Psychological Process of Changing Sex

Some people feel they were born the wrong sex and desire a sex change. Learn about the psychological aspects of changing sex, sex reassignment.

Defining Transexualism, Gender Identity Disorder

Transexualism is the condition that generally results in a desire for a person to "change their sex." In transexualism the person sees themselves as truly having been born "the wrong sex" -- ie, a man in a woman's body or vice versa. In the psychiatric manual DSM IV the transexualism is defined as:

  • A desire or insistence that one is of the opposite biological sex
  • Evidence of persistent discomfort with, and perceived inappropriateness of the individual's biological sex
  • The individual is not intersexed due to a biological condition
  • Evidence of clinically significant distress or impairment in work or social life.

At present, many professionals call the condition "gender identity disorder." It does not mean that the person is simply a "cross dresser" who dresses as the opposite sex due to psychological factors. Instead, these individuals have a feeling they are truly psychologically more of the opposite sex rather than their present physical sex. Transsexuals may be either heterosexual or homosexual after sex change treatment, but usually they prefer sex with members of the opposite sex than they are AFTER THEIR SEX CHANGE.

Psychological Evaluation Before Undergoing a Sex Change, Sex Reassignment

Not all transsexuals attempt to actually change their sex - many chose to live as the sex they were born; although they often have a sense of severe discomfort being of that sex throughout their lifetime. Others chose to undergo sex change (or sex reassignment treatment including the use of hormones, and ultimately sex reassignment surgery). Before getting to that point, however, most treatment programs require at least a year's worth of psychological evaluation or treatment.

Over the years, I have personally participated in such treatment. In fact, I helped with the sex reassignment program at my medical school when I was a psychiatric resident. I have evaluated many with the condition. The first step involves making certain that there are no other psychological or psychiatric co-existing conditions that cause severe distress for the person, and in some cases may be the true cause of the desire to change sex. Examples might be: schizophrenia, substance abuse, homosexuality that is not psychologically acceptable to the person, and borderline personality disorder.

Next in the psychological treatment is to determine the emotional stability of the person with Gender Identity Disorder. While many have experienced extreme emotional discomfort from having to appear as a member of the sex opposite of the one they believe themselves to be psychologically, it is important that there be basic emotional stability present before the medical procedures can begin.

Watch HealthyPlace TV Show on Psychology of Changing Sex

On our show, this Tuesday, August 11, our guest will be discussing her sex change and the psychological aspects behind it. You can watch it live (5:30p PT, 7:30 CT, 8:30 ET) and on-demand on our website.

Dr. Harry Croft is a Board-Certified Psychiatrist and Medical Director of Dr. Croft is also the co-host of the HealthyPlace TV Show.

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~ other mental health articles by Dr. Croft

APA Reference
(2009, August 2). Psychological Process of Changing Sex, HealthyPlace. Retrieved on 2024, July 16 from

Last Updated: January 14, 2014

Medically reviewed by Harry Croft, MD

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