From Bruce to Caitlyn Jenner: What gender reassignment entails

The dramatic changes Bruce Jenner underwent to become Caitlyn Jenner are featured on this month’s cover of “Vanity Fair,” helping to shed a great deal of light on the gender reassignment process and surgery. Just four hours after emerging on Twitter, Jenner’s account became the fastest to reach one million followers, breaking a record previously held by President Obama.

Jenner’s reemergence as Caitlyn and her subsequent popularity on social media is also helping to raise awareness about transsexualism at a crucial time where the attempted-suicide rate in the transgender community stands at 41 percent, according to a 2014 Williams Institute study. While these numbers show that the mental impact is substantial, whether transsexualism will continue to be considered a mental illness by the International Classification (ICD) and the Diagnostic and Statistical Manual of Mental Disease (DSM) remains to be seen. Dr. Jack Drescher, a New York City-based psychiatrist with extensive experience in the field of gender told that much like homosexuality, which was once considered a “mental illness,” transsexualism may soon be considered a “condition related to sexual health,” and labeled “gender incongruence.” The change is meant to remove the stigma associated with transsexualism.

Dr. Jeffrey Spiegel, a board-certified facial plastic surgeon and RealSelf advisor, told that those who are transsexual “have a disorder where they have a disconnect from what they feel to what they see.” Spiegel added that while “no one wants to be transgender,” there is a process that can help.

Therapy can help a transgendered person understand the feelings that they are experiencing and help them to begin to understand why as a physical male, they feel like a woman, but see a man in the mirror, or vice versa. Transsexuals may also consider gender reassignment surgery to help feel more true to themselves.

“There is no treatment that makes a person’s brain match their external appearance, but they can make their external appearance match their internal feelings,” Spiegel said.

“Transsexuals want to be seen as the gender they feel inside,” Spiegel said, but there is a process that comes before surgery. Spiegel said that based on his experience, many of his patients usually begin with therapy to discuss their reasons and motivations, then consider hormone therapy and lifestyle changes before they decide to go under the knife.

The hormonal therapy for male-to-female transformation helps develop breasts and changes hair patterns. The hormones can also redistribute fat, creating a more feminine body. Spiegel said that for male-to-female transsexuals it’s a boost mentally because it gives the patient a peace of mind that they are proactively fixing a struggle they have been living with their entire lives.

The first surgical changes most go under is facial feminizing procedures which, according to Siegal, is likely the most important.

“The face says a lot,” Spiegel said, adding that the it’s the first thing that others see and is often your identity, which is probably the reason many transsexuals stop at facial reconstruction instead of going through with a full-genital reassignment surgery. For many transsexuals, Spiegel said facial change alone will fulfill their need to be treated as the gender they feel.

The complicated process of facial feminizing involves multiple surgeries with varied recovery times. The process can include everything from reshaping the entire skull to changing the pitch of the person’s voice, according to Spiegel.

Spiegel warned that while patients may come out of surgery looking fantastic, it is not a cure all. “They may still carry their old insecurities and it takes a while to change their mindset,” Spiegel said, likening the process to people who have had weight reduction surgeries but continue to see themselves as overweight after the procedure.

Surgery is an option for some transsexuals, but Spiegel noted that others who may have already settled down with a family or into a career may be more hesitant. “Either way, it’s a difficult process,” he said.

While results vary depending on each patient’s goals and needs, Spiegel said even a small step toward providing relief for a patient is a positive one.

“Anytime you can help a person live a happier, more complete life – it’s better,” he said.