Challenges in the diagnosis and treatment of transsexualism in contemporary China

A full-text Chinese translation will be available at www.saponline.org from April 15, 2014. According to the International Classification of Diseases 10 Edition (ICD-10), transsexualism refers to the condition where an individual desires to live and to be accepted as someone of the gender which is opposite their biological sex. It is usually accompanied with discomfort or distress about their anatomic sex. In some cases, individuals with this condition modify their body features using laser or plastic surgeries to resemble the physical characteristics of their preferred gender. To meet the diagnostic criteria for transsexualism the condition should: (a) have lasted for at least two years; (b) not be due to other mental disorders, (e.g., schizophrenia); and (c) occur in an individual who is not intersexual and does not have other genetic mutations or chromosomal changes. Based on data from other countries, the reported prevalence of transsexualism is 1 to 2 per 100,000 people and the male to female ratio is 3:1. Due to high levels of stigma against this condition, prior to the 1990s very few individuals in China had sought treatment for transsexualism. More recently there has been a dramatic change in the situation. Over 100,000 individuals have requested sex change operations and more than 1000 have completed sex reassignment surgeries. For individuals with the condition, sex reassignment surgery can significantly improve their quality of life. However, the surgery is invasive and irreversible. Sex organ transplantation – which does not give the individual the capacity to function reproductively – usually requires the subsequent long-term use of immunosuppressants, which can adversely affect quality of life. And the concomitant long-term use of external sex hormones is associated with serious side effects including high blood viscosity, elevated levels of blood lipids, weight gain, diabetes, prolactinemia, cholelithiasis, and liver tumors. Given the high prevalence of certain personality traits among these individuals and the unique challenges of the surgery and of the long-term followup of the surgery, serious psychological problems may occur if pre-surgery preparation is insufficient. Some individuals who have the operation are not able to transition to post-operation life smoothly because the new challenges exacerbate pre-existing psychological problems.