True identity: Learning about sex reassignment surgery

Imagine feeling like you are in the wrong body - feeling so uncomfortable in your own skin, you are willing to drastically change your body, so that you can reflect your true identity.

Such was the case for Chaz Bono and Jenna Talackova. Recent headlines involving Bono and Talackova have people talking and wondering about transgendered individuals.

Bono, born Chastity, may have stunned the world when he announced he wanted to transition from female to male. The only daughter of singing duo Sonny and Cher competed on “Dancing With the Stars” as a male.

Talackova, a transgender model from Canada, was originally ousted from the Miss Universe competition earlier this year, sparking controversy – until the Miss Universe Organization finally cleared her to compete, as long as she met certain gender recognition requirements.

Dr. Manny Alvarez, senior managing health editor of, sat down with Dr. Sherman Leis, founder of the Philadelphia Center for Transgender Surgery, to learn more about people living with gender identity disorder.

“Gender identity disorder is also transsexualism,” Leis told Alvarez. “It’s basically when the brain is one gender and the body is that of the opposite.”

Leis cleared up what he said was a common misconception, by noting that transsexualism has nothing to do with being gay or lesbian, as a gay person does not want to necessarily change their gender. Bono has acknowledged he first thought he was a lesbian before realizing he was transgender.

Leis said there are anatomic studies to prove this –- like the one done by University of Amsterdam, which found in the average male, the brain’s bed nucleus is one size and shape, but in a transsexual male, the bed nucleus is the same size as that of a female.

“And probably vice versa, although that wasn’t part of the study,” Leis said.

'For as long as I can remember'
Leis said he asks every patient how long he or she has felt different – and they all answer, ‘For as long as I can remember.’ Usually the patient begins to notice something is different around 3 or 4 years old – and maybe they can’t identify exactly what the difference is, but once they reach puberty and start reading and hearing stories, they put it together. Talackova, who was born a male, has said she realized something was different around the age of 4.

“And it’s very frustrating (for them),” Leis said.

At the start of transition, Leis said, from becoming a male to female, or female to male, the patient should receive counseling and go through psychological testing. It’s vital the person sees a mental health specialist who is trained in gender identity issues, because the average physician may not know what is going on in the transgendered world. In order to go through with sex reassignment surgery, Leis requires the patient have recommendation letters from two different mental health specialists.

Next, after the patient has established a relationship with a mental health specialist, he or she needs to visit an endocrinologist to start hormone therapy. Finally, the patient can see a surgeon, like Leis, to discuss what surgical options are available.

Leis said he performs at least six surgeries a week – ranging from facial feminization procedures, to breast reduction or augmentation, to genital reassignment surgeries.

“Rarely do we do female-to-male procedures, because once they start taking hormones, and develop a beard, cut their hair short and wear men’s clothing, they look masculine,” he said.

“But on other hand, men who are tall, have a big nose, long upper lip, heavy bones of the forehead, a big Adam’s apple, with a square jaw and square chin . . . it’s hard to look feminine,” Leis added.

Transsexual surgery started in the 1950s and 60s, Leis said, and the techniques are being refined every day.

Unfortunately, transsexuals have a high rate of depression, Leis said.

“These people have very frustrating lives; they are confused in the beginning as to who they are,” he added.

According to Leis,  70 percent of transgendered people contemplate suicide, and 40 percent actually attempt it. After the person has transitioned, the rates drop much lower to just a bit higher than the average population.

“I like them to follow up with a mental health counselor or therapist,” Leis said. “But many people are so happy that they finally found themselves, they throw away the antidepressants.”