Psychosocial characteristics of applicants evaluated for surgical gender reassignment

Social, sexual, economic, familial, and psychological characteristics of 764 applicants for surgical gender reassignment, 479 males and 285 females, who completed the application questionnaire and were subsequently interviewed by the Gender Dysphoria Program in Palo Alto, California, are examined. All information except diagnosis was obtained from the applicants' responses to a standardized 100-item questionnaire. Diagnosis was determined by a psychiatrist after a 1 1/2-hour interview. A comparison of male applicants to female applicants indicated differences in five areas: (1) sexual history; (2) acting-out behavior or sociopathy; (3) work history; (4) strategies for physically passing in the desired gender, e.g., hormone therapy; and (5) diagnosis. Females had experienced more stable same-sex sexual relationships and fewer opposite-sex sexual relationships than the males had experienced. The females exhibited less acting-out behavior, indicated by few criminal convictions and little involvement in prostitution, compared to the male applicants. Twice as many males as females were unemployed and receiving welfare at the time of application. In addition, males used cosmetic surgery and hormone therapy more frequently to facilitate physically passing in the desired gender than did the females. The most frequent diagnosis for males was transvestitism, while for the females it was classic transsexualism.