Two non-homosexual male-to-female transsexuals expressed regrets. The vast majority functioned quite well psychologically, socially and sexually. Vocal therapists may help their patients improve their pitch, resonance, inflection, and volume. Although the exact etiology of transsexualism is still not fully understood, it is most probably a result of a combination of various biological and psychological factors. After about one year, penile erection prosthesis and testicular prostheses can be implanted when sensation has returned to the tip of the penis. In the International Classification of Diseases the diagnosis is known as transsexualism . It is always advised that all changes in therapeutic hormonal treatment should be supervised by a physician because starting, stopping or even changing dosage rates and levels can have physical and psychological health risks. The study states that "no inferences can be drawn [from this study] as to the effectiveness of sex reassignment as a treatment for transsexualism," citing studies showing the effectiveness of sex reassignment therapy, though noting their poor quality.
But in trans men, some hormonally-induced changes may become virtually irreversible within weeks, whereas trans women usually have to take hormones for many months before any irreversible changes will result. For trans women, the extra time is required to allow for complete breast development from hormone therapy. Her paper was allegedly instrumental in removing Medicaid and Medicare support for sex reassignment therapy in the US. After about one year, penile erection prosthesis and testicular prostheses can be implanted when sensation has returned to the tip of the penis. Some satisfactory outcomes were reported, but the magnitude of benefit and harm for individual surgical procedures cannot be estimated accurately using the current available evidence. McHugh is a well-known opponent of sex reassignment therapy. In adolescents, careful diagnosis and following strict criteria can ensure good post-operative outcomes. Gender nonconformity is not the same as gender dysphoria; nonconformity, according to the standards of care, is not a pathology and does not require medical treatment. Sex reassignment surgery Sex reassignment surgery SRS refers to the surgical and medical procedures undertaken to align intersex and transsexual individuals' physical appearance and genital anatomy with their gender identity. According to his own article,  when he joined Johns Hopkins University as director of the Department of Psychiatry and Behavioral Science, it was part of his intention to end sex reassignment surgery there. Hormone replacement therapy trans For trans people, hormone replacement therapy HRT causes the development of many of the secondary sexual characteristics of their desired sex. Binding of the chest tissue can cause a variety of health issues including reduced lung capacity and even broken ribs if improper techniques or materials are used. Gender reassignment usually consists of a diagnostic phase mostly supported by a mental health professional , followed by hormonal therapy through an endocrinologist , a real-life experience, and at the end the gender reassignment surgery itself. Generally, those traits that are easily reversible will revert upon cessation of hormonal treatment, unless chemical or surgical castration has occurred, though for many trans people, surgery is required to obtain satisfactory physical characteristics. This treatment is controversial as the use of puberty blockers involves a small risk of adverse physical effects. However, some successful patients who wish to blend into the community as men or women do not make themselves available for follow-up. On the other hand, some clinics provide hormone therapy based on informed consent alone. Although the exact etiology of transsexualism is still not fully understood, it is most probably a result of a combination of various biological and psychological factors. The next operative procedure consists of the genital transformation and includes a vaginectomy, a reconstruction of the horizontal part of the urethra, a scrotoplasty and a penile reconstruction usually with a radial forearm flap or an alternative. Therefore, many surgeons are willing to perform some or all elements of sex reassignment surgery without a real-life test. Complications are common, especially in procedures that involve extending the urethra into the neophallus. In the International Classification of Diseases the diagnosis is known as transsexualism . For trans women , breast augmentation is done in a similar manner to those done for cisgender women. However, many of the existing primary and secondary sexual characteristics cannot be reversed by HRT. As Medicaid and private insurers often take their cues from Medicare on what to cover, this may lead to coverage of sex reassignment therapy by Medicaid and private insurers. Similar to trans women, trans men should live in the male gender role for at least 1 yr before surgery.
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