistical significance
of the differences between the transgendered and transsexual groups, but
some differences will be noted in the discussion section.
Relationships. Twelve
individuals reported being in a romantic relationship. The majority
(n=9, 75%) reported that their partners were female. One person reported
being in a relationship with a biological male. One person was in a
relationship with another FTM. One person reported that his partner was
"bigendered". Five people had been in relationships for a year
or less. Seven had had been with their partner for two years or more.
Duration ranged up to 13 years with a median time of 3 years.
Sexual preference - The majority
of the respondents (n=12, 63%) reported that they preferred women as
sexual partners (a relationship they considered to be heterosexual).
Three (16%) reported that they preferred men as sexual partners (a
relationship they considered to be homosexual). The other 4 (21%)
experienced a bisexual orientation.
Gathering information regarding
genital reconstructive surgery (GRS) Ninety-five percent (n=18) of
the participants obtained information about surgical options from
transgendered/transsexual peers and had seen photographs of surgery (see
Table 1). More than half of the respondents
(n=12, 63%) reported that they had seen in-vivo surgical results.
Eighty-nine percent (n=17) relied on pamphlets, newsletters, books, and
articles distributed through the transgender community. Seventy- four
percent (n=14) had received information from a helping professional.
Additional information was obtained from medical journals, film or
television, and popular magazines.
Subjects then rated the relative
influence of these sources of information on their surgical
decision-making. Table 1 shows the frequency with
which each item was mentioned as a source of information. The table also
shows the percentage of people who rated that item as having the
greatest impact on their decision (1 being most impact and 10 being
least impact). Speaking with transgendered peers, viewing photographs of
surgical results, looking at in-vivo surgical results, and reading
literature from within the FTM community was rated as the most
influential experiences. Therapists and Physicians were rated as most
influential by only 21% of the respondents.
|
Table
1: Sources of Information About Surgical Options And
Relative Impact of Sources on Surgical Decisions
|
|
Source of Information
|
Obtained Information
from this source
|
named as
influential
|
Ranked 1 or 2** -
most influential
|
|
|
n
|
%*
|
n
|
n
|
%*
|
|
TG/TS Peers
|
18
|
95
|
12
|
12
|
63
|
|
Photos of Surgery
|
18
|
95
|
11
|
11
|
58
|
|
Actual Surgery
|
12
|
63
|
7
|
7
|
37
|
|
FTM Lit/Newsletter
|
17
|
89
|
7
|
7
|
37
|
|
Therapist
|
14
|
74
|
4
|
4
|
21
|
|
Physician
|
12
|
63
|
4
|
4
|
21
|
|
Medical Journal
|
12
|
63
|
5
|
3
|
16
|
|
Autobiography
|
17
|
89
|
2
|
1
|
5
|
|
Popular Magazine
|
6
|
32
|
2
|
0
|
0
|
|
FTM Conference
|
2
|
11
|
2
|
2
|
11
|
|
Film or TV
|
12
|
63
|
1
|
1
|
5
|
|
NonTG/Ts Friends
|
4
|
21
|
1
|
1
|
5
|
|
**1 indicates "most
influential" and 10 indicates "least
influential".
*Percentages exceed 100% because subjects were allowed to
include as many options as applied.
|
Decisions made regarding genital
reconstructive surgery (GRS). Participants’ decisions regarding
surgery are listed in Table 2. Four of the
subjects reported that they had undergone GRS. Two of them reported
having had phalloplasty, two had metoidioplasty. Sixteen of the
respondents reported that they were considering having some type of GRS
in the future (some specified that they were waiting for advances in
technology). Of these 16, 8 had actually made the decision or were
leaning towards surgery in the near future. More than twice as many were
considering metoidioplasty as phalloplasty. Most had rejected
phalloplasty. The questionnaire contained the open-ended question
"What surgical options did you reject and why?" Individuals
had rejected specific options because of unattractiveness (36%),
inauthenticity of surgical results (42%), lack of functionality (16%),
and risks and complications (42%).
|
Table
2: Decisions Made Regarding Genital Reconstructive Surgery
|
|
Surgical Option
|
n
|
%*
|
|
Had Phalloplasty
|
2
|
11
|
|
Had Metoidioplasty
|
2
|
11
|
|
Considering Phalloplasty
|
4
|
21
|
|
Considering Metoidioplasty
|
10
|
53
|
|
Rejected Phalloplasty
|
11
|
58
|
|
Rejected Metoidioplasty
|
1
|
5
|
|
Decided not to have surgery at
this time
|
5
|
26
|
|
Considering Surgery in the
future
|
16
|
84
|
|
*Percentages exceed 100%
because subjects were allowed to include as many options as
applied.
|
Many factors contributed to surgical
decisions. Table 3 shows that lack of money and
dissatisfaction with surgical options were most frequently mentioned as
a contributing factor. None of the individuals rejected surgery because
they were satisfied with their own body and none of the individuals said
that they were influenced by a partner’s resistance to their
transition.
|
Table
3: Factors Contributing to Surgical Decisions
|
|
Factors Contributing to
Surgical Decisions
|
n
|
%*
|
|
Don’t have the
money/insurance
|
8
|
42
|
|
Not satisfied with options
|
7
|
37
|
|
Saw pictures
|
6
|
32
|
|
Saw actual surgical results
|
4
|
21
|
|
Heard people talking about it
|
3
|
16
|
|
Fear regret
|
1
|
5
|
|
Partner is against it
|
0
|
0
|
|
Feel fine the way I am
|
0
|
0
|
|
*Percentages exceed 100%
because subjects were allowed to include as many options as
applied.
|
Obstacles to Surgery. After
participants made decisions about the type of surgery that they would
like to have, they were prevented from having surgery for a number of
reasons. Lack of money and flaws in the medical technology, were major
factors in making the decision, but were even greater concerns in
implementing the choice. Some respondents did not feel that they had
access to adequate information in order to make an informed decision.
Some admitted to fear of physical pain and surgical complications. Some
had realistic practical concerns such as difficulty taking time away
from work and family, or poor health. Difficulty finding a surgeon and
the long distances necessary to travel to a surgeon were also obstacles.
None of the respondents reported difficulty getting a letter of approval
from a mental health professional, a clinic, or medical professional.
|
Table
4: Obstacles to Surgery After Decisions Had Been Made
|
|
Variable
|
n
|
%*
|
|
Money or lack of insurance
coverage
|
17
|
89
|
|
Technology is inadequate
|
11
|
58
|
|
Fear of complications
|
4
|
21
|
|
Difficulty finding a surgeon
|
4
|
21
|
|
Distance to surgeon
|
3
|
16
|
|
Time away from work and family
|
3
|
16
|
|
Fear of physical pain
|
3
|
16
|
|
Lack of available information
|
2
|
11
|
|
Poor health
|
2
|
11
|
|
Difficulty obtaining letter of
approval
from a mental health professional
|
0
|
0
|
|
Difficulty obtaining letter of
approval
from clinic or medical professional
|
0
|
0
|
|
*Percentages exceed 100%
because subjects were allowed to include as many options as
applied.
|
The Transgendered Group. The 8
individuals in the transgendered group had similar patterns of
relationships to those in the transsexual group, but they differed from
the transsexual group in a number of interesting ways. None of the
transgendered individuals had genital surgery or were actively planning
surgery in the near future. Five were still considering it in the future
(two specified that it was contingent on improved technology). Two
reported that they were considering metoidioplasty, but were very
ambivalent. Three of the transgendered subjects mentioned their
partner’s resistance to their transition as a major obstacle to
surgery, versus none in the transsexual group. Three of the 8 said that
they liked their body the way it was, versus none for the transsexual
group. Nearly half of the subjects in the transsexual group had seen
actual live surgical results as compared with no subjects in the
transgender group.
Discussion
Summary of Results
Even though the sample (27) is too
small, and the response rate (23%) too low as to have any statistical
power, the following clinical conclusions can be drawn from this study.
Participants rated contact with other
FTMs and information from within the FTM community as the most important
factors influencing their decision of whether and what type of surgery
to pursue. This was true regardless of age, sexual orientation, and/or
relationship with a partner. Mental health and medical professionals
were rated as less influential than peers. The majority of respondents
had rejected phalloplasty in favor of metoidioplasty as an acceptable
surgical option. Most reported that they did so because the present
technology was in some way inadequate or because of cost. It is
interesting to note that none of the individuals in the transsexual
group rejected surgical options because they were satisfied with their
own body. They wanted male genitals, if only they were attainable.
None of the respondents reported that
they had difficulty obtaining a letter of approval from mental health or
medical professionals. This may be because they had not requested such
approval or because the sample was self-selected on variables which
professionals associate with postsurgical success. This finding brings
into question some of the controversy about "gatekeeping".
Gatekeeping is a phrase used to refer to the ability of the therapists
to control access to medical services based on whether or not they write
letters to physicians in support of their clients’ desire for surgery
or hormones. The results of this study did not support concerns about
gatekeeping and suggest the possibility that, for this sample, providers
were not reluctant to support requests for surgery and did not act as
obstacles to treatment.
The Role of Peer Support
This sample was comprised of people who
had sought out community resources either in a support group or at a
conference. Virtually all of them had met other FTMs and had access to
information provided by the community. The results demonstrate the
significance of contact with others in shaping surgical decisions. The
FTM community, as it is developing, places a high priority on
information exchange among peers. The burgeoning peer support movement
has implications regarding the nature of treatment decisions by
consumers and professionals. It is particularly noteworthy that mental
health and medical professionals were devalued as sources of information
among this sample of subjects. The influence of professionals would no
doubt be more prominent in a clinical sample or a group of subjects who
did not have peer support networks and other resources.
Implications
Since the time of Harry Benjamin the
desire for surgery has been treated as an inherent quality of the
individual, symptomatic of their cross-gender identity. The results of
this research suggest that surgical choices have to do not only with
gender identity but also with available resources, technology and
individual life circumstances. Research in this area is extremely
important for several reasons. Attitudes towards GRS, and one's
relationship with one's natural genitals, is frequently part of the
diagnostic profile used to determine medical care and legal status for
transsexual people. For example, a person who has not had, or does not
plan to have, GRS may be denied hormones, surgery (particularly
mastectomy or hysterectomy), a legal name or gender change, or ability
to legally marry. It is crucial to be realistic and allow that many FTMs
will choose not to have surgery not because they do not want a penis,
but because we can not offer them an affordable, realistic, and fully
functioning penis. They may also choose not to undergo surgery because
of family obligations, the extensive convalescent time involved in
numerous operations, or prohibitive health problems (such as diabetes or
HIV status). Restricting the definition of an FTM to someone who
requests a risky, costly, often technologically inadequate surgery is
unrealistic.
The results of this research also have
implications for the way mental health and medical professionals work
with transgendered and transsexual people. Helping professionals have a
unique contribution to make as facilitators of a decision-making
process. The individuals in this sample placed a high value on
information received through contact with FTM peers. These results
suggest that it may be advantageous for professionals to work
cooperatively with community and peer support services.
Suggestions
for future research
This research was limited by the small
sample size and by the lack of in-depth information about the subjects.
While all participants in the transsexual group claimed to be
male-identified, and even to live most or all of the time in the male
role, the variations in the endurance, degree, and stability of that
male identification was not examined. The small group of transgendered
individuals demonstrated notable differences in gender identity and in
surgical choice. As described above, there are many reasons why some
individuals with a strong and stable male gender identity will not
request the currently available surgery. For some portion of the
transsexual population sex reassignment surgery is a desirable,
necessary, and sometimes life-saving procedure. There are Female-To-Male
Transsexuals who are intent on sacrificing everything necessary to
obtain the currently available surgically-constructed phallus and there
are FTMs who do not have that focus. Both groups have the potential to
be accepted as men by their partners, family, friends, and associates.
What differentiates between FTMs who do
and don’t pursue surgery? Apparently the desire for surgery is related
to, but not completely dependent upon, gender identity. Further research
is needed to examine how the intensity and stability of gender identity
and desire to live as a man is related to the desire for surgery. This
research does not answer the question "what drives some people to
pursue surgery." It strongly suggests that gender identity is not
the only factor.
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Correspondence and requests for materials
to Katherine Rachlin, Ph.D. 153 Waverly Place, Suite 713. New York, NY.
10014. e-mail KRachlin@aol.com.
Citation:
Rachlin, Katherine (1999) Factors Which Influence Individual’s Decisions
When Considering Female-To-Male Genital Reconstructive Surgery. IJT 3,3,
http://www.symposion.com/ijt/ijt990302.htm
Author’s Note: Parts of this research were presented at the XV Harry
Benjamin International Dysphoria Association Symposium in Vancouver,
Canada. September 10-13, 1997 and at The Third International Congress on
Sex and Gender in Oxford, England, September 18-20, 1998.
Acknowledgments: I would like to thank Dr. Myles Schwartz for reviewing
earlier drafts of this paper.
