Twenty-three male to female (MfF) patients were asked to give their opinion on vulval aesthetics with reference to the photographs in Femalia (Blank, 1993). The results are illustrated and the author’s attempts to reach these impossible standards are illustrated. A literature search was conducted using the keywords: vulva, vagina, cosmetic, aesthetic, and transsexual and the results are annotated.

After having undergone successful sexual reassignment surgery male-to-female (MtF) transsexuals are very often negatively affected by their unchanged masculine voice, which contrasts with their feminine appearance and this interferes considerably with their social integration as women. Since hormonal treatment or logopedic therapy alone will not achieve a permanent increase in voice pitch, the development of a phonosurgical technique to achieve a permanent elevation of the voice pitch is of great importance. Since 1993, 67 MtF transsexuals have undergone cricothyroidopexy at the department of otorhinolaryngology, in the university hospital in Halle, according to Berghaus and Neumann (1996). Increased tension of the vocal cords results in a permanent elevation of the fundamental frequency range by five to six semitones on average. While pre-operatively none of the patients had a feminine speaking voice pitch, after the surgery, about 30 percent attained a voice pitch within the feminine range, and 38 percent attained at least a neutral voice pitch. In the long-term, mostly combined with further voice training, the results proved to be of a permanent character, and in 45 percent of the cases, a further increase was observed. The operation technique in question has proved to be generally successful with a minimum of risk factors.

The effect that voice therapy can have on the social integration of the persons in question and to what extent they were satisfied with the results of voice treatment was assessed by means of a questionnaire, which was developed with the Institute of Psychology at the Martin-Luther University of Halle-Wittenberg. Twenty-eight questionnaires were evaluated, and in most cases, the feminisation of the voice had improved and facilitated better social integration was achieved by the MtF transsexuals who had undergone treatment

This paper formulates a social psychological perspective for the mental health functioning of transgender persons. Affective symptomatology in this population is viewed as significantly affected by the extent to which transgender identity is successfully incorporated in social roles and relationships. The extent to which transgender identity is disclosed to others so as to be recognized by them, performed in the presence of others, responded to by others, and supported by others, is summarized in terms of a broad construct—transgender identity affirmation. Affirmation of identity, following social psychological identity theory, is posited as crucial for emotional well-being. Some support for this perspective was observed in a preliminary study of 43 trans women sex workers in New York City. Additional research along these lines is needed to better understand the complex association between transgender identification and mental health functioning.

A person who has happily lived as a woman for 12 years and her therapist of five years discuss the situation that led to a series of returns to the male gender role. In 1991, when the patient informed his wife that he wanted to spend the rest of his life with her as a woman, she gracefully accommodated him. Years later, the patient presented himself as a male when his wife’s career required this. In doing so, the patient was able to more deeply understand the meaning and the mutual obligations of love. By thinking of it as a gift of love, the impossible was accomplished with ease and pride. The patient and wife are once again living full time as women.

This article presents results of interviews held via email with 19 female-to male transsexual and transgender people regarding the role of mass media in their identification processes. A preliminary review of the television reception studies of Morley (1980), Liebes and Katz (1991), and D’Acci (1994) examines previous findings on the relationship of audiences’ social identities to their interpretation of media texts, including the place of these interpretations in the identification process. Results of the current study indicate that 1) media facilitated transsexual and transgender respondents’ identification processes in various and significant ways, 2) the gendered self-perceptions upon which respondents based their identifications were socially informed but did not originate in social arenas, and 3) media functioned like an ‘actualizing agent’ during the development of respondents’ transsexual and transgender identities.

A survey was conducted among transsexual women to ask their opinion about the option of freezing sperm, before the start of any medical treatment. We received responses from 121 women. The vast majority feel that the availability of freezing sperm should be discussed and offered by the medical world. A smaller majority would indeed have frozen their own sperm, or at least have seriously considered doing so, if this had been an option. Most women in favour of the idea of sperm freezing were under 40 years of age and identified as lesbian or bisexual. A minority of respondents expressed concern about possible risks of genetically transmitting transsexualism to their children, or considered the whole idea of sperm freezing to be in conflict with their female core identity. Many women expressed regret that they could not become pregnant and have a child themselves.

After adapting the primary sex characteristics, the raising of voice pitch should be an option offered as part of male-to-female transition. Hormonal treatment is not capable of raising voice pitch, and logopedic treatment on its own cannot, as a rule, guarantee lasting success. Since 1993, a modified cricothyroidopexy via miniplates, following Isshiki’s technique, has been performed at the ENT Department of the Martin-Luther University of Halle-Wittenberg. This procedure is based upon an approximation of the cricoid and thyroid cartilages resulting in an increase in the vocal cord tension. Combined with a chondrolaryngoplasty it allows for a reduction of the laryngeal prominence. So far 67 patients have undergone this surgical intervention. Laryngoscopy and a detailed voice diagnostics, as well as ultrasound and computer-tomographic examinations of the larynx are performed pre- and post-operatively in order to record the anatomical, physiological and functional data. So far good functional results have been achieved showing an average increase of the fundamental frequency by approximately five semitones.

The effects of hormone therapy on glucose tolerance in male-to-female transgender patients have not been specifically addressed in the medical literature. Three cases of new onset type 2 diabetes mellitus during the course of feminizing therapy are examined in light of current literature regarding sex hormones and glucose tolerance. Feminizing therapy may contribute to the onset of diabetes in male-to-female patients with concomitant risk factors. Further research is needed to evaluate the effect of feminizing regimens on glucose tolerance, and to elucidate which patients may benefit from regular screening during the course of therapy.

In an article published earlier in The International Journal of Transgenderism (Winter and Udomsak, 2002) showed that while Thai MtF transgenders displayed actual self-concepts that were strongly female-stereotyped (that is, consistent with their own beliefs about femaleness) their ideal self concepts, and aspirations for change were distinctly less female-stereotyped.

This finding raised the following question: what underlying considerations, if not the simple pursuit of stereotyped femaleness, governed their ideal self and aspirations for personal growth? To answer this question, the Adjective Checklist (ACL) data from the original study (Winter and Udomsak, 2002) were further analysed in a three-step procedure.

Firstly, an attempt was made to identify the underlying essence of the traits we employed in the ACL. Using findings from earlier ACL research by Williams and co-workers (Williams and Best, 1990; Williams et al., 1998, 1999), we ascribed to each ACL trait-item a set of 14 scores, each of which reflected the degree to which that trait reflected an important psychological feature. These features represented (a) affective meaning (three scores: favourability, strength and activity), (b) ego-state (five scores: critical parent, nurturing parent, adult, free child and adapted child), (c) higher-order personality factors (five scores: extraversion, agreeableness, conscientiousness, emotional stability and openness), and (d) psychological importance (one score: indicating the degree to which the trait is a ‘core’ element of personality).

Secondly, in order to reduce the data somewhat, these scores were factor analysed. The 14 scores were loaded onto four factors. On the basis of the loadings, these factors were labelled: ‘resourceful/dependable’ (factor I), ‘intrusive/controlling’ (factor II), ‘risk-taking/stimulation-seeking’ (factor III), and ‘caring/harmonious’ (factor IV).

Thirdly, multiple regression analyses were employed to identify which if any of these factors appeared to underlie participants’ (i) gender-trait stereotypes, (ii) actual-self, (iii) ideal-self, (iv) aspirations to acquire traits (traits desired but not possessed) and (v) aspirations to lose traits (traits possessed but not desired).

The analysis revealed that gender-trait stereotypes were predicted by factors I, II and III (all underlying male-stereotyped traits) as well as by IV (underlying those that were female-stereotyped). Factors I, II and III could therefore be considered ‘male’ factors, while factor IV was ‘female’. As one might expect, factor IV (the ‘female’ factor) predicted those traits endorsed for actual self, while factor II (a ‘male’ factor) acted in a counter-predictive way.

Our main interest focused on finding factors that might shed light on our earlier findings on ideal self and aspirations for change. We found that ideal self was predicted by a gender-inconsistent mix of factor IV (the ‘female’ factor) and factor I (a ‘male’ factor). Factor I was also important in predicting those traits which participants aspired to acquire, and in counter-predicting those (unwanted) traits, which they aspired to lose. Beyond this, factor IV (the ‘female’ factor?) somewhat paradoxically predicted aspirations to lose traits.

In short, participants’ ideals for self seemed to embody qualities of care and harmony (‘female’ qualities), but also resourcefulness and dependability (‘male’ qualities). Indeed, participants wished not only to retain whatever ‘male’ qualities of resourcefulness and dependability they had, but also to acquire more of these qualities. Furthermore, while they valued many ‘female’ qualities like care and harmony, they also aspired to lose some of these qualities.

These findings, which are, at face value, gender-anomalous, attest to personal growth goals that transcend (or indeed run counter to) gender stereotype; instead they conform to notions of maturity and personal efficacy.

This article describes the Transgender Recovery Program, a residential substance use treatment program for male-to-female transgender women receiving substance use treatment and mental health services at San Francisco’s Walden House. With an 81% success rate in retaining clients in its first nine months, the program provides male-to-female transgender women with transgender staff and support groups, helps transgender clients build ties among themselves and with other agency clients, and helps transgender women re-enter the community by building a network of employers and landlords who are friendly toward transgender individuals. The program also provides sensitivity training and education about transgender issues for clients, staff, and community agencies, as well as conducting outreach in the community. Elements of program success include affirming transgender people as women and individuals, developing peer support, and expanding clients’ social and vocational horizons.

Traditionally, the research, assessment and treatment of ‘gender dysphoria’ (GD) and ‘gender variance’ (GV) has tended to pathologize transvestites/crossdressers, transsexuals and transgendered people, including ‘transqueers’. This article will cite examples of clinical ‘transphobia’ to underscore the need to revolutionize our way of doing therapy with transpeople. To optimize the recent trend towards a more respectful, collaborative relationship between GD/GV clients and the mental health community, we must ensure that our clinical orientation is truly responsive to the changing real-life needs of a highly-diversified trans population, including the rights to self-determination and comprehensive health care. To help meet this goal, this paper will develop a generic transpositive therapeutic model, building from existing trans-affirmative approaches.

A series of nine major guidelines to build the theoretical framework for a transpositive model of psychotherapy is proposed, with specific recommendations around: 1) clinical orientation/treatment philosophy, 2) assessment considerations, 3) treatment considerations (including psychotherapy, diversified subpopulations and marginalized subpopulations), 4) the therapeutic relationship, 5) comprehensive case management, 6) accountability/quality assurance, 7) advocacy/alliance building, 8) knowledge base/professional development, and 9) research.

This paper presents findings of a detailed service audit of cases seen at a specialist service for children and adolescents with gender identity disorders. The audit looked at clinical features, associated features, demographic characteristics and complexity of the cases. Data were extracted from patient files of the first 124 cases seen by the service. Clinical features were assessed based on DSM-IV criteria (American Psychiatric Association, 1994) and associated features were based on the clinical features list of the Association of Child Psychology and Psychiatry (ACPP) data set (Berger et al., 1993). A range of results is presented documenting the occurrence and frequency of different clinical features at different ages. These include the finding that stereotypically gendered clothing (i .e. boys cross-dressing and girls refusing to wear skirts) is more significant in pre-pubertal children, whereas dislike of bodily sexual characteristics becomes more predominant in post-pubertal children. The most common associated features were relationship difficulty with parents/carers (57%), relationship difficulty with peers (52%) and depression/misery (42%). Gender identity problems have wide-reaching implications for children and their families and problems may become more entrenched with the onset of puberty. Although specialist support and co-ordination of services becomes essential particularly at this time, interventions in childhood may have the function of preventing difficulties becoming more severe during adolescence.

This research examined Transgender and Transsexual individuals’ experiences in psychotherapy accross a range of treatment settings. Participants completed a survey that asked why they had sought mental health services and what their experience of treatment had been. The sample consisted of 93 participants (70 Female-to-Male and 23 Male-to-Female) who reported on 150 contacts with various psychotherapists. Results indicated that it was common to have seen a psychotherapist for general personal growth issues earlier in life and to later seek out a therapist who had experience in transgender work in order to focus on gender issues. Provider experience in working with gender issues was associated with a higher number of positive changes, higher patient satisfaction with progress in both general personal growth, and gender related issues. Individuals consistently expressed appreciation for therapists who were flexible in their treatment approach and demonstrated respect for the patient’s gender identity.

Two hundred and four Thai Male-to-Female (MtF) transgenders (mean age 23.0 years) completed questionnaires designed to examine self-concept (actual and ideal) and gender-trait stereotypes held towards men and women.

Findings indicated that (a) participants’ gender-trait stereotypes were similar to those of non-transgenders examined in other studies (both in their own country and internationally), (b) their actual and ideal self-concepts each displayed much more consensus about traits not possessed than about those possessed, (c) their actual and ideal self-concepts were commonly discrepant, and (d) while they commonly held a stereotypically female view of themselves, they often aspired towards a broad range of traits that were less stereotyped. Indeed, (e) they commonly disowned stereotypically female traits.

These last two findings suggest that transgenders have personal growth goals that transcend, or even run counter to, gender-stereotype. They may instead conform to more fundamental ideas about favourable human qualities.

This paper considers Ray Blanchard’s taxonomic, typological and diagnostic approach to his concept of ‘autogynephilia’ (‘love of oneself as a woman’) in male-to-female transsexuals, in the context of Anne Lawrence’s appropriation of the concept in the service of her personal transgendering identity formation and transgendering identity politics. A striking contemporary example of the umbilical cord that exists between the formulations of science and those of sections of the transgendered community is provided by the interrelations between Blanchard’s and Lawrence’s work on autogynephilia. The concept of autogynephilia is considered from the standpoint of the sociology of transgendering put forward in Ekins (1997) and Ekins and King (1999, 2001a, 2001b). In particular, the interrelations between transgendering, ‘migrating’ and the role of autogynephilia are examined with reference to selected material from life history work with three male-to-female transsexual informants. While it is not difficult to find autogynephilic components in transgendering trajectories, the interesting questions relate to the status of those components over diverse trajectories, including the constituting and consolidating (Ekins, 1993, 1997) of autogynephilic identities. The sociological approach presented in this paper provides the conceptual wherewithal to unpack a number of controversial issues surrounding the concept of autogynephilia and its reception.

The aim of the study was to investigate whether cross-sex hormone treatment in transsexuals affected the intensity of negative and positive emotions in general, and aggressive and sexual feelings in particular. With respect to emotional behavior, changes in non-verbal expressiveness and anger readiness were examined in 47 female-to-male transsexuals (FtMs) and 54 male-to-female transsexuals (MtFs). We were also interested in finding out whether, in FtMs, the rapidly changing testosterone levels in the two-week cycle testosterone treatment had predictable effects on moods, the development of male physical characteristics and sexuality.

Estrogen hormone in male-to-female transsexuals is a major component of therapy in the treatment of gender dysphoria. There are many adverse reactions to estrogen therapy that require close monitoring. We describe a case of autoimmune hepatitis that may have been exacerbated by estrogens: this is an additional adverse effect of estrogens on liver function that has not previously been reported. We recommend routine liver function tests to screen for such adverse reactions.

This paper discusses a study of male transsexuals in Malaysia, known locally as mak nyahs. This detailed study, funded by the Ministry of Science, Technology and Environment, involved the use of questionnaires and interviews. The questionnaire for the mak nyahs, which consisted of 142 questions, was divided into three parts: a) the social aspect; b) HIV/AIDS knowledge; and c) related health issues. In addition to questionnaires, interviews were carried out with some of the mak nyahs as well as with the relevant authorities.

This paper looks into the social aspect of transsexualism in Malaysia. The questions in this section of the questionnaire were derived from studies undertaken in the West. The writer found that transsexuals in Malaysia have many characteristics similar to those from other parts of the world. However, the identity of the mak nyahs in Malaysia is influenced by cultural and religious factors. The definition and identity of male transsexuals in Malaysia may differ in some ways from those in other parts of the world.

A case of intraepithelial neoplasia (carcinoma in situ) of the neovagina in a male-to-female (MtF) transsexual is presented. Vaginal carcinoma is rare in natal women, including those who have undergone vaginoplasty for vaginal atresia. Vaginal cytology examinations (Pap smears) are not recommended following hysterectomy for benign disease; they probably have limited value following vaginoplasty for benign conditions as well. MtF transsexuals should receive annual pelvic examinations following vaginoplasty, but there no evidence to suggest that they would benefit from vaginal cytological screening in most cases. However, if the glans penis has been retained as a neocervix, cytological examination of the neocervix is a reasonable practice.

The first sex reassignment surgery (SRS) performed officially in Japan—for a female-to-male (FtM) person in 1998 and for a male-to-female (MtF) person in 1999—are reported. For the FtM, two-stage conversion was applied. In the first operation, salpingo-oophorectomy, hysterectomy, colpectomy, metoidioplasty, and mastectomy were performed. A free flap phalloplasty with the deltoid flap is planned as the second stage. For the MtF, one-stage neovaginoplasty was performed by penile skin inversion technique with sensate pedicled neoclitoplasty.

Transgender was first researched by Magnus Hirschfeld and Havelock Ellis although they did not call it that. Few immediately followed up on their pioneering work and most of those who did were psychiatrists. Freudian theories remained dominant in U.S. It was the Christine Jorgensen case, which gave renewed impetus to the study of transgendered individuals, and Harry Benjamin was particularly influential. The concept of gender as distinct from sex was developed by John Money and popularized by the second wave of feminists. The growth of organized transvestitism provided a natural research group that went beyond the clinical case study and led to new explanations and theories about gender.

In theory, transgender is a challenge to the social construction of gender. In practice, it usually is not. Transgendered people—in one way or another—place themselves outside the conventional female/male dichotomy, yet live in a social world that recognizes only females and males. How could a self-identified transgendered person earn and maintain a transgender attribution, when others are constrained to attribute an unproblematic “male” or “female” gender to him/her? Is it possible to alter, in practice, what seems to be the incorrigibility of the gender attribution process? Is this, in fact, what transgendered people want to do? In the light of three possible meanings of trans, we consider whether there is any point to deconstructing gender.

This article is a version of Chapter One: Sexing the Body: Gender Politics and the Construction of Sexuality. In it is argued that science is often thought of as being beyond the reach of social and political debates. In fact, it is precisely such debates that have dictated the course of scientific research, ranging from the very questions scientists pose to the experimental methods they employ. And this is highly pertinent to the ongoing debate concerning the biological versus social nature of gender and sexuality. In most public and in most scientific discussions, sex and nature, are thought to be real, while gender and culture are seen as constructed. But these are false dichotomies. In fact, it is argued, there is a complex and subtle interaction that exists between the biological and the social/political that must be understood and reexamined.

Deirdre McCloskey, although having transitioned and lived full time as a woman for four years, is still a Chicago-School, quantitative, historical economist who continues to “believe in markets”. But the impact of living as a woman and inculcating values more highly prized by the “opposite” sex leads to a reconsideration of what is important and how it ought to be valued. Economics is about value, but those values do not come without political and social considerations. In considering, for example, the classic virtues prudence is the one almost exclusively considered by economists, but it is argued, faith, hope and love must also be brought into the formulation.

Contemporary gender theorists have applied social construction theory to the binary gender system, and argue that the very division of the world into two distinct genders correlated to two distinct sexes is an artifact of social practice and political institutions and can and ought to be modified. Notable thinkers such as Judith Butler and Marjorie Garber view the gender rule breakers as the very proof that gender is a variable and not a constant, that one can change one’s gender, construct one’s sex, or maintain a status not directly identifiable as one or the other classic gender. Most of the discussions on this subject have focused on two main groups. The first are transsexuals who move entirely from one gender/sex locus to the other, and the second are drag queens and kings who, by and large, identify as their birth-designated sex, but who play at or perform at the opposite gender. More or less lost in this formula is the run-of-the-mill cross dresser who periodically adorns himself in women’s clothes and participates in activities ranging from hiding timidly in a drapes-drawn home to marching boldly into public shops and restaurants.

Thirty years after co-editing Transsexualism and Sex-Reassignment, this speciality’s first multi-disciplinary text, the author reflects on changes over the past three decades. Transsexualism, then esoteric, is now familiar to school children. Previously solid medical opposition to endocrine and surgical treatment has melted. Origin(s) of transsexualism remain enigmatic but more evidence is in place for a substantial biological contribution. More is also known about the variability of sexual orientation of transsexuals, with extensive experience with males becoming lesbian women and limited experience with females becoming gay men. Post-reassignment follow-up data are overwhelmingly positive when pre-operative patients fulfil the Real Life test. Newer areas of controversial treatment options include surgery on demand for self-diagnosed transsexuals, gender-neutering procedures for the “third sex”, and hormonal and surgical intervention for gender dysphoric adolescents. Legal obstacles in the path of transsexuals remain in the terrain of employment, health care, marriage and parenting.

A noteworthy change is the integration of transsexual men and women into its leadership and the biannual meeting presentations of the Harry Benjamin International Gender Dysphoria Association.

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.

The author reviews the relevant current literature on the subject. He goes on to outline detailed treatment recommendations for MTFs with estrogens and antiandrogens. He highlights side effects and complications such as venous thrombosis, breast cancer in individuals with a predisposing family history and the rare incidence of prolactin producing tumors.

Similarly, a detailed review of androgen administration in FTMs is provided describing the cessation of menstruation and the development of a male hair pattern. Contraindication against high dose use of sex steroids consist of serious liver, cardiovascular, cerebrovascualar, and thromboembolic disease, marked obesity, and poorly controlled diabetes mellitus.

Finally, the complicated medicolegal issues of juvenile gender dysphoria are mentioned. Rather than giving heterotypical sex steroids, the author recommends hormonal delay of the onset of puberty until an age when a responsible decision can be made.

Transvestites in Brazil are members of an intricate and distinct subculture whose marginalization uniquely impacts the effectiveness of HIV prevention/intervention programs. As such, the purpose of this research was to assess the drug using and sexual behaviors, and prevalence of HIV-1 infection among a sample of 100 male transvestite sex workers, and to develop appropriate intervention strategies. AIDS risk behaviors were common among the transvestites studied, and almost half tested positive for HIV infection. Recommendations for prevention efforts include the incorporation of condom negotiation and empowerment techniques. Female condom demonstration and distribution (for anal sex) should also be included since the findings show it was well-received by transvestites. Finally, nearly all of the clients reported non-hygienic use of needles for silicone injections, suggesting that needle cleaning techniques also should be included in future prevention initiatives targeting transvestite sex workers.

In Brazil, transvestism is a specific social and cultural construct in which both gender and sexuality are mapped out and performed in highly particular ways (1). Moreover, it has a long history, both as an integral theme during Carnaval, and as a gender variation with its own distinct culture (2, 3, 4). At Carnaval, best described as an enthusiastically celebrated street festival and parade during the five days prior to Ash Wednesday, many males—both gay and heterosexual—participate dressed as women, not only to glorify and venerate women, but also as a projection of male sexual fantasies (4).

In contrast to Carnaval cross-dressing, the travestis of Brazil view transvestism as an identity and a designation that pervades every aspect of their lives. Although the clinical literature emphasizes that transvestites do not live continuously in the cross-gender role, and that their cross-dressing is periodic and fetishistic (6, 7), for the travestis of Brazil, transvestism appears to be enduring—typically life long.

Transvestites in Brazil, as in other cultures, are marked by an exaggerated femininity in both dress and makeup. They come almost exclusively from the poorest segments of Brazilian society, but there is little toleration for them in either the favelas (shantytowns) or the traditional, low income suburban areas. Thus, as they begin to cross the lines of gender, most leave behind family and friends, emigrating to Rio de Janeiro, Sao Paulo, and other large cities into districts where: … a mixture of socially marginal and often illegal activities creates not only a kind of moral region but a moral anonymity in which the traditional values of Brazilian society cease to function. Within this world (which is also the world of female prostitution, drug trafficking, homosexuality, and the more sporadic prostitution of the miches [male prostitutes]), given pervasive prejudice and discrimination, almost no options other than prostitution are open to the travesti for earning a living; as a result, almost all travestis quickly become involved in prostitution as their primary activity (8).

Most transvestites live in close proximity to each other, and they always dress as women. Many use drugs, and because of their involvement in street prostitution, they are regularly exposed to both violence and a full range of sexually transmitted diseases, including HIV and AIDS. For example, among 57 drug-using transvestites engaging in prostitution in Rome (the great majority of whom had emigrated from Brazil), the overall prevalence of HIV was 74 % (9). Studies conducted in various parts of Brazil over the past ten years also reflect high rates of HIV seropositivity among transvestite sex workers. Among 37 transvestites tested in Sao Paulo during 1988, 62 % were found to be HIV positive (10), and among 112 transvestites contacted four years later, 60.7 % tested positive (11).

In Rio de Janeiro, it is estimated that there are at least 2,000 transvestites, (and they prefer the term “transvestite,” or travesti in Brazilian Portuguese, as opposed to transsexual or transgender), 80 % of whom support themselves through prostitution. Within this context, the following discussion examines aspects of the subculture of male transvestite sex workers in Rio de Janeiro, with a particular focus on their drug-using and sexual risk behaviors.

This article describes difficulties transgenders encounter in obtaining health and social services, including targeted HIV prevention. Based on an anthropological HIV/AIDS needs assessment for the transgender community of Boston, Massachusetts, we identify misperceptions that interfere with the provision of caring and appropriate services, including for the most economically vulnerable male-to-female transgenders who were the focus of the study. Drawing on the work of a Boston-based transgendered activist, Rebecca Durkee, we recommend specific steps for HIV/AIDS prevention that can contribute to reducing transgenders’ risks of HIV infection. These steps can also contribute to community building and pride and thereby to diminishing the social stigma and discrimination that shape both transgenders’ HIV risk and their difficulties in obtaining health and social services.

This paper analyzes data collected from a transgender HIV Harm Reduction Program located in Hollywood, CA. Over an eighteen-month period, from January 1996 to June 1997, 209 male-to-female transgenders participated in the program. Demographic data and baseline HIV risks were collected at first contact and first intervention session, respectively. Within this sample, HIV infection risk seems to be related to whether participants engaged in sex work. The sex workers were more likely to have used alcohol and other drugs, including injection drugs, within the previous 30 days than the non-sex workers.

Objective: To qualitatively describe the level of HIV risk behaviors and access to HIV-prevention and health services among transgendered individuals in San Francisco.

Methods: Eleven focus groups were conducted with 100 Male-To-Female and Female-To-Male transgendered individuals. Focus groups were transcribed, reviewed, and comments were coded into categories that emerged naturally from the data. Unduplicated comments were enumerated and summarized.

Findings: HIV risk behaviors such as unprotected sex, commercial sex work, and injection drug use were common. Low self-esteem, economic necessity, and substance abuse were cited as common barriers to adopting and maintaining safer behaviors. Many individuals did not access prevention and health services because of competing priorities and the insensitivity of service providers. Participants’ recommendations for improving services include hiring transgendered persons to develop and implement programs and training existing providers in transgender sensitivity and standards of care.

This article presents the results of a study of transgendered people and HIV/AIDS in Quebec, summarizing the data from the needs assessment relevant to FTMs. Using qualitative research methods (interviews and a discussion/focus group), FTMs were asked to identify their needs with respect to health care and social services more broadly, and HIV/AIDS more specifically. The needs assessment identified five salient issues with respect to FTMs and HIV: 1) there is a lack of informational and educational materials about FTM bodies and sexualities; 2) many FTMs do not consider themselves to be at risk for HIV; 3) poor access to intramuscular needles, used to inject hormones, creates conditions which put FTMs at risk of HIV transmission; 4) low self esteem may prevent FTMs from adopting safe behaviors with regards to drug use and sexual activity; 5) the administrative practices of social service agencies exclude FTM transsexuals. The paper concludes with some recommendations in terms of health care policy, program delivery, and research methods.

This paper will describe a series of HIV prevention workshops for Enterprise, an ongoing support group for female-to-male transsexuals of different sexual orientations and stages of gender transition in Greater Boston. The workshops are based on the premise that information-based HIV prevention strategies have limited efficacy in helping individuals sustain behavior change over time, and that marginalized populations require interventions that address their particular psychosocial issues and needs. The intervention focuses on core issues in HIV prevention and risk management:

1. HIV/STD transmission and risk reduction information;
2. disclosure of personal information in relationships and sexual encounters;
3. verbal and nonverbal negotiation skills;
4. the connections between cognitive learning and human sexual response;
5. the meanings of sexual behaviors;
6. the value of sexual pleasure;
7. the relationship between sexual desire and personal identity; and
8. mobilizing ongoing support for managing HIV/STD risk.

In the context of a paradigm shift toward transgender coming out and empowerment, we mobilized a core group of transgender community representatives to develop targeted HIV prevention education. Focus groups assessed transgender-specific prevention needs and enabled participants to become invested in the project. Community members designed and distributed recruitment materials. Trained peer educators facilitated a workshop. A video created by transgender artists personalized HIV/AIDS for participants, a panel of transgender persons living with HIV/AIDS enhanced perceived susceptibility to HIV infection, and sexually explicit materials depicting transgender role models eroticized safer sex. A transsexual community activist facilitated a special segment on empowerment and building community. Community involvement ensured cultural sensitivity of program intervention and evaluation. Together, these strategies helped the community take ownership of the project and raised the credibility of the prevention message. Further university-community collaboration in HIV prevention research is recommended.

It can be said that in the absence of frank AIDS (CD4 Lymphocyte count of 200 or less) the HIV infected transsexual can undergo reassignment surgery with little more likelihood of adverse results than their uninfected peers. Providing universal precautions are undertaken and everybody in the operating team and postoperative care team understand the situation there should be no needle sticks or infected blood spillage. This report focuses on the author’s experience with performing sex reassignment surgery for 10 male-to-female transsexuals.

Legal policy in varying degrees favorably recognizing transsexualism, in common law countries, has rested upon a classical medical model which apparently has recently lost substantial support and has become much more diffuse. Special legal provisions concerning transsexualism may now be challenged: (1) as lacking a sound and persuasive rationale; (2) as making unfair distinctions among persons with nonstandard gender or sex identities who do, or do not, take various particular steps along a now disputed medical route toward personal adjustment. Although perhaps valuable in other ways, the current ferment of criticism here called transgender liberationism has not provided us with viable legal policy suggestions. The paper argues that, as we reexamine this area, a legal policy which does not attempt to make special provisions for transsexualism (no special legal recognition) deserves further serious consideration, as the least harmful and fairest policy in the long run.

Continuing contact between transsexual parents and their children has met with significant opposition. Two areas of concern are effects on the gender identity of the children and reactions by the children’s peer group. Eighteen children, 10 boys, 8 girls of 9 transsexual parents, have been evaluated. Their ages range from 5-16 years. All live with or have regular contact with their transsexual parent. No child has gender identity disorder. No child has had extensive conflict with the peer group. All continue positive relationships with their transsexual parent.

Although sex reassignment surgery (SRS) is an effective treatment method with largely successful results, clinicians occasionally come across persons who regret their decision to undergo SRS. This regret can be inferred from their overt behavior, such as a second social role reversal, or their statements that they regret the steps they have taken. However, their statements and behavior do not always correspond. By means of a semistructured interview, we have extensively interviewed 10 persons who reported feelings of regret or whose overt behavior indicated a significant degree of non-successful postoperative functioning, possibly associated with regret. It appeared that the majority of this group had a (very) late start of cross-dressing and serious psychological problems, which do not merely seem to be a result of their gender dysphoria, before requesting SRS.