Editor's note

To most psychiatrists the phenomenon of gender identity is a mystery at the edges of their consciousness. This is not surprising, for the conditions subsuming it are rare, and not specifically associated with other psychopathology. The people who have these conditions are now getting increasingly well informed and therefore funnel towards clinics that specialize in the management of these conditions, which often require surgical intervention and close liaison between medical disciplines. This chapter shows a great deal has been learnt in the 40 years since this group first attracted real attention, and the evidence, although limited, indicates the value of intervention.

Note: throughout this chapter the terms ‘male’ and ‘female’ refer to sex assigned at birth.

Introduction

Disorders of gender identity have probably always existed, inside and outside Europe (Vietnam, in the case described by Heiman et al., 1975), and as demonstrated in the nineteenth century historical study by Ball et al. (1978). It seems that incidence of transsexualism is very roughly one in 60 000 males and one in every 100 000 females and seems to have remained constant (Landen et al., 1996). These disorders did not come to the attention of psychiatric services, though, until 1966, when Dr Harry Benjamin (then just retired) started to see people with disorders of gender identity in the USA.

From the early 1950s, there were attempts to offer some sort of gender reassignment surgery to people with disorders of gender identity, with some of these cases gaining wider public attention.