health

Treatment focuses on resolving the specific complaint of
patients with pathophysiological sexual disorder. Two well-known treatments
are hormonal replacement therapy and sex reassignment surgery.
Hormone replacement therapy involves prescribing synthetic hormones
to imitate the effects of the normal hormonal levels. For men the synthetic
hormone replaces testosterone; for women, the synthetic hormone
replaces estrogen. For men and women, this treatment is fairly effective,
but not without complications. Testosterone replacement in men is associated
with liver disorders. Estrogen replacement in women contributes
to higher risks of breast cancer.
Through much of the 20th century, doctors recommended sex reassignment
operations at an early age, based on the assumption that young children
can adapt to the reassigned sex and experience little trauma and discontinuity
in development. Advocates also felt that early reassignment increased the
effectiveness of parent/child bonding as the parents would know to treat the
child as a member of the reassigned sex. The child would grow up knowing
to accept the gender role of the reassigned sex. For this to be effective, the
parents had to be strong in their decision from the start and had to continue
with that decision through consistent behavior for the rest of the child’s life.
Arguing for the contrary point of view is the case of David Reimer.
David lived a traumatic childhood, partly because he thought he was a
girl but did not feel like a girl. Once David found out that he was born
male, he changed his life to live as a man, but he was unhappy and died
early as a suicide. The Reimer case led to more criticism of early surgical
sex reassignment for ambiguous genitalia and other physiological conditions
of intersex. Critics point out that structural changes made surgically
do not affect genetic composition.
Many serious studies of sex reassignment have found that most of the
affected people do not adjust well. As much as possible, these individuals
should be recognized by their chromosomal gender. If the chromosomal
gender is clearly identified, minor operations may be done to reduce genital
abnormalities. Also, if the sexual disorder is influenced by hormonal
deficiencies, the doctor may recommend hormone treatments. If gender
clarification surgery is necessary later in life, it should be at a time when
affected individuals can have a voice in the decision making.