Factors which influence Individuals'
Decisions when considering Female-to-Male Genital Reconstructive Surgery
Katherine Rachlin
[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.
