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Please help <a class="external text" href="//web.archive.org/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&action=edit">improve this article</a> by adding citations to <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources" title="Wikipedia:Identifying reliable sources">reliable sources</a>. Unsourced material may be <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Template:Citation_needed" title="Template:Citation needed">challenged</a> and <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Wikipedia:Verifiability#Burden_of_evidence" title="Wikipedia:Verifiability">removed</a>. <small><i>(February 2009)</i></small></td> </tr> </table> <table class="infobox" style="width:17.0em; margin:0 0 0.5em 1.0em; font-size:95%; text-align:center;"> <tr> <th style="font-size:125%;"><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transgender" title="Transgender">Transgender</a> topics</th> </tr> <tr> <th style="background:#E6E6FA;"><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Gender_identity" title="Gender identity">Identities</a></th> </tr> <tr> <td><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Androgyny" title="Androgyny">Androgyne</a> <span style="font-weight:bold;">·</span> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Genderqueer" title="Genderqueer">Genderqueer</a><br/> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Hijra_(South_Asia)" title="Hijra (South Asia)">Hijra</a> <span style="font-weight:bold;">·</span> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Sex_and/or_gender_diverse" title="Sex and/or gender diverse">Sex and/or gender diverse</a> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Third_gender" title="Third gender">Third gender / Third sex</a><br/> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transgender" title="Transgender">Transgender</a> <span style="font-weight:bold;">·</span> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Trans_man" title="Trans man">Trans man</a><br/> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Trans_woman" title="Trans woman">Trans woman</a> <span style="font-weight:bold;">·</span> <a 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href="/web/20120513072327/http://en.wikipedia.org/wiki/Intersex" title="Intersex">Intersexuality</a> <span style="font-weight:bold;">·</span> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Questioning_(sexuality_and_gender)" title="Questioning (sexuality and gender)">Questioning</a><br/> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transsexualism" title="Transsexualism">Transsexualism</a><br/> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Gender_identity_disorder" title="Gender identity disorder">Gender identity disorder</a><br/> (<a href="/web/20120513072327/http://en.wikipedia.org/wiki/List_of_transgender-related_topics" title="List of transgender-related topics">more</a>)</td> </tr> <tr> <th style="background:#E6E6FA;">Attitudes</th> </tr> <tr> <td><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transphobia" title="Transphobia">Transphobia</a><br/> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Androphilia_and_gynephilia" title="Androphilia and gynephilia">Androphilia and gynephilia</a></td> </tr> <tr> <th style="background:#E6E6FA;"><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Legal_aspects_of_transsexualism" title="Legal aspects of transsexualism">Legal issues</a></th> </tr> <tr> <td><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Legal_aspects_of_transsexualism" title="Legal aspects of transsexualism">Legal aspects of transsexualism</a><br/> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Gender-neutral_toilet" title="Gender-neutral toilet">Gender-neutral toilets</a></td> </tr> <tr> <th style="background:#E6E6FA;">Lists</th> </tr> <tr> <td><a href="/web/20120513072327/http://en.wikipedia.org/wiki/List_of_lesbian,_gay,_bisexual_or_transgender-related_films" title="List of lesbian, gay, bisexual or transgender-related films">LGBT-related films</a><br/> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/List_of_transgender_people" title="List of transgender people">People</a> <span style="font-weight:bold;">·</span> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/List_of_transgender-related_topics" title="List of transgender-related topics">Topics</a></td> </tr> <tr> <th style="background:#E6E6FA;"><a href="/web/20120513072327/http://en.wikipedia.org/wiki/List_of_transgender-related_topics" title="List of transgender-related topics">List of transgender-related topics</a> <span style="font-weight:bold;">·</span> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Portal:Transgender" title="Portal:Transgender">Transgender portal</a></th> </tr> <tr> <td> <div class="noprint plainlinks hlist navbar" style=""> <ul> <li class="nv-view"><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Template:Transgender_sidebar" title="Template:Transgender sidebar"><span title="View this template" style="">view</span></a></li> <li class="nv-talk"><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Template_talk:Transgender_sidebar" title="Template talk:Transgender sidebar" class="mw-redirect"><span title="Discuss this template" style="">talk</span></a></li> <li class="nv-edit"><a class="external text" href="//web.archive.org/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Template:Transgender_sidebar&action=edit"><span title="Edit this template" style="">edit</span></a></li> </ul> </div> </td> </tr> </table> <p><b>Sex reassignment surgery</b> (initialized as <b>SRS</b>; also known as <b>gender reassignment surgery</b>, <b>genital reconstruction surgery</b>, <b>sex affirmation surgery</b>, <b>sex realignment surgery</b> or <b>sex-change operation</b>) is a term for the <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Surgical" title="Surgical" class="mw-redirect">surgical</a> procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble that of the other <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Sex" title="Sex">sex</a>. It is part of a treatment for <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Gender_identity_disorder" title="Gender identity disorder">gender identity disorder</a>/gender dysphoria in <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transsexual" title="Transsexual" class="mw-redirect">transsexual</a> and <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transgender" title="Transgender">transgender</a> people. It may also be performed on <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Intersex" title="Intersex">intersex</a> people, often in infancy and without their consent.</p> <p>Other terms for SRS include <i>sex reconstruction surgery,</i> <i>gender confirmation surgery,</i> and more clinical terms, such as <i>feminizing genitoplasty</i> or <i>penectomy, orchidectomy and <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Vaginoplasty" title="Vaginoplasty">vaginoplasty</a></i> are used medically for trans women, with <i>masculinizing genitoplasty</i> often similarly used for trans men.</p> <p>People who pursue sex reassignment surgery are usually referred to as <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transsexual" title="Transsexual" class="mw-redirect">transsexual</a>; "trans" - across, through, change; "sexual" - pertaining to the sexual <a href="//web.archive.org/web/20120513072327/http://en.wiktionary.org/wiki/characteristic" class="extiw" title="wikt:characteristic">characteristics</a> (not sexual actions) of a person. More recently, people pursuing SRS often identify as <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transgender" title="Transgender">transgender</a> instead of transsexual.</p> <table id="toc" class="toc"> <tr> <td> <div id="toctitle"> <h2>Contents</h2> </div> <ul> <li class="toclevel-1 tocsection-1"><a href="#Scope_and_procedures"><span class="tocnumber">1</span> <span class="toctext">Scope and procedures</span></a></li> <li class="toclevel-1 tocsection-2"><a href="#Differences_between_trans_women_and_trans_men_SRS"><span class="tocnumber">2</span> <span class="toctext">Differences between trans women and trans men SRS</span></a></li> <li class="toclevel-1 tocsection-3"><a href="#Medical_considerations"><span class="tocnumber">3</span> <span class="toctext">Medical considerations</span></a></li> <li class="toclevel-1 tocsection-4"><a href="#Potential_future_advances"><span class="tocnumber">4</span> <span class="toctext">Potential future advances</span></a></li> <li class="toclevel-1 tocsection-5"><a href="#Standards_of_care"><span class="tocnumber">5</span> <span class="toctext">Standards of care</span></a></li> <li class="toclevel-1 tocsection-6"><a href="#History"><span class="tocnumber">6</span> <span class="toctext">History</span></a></li> <li class="toclevel-1 tocsection-7"><a href="#See_also"><span class="tocnumber">7</span> <span class="toctext">See also</span></a></li> <li class="toclevel-1 tocsection-8"><a href="#References"><span class="tocnumber">8</span> <span class="toctext">References</span></a></li> </ul> </td> </tr> </table> <h2><span class="editsection">[<a href="/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&action=edit&section=1" title="Edit section: Scope and procedures">edit</a>]</span> <span class="mw-headline" id="Scope_and_procedures">Scope and procedures</span></h2> <p>The best known of these surgeries are those that reshape the genitals, which are also known as <i>genital reassignment surgery</i> or <i>genital reconstruction surgery</i> (GRS). However, the meaning of "sex reassignment surgery" has been clarified by the medical subspecialty organization, the <a href="/web/20120513072327/http://en.wikipedia.org/wiki/World_Professional_Association_for_Transgender_Health" title="World Professional Association for Transgender Health">World Professional Association for Transgender Health</a> (WPATH), to include any of a larger number of surgical procedures performed as part of a medical treatment for "gender dysphoria", "transsexualism" or "gender identity disorder". According to WPATH, medically necessary sex reassignment surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation [...] including breast prostheses if necessary, genital reconstruction (by various techniques which must be appropriate to each patient[...])[...] and certain facial plastic reconstruction."<sup id="cite_ref-0" class="reference"><a href="#cite_note-0"><span>[</span>1<span>]</span></a></sup> In addition, other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial electrolysis.</p> <p>A growing number of public and commercial health insurance plans in the United States now contain defined benefits covering sex reassignment-related procedures, usually including genital reconstruction surgery (MTF and FTM), chest reconstruction (FTM), breast augmentation (MTF), and hysterectomy (FTM).<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span>[</span>2<span>]</span></a></sup> In June 2008, the American Medical Association House of Delegates declared that discrimination,<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span>[</span>3<span>]</span></a></sup> stating that the denial to patients with Gender Identity Disorder of otherwise covered benefits represents discrimination, and that the AMA supports "public and private health insurance coverage for treatment for gender identity disorder as recommended by the patient's physician." Other organizations have issued similar statements, including WPATH,<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span>[</span>4<span>]</span></a></sup> the American Psychological Association,<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span>[</span>5<span>]</span></a></sup> and the National Association of Social Workers.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span>[</span>6<span>]</span></a></sup></p> <h2><span class="editsection">[<a href="/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&action=edit&section=2" title="Edit section: Differences between trans women and trans men SRS">edit</a>]</span> <span class="mw-headline" id="Differences_between_trans_women_and_trans_men_SRS">Differences between trans women and trans men SRS</span></h2> <p>The array of medically necessary surgeries differs for <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Trans_women" title="Trans women" class="mw-redirect">trans women</a> (male to female) rather than <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Trans_men" title="Trans men" class="mw-redirect">trans men</a> (female to male). For trans women, genital reconstruction usually involves the <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Vaginoplasty" title="Vaginoplasty">surgical construction of a vagina</a>, whereas in the case of trans men, genital reconstruction may involve construction of a penis through either <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Phalloplasty" title="Phalloplasty">phalloplasty</a> or <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Metoidioplasty" title="Metoidioplasty">metoidioplasty</a>. In both cases, for trans women and trans men, genital surgery may also involve other medically necessary ancillary procedures, such as <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Orchiectomy" title="Orchiectomy" class="mw-redirect">orchiectomy</a> or <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Vaginectomy" title="Vaginectomy">vaginectomy</a>.</p> <p>As underscored by WPATH, a medically-assisted transition from one sex to another may entail any of a variety of non-genital surgical procedures, any of which are considered "sex reassignment surgery" when performed as part of treatment for transsexualism. For trans men these may include <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Mastectomy" title="Mastectomy">mastectomy</a> (removal of the female breasts) and chest reconstruction (the shaping of a male-contoured chest), or <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Hysterectomy" title="Hysterectomy">hysterectomy</a> and bilateral <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Oophorectomy" title="Oophorectomy">salpingo-oophorectomy</a>. For some trans women, <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Facial_feminization_surgery" title="Facial feminization surgery">facial feminization surgery</a> and <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Breast_augmentation" title="Breast augmentation">breast augmentation</a> are also medically necessary components of their surgical treatment.</p> <h2><span class="editsection">[<a href="/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&action=edit&section=3" title="Edit section: Medical considerations">edit</a>]</span> <span class="mw-headline" id="Medical_considerations">Medical considerations</span></h2> <p>People with <a href="/web/20120513072327/http://en.wikipedia.org/wiki/HIV" title="HIV">HIV</a> or <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Hepatitis_C" title="Hepatitis C">hepatitis C</a> may have difficulty finding a surgeon able or willing to perform surgery. Many surgeons operate out of small private clinics that cannot adequately treat potential complications in these populations. Some surgeons charge higher fees for HIV- and hepatitis C-positive patients; other medical professionals assert that it is unethical to deny surgical or hormonal treatments to transsexuals solely on the basis of their HIV or hepatitis status.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span>[</span>7<span>]</span></a></sup></p> <p>Other health conditions such as <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Diabetes" title="Diabetes" class="mw-redirect">diabetes</a>, <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Blood_clotting#Disorders_of_hemostasis" title="Blood clotting" class="mw-redirect">abnormal blood clotting</a>, and <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Obesity" title="Obesity">obesity</a> do not usually present a problem to experienced surgeons. The conditions do increase the <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Anesthetic" title="Anesthetic">anesthetic</a> risk and the rate of post-operative complications. Surgeons may require overweight patients to reduce their weight before surgery and smoking patients to refrain from <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Tobacco_smoking" title="Tobacco smoking">smoking</a> before and after surgery. Surgeons commonly stipulate the latter regardless of the type of operation.</p> <h2><span class="editsection">[<a href="/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&action=edit&section=4" title="Edit section: Potential future advances">edit</a>]</span> <span class="mw-headline" id="Potential_future_advances">Potential future advances</span></h2> <div class="rellink boilerplate seealso">See also: <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Uterus_transplantation#Application_on_transgendered_women" title="Uterus transplantation">Uterus_transplantation#Application_on_transgendered_women</a></div> <p>Medical advances may eventually make childbearing possible by using a donor <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Uterus" title="Uterus">uterus</a> long enough to carry a child to term as <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Immunosuppressive_drug" title="Immunosuppressive drug">anti-rejection drugs</a> do not seem to affect the fetus.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span>[</span>8<span>]</span></a></sup><sup id="cite_ref-Fageeh2002_8-0" class="reference"><a href="#cite_note-Fageeh2002-8"><span>[</span>9<span>]</span></a></sup><sup id="cite_ref-Priore2007_9-0" class="reference"><a href="#cite_note-Priore2007-9"><span>[</span>10<span>]</span></a></sup><sup id="cite_ref-Nair2008_10-0" class="reference"><a href="#cite_note-Nair2008-10"><span>[</span>11<span>]</span></a></sup> The <a href="/web/20120513072327/http://en.wikipedia.org/wiki/DNA" title="DNA">DNA</a> in a donated <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Ovum" title="Ovum">ovum</a> can be removed and replaced with the DNA of the receiver. Further in the future <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Stem_cell" title="Stem cell">stem cell biotechnology</a> may also make this possible, with no need for anti-rejection drugs.</p> <h2><span class="editsection">[<a href="/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&action=edit&section=5" title="Edit section: Standards of care">edit</a>]</span> <span class="mw-headline" id="Standards_of_care">Standards of care</span></h2> <div class="rellink boilerplate seealso">See also: <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Legal_aspects_of_transsexualism" title="Legal aspects of transsexualism">Legal aspects of transsexualism</a></div> <p>Sex reassignment surgery can be difficult to obtain, due to a combination of financial barriers and lack of providers. An increasing number of surgeons are now training to perform such surgeries. In many regions, an individual's pursuit of SRS is often governed, or at least guided, by documents called <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Standards_of_Care_for_the_Health_of_Transsexual,_Transgender,_and_Gender_Nonconforming_People" title="Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People">Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People</a> (SOC). The most widespread SOC in this field is published and frequently revised by the <a href="/web/20120513072327/http://en.wikipedia.org/wiki/World_Professional_Association_for_Transgender_Health" title="World Professional Association for Transgender Health">World Professional Association for Transgender Health</a> (WPATH, formerly the Harry Benjamin International Gender Dysphoria Association or HBIGDA). Many jurisdictions and medical boards in the United States and other countries recognize the WPATH Standards of Care for the treatment of transsexualism. For many individuals, these may require a minimum duration of <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Psychological_evaluation" title="Psychological evaluation">psychological evaluation</a> and living as a member of the target gender full time, sometimes called the real life experience (RLE) (sometimes mistakenly referred to as the real life test (RLT)) before genital reconstruction or other sex reassignment surgeries are permitted.</p> <p>Standards of Care usually give certain very specific "minimum" requirements as guidelines for progressing with treatment for transsexualism, including accessing cross-gender hormone replacement or many surgical interventions. For this and many other reasons, both the WPATH-SOC and other SOCs are highly controversial and often maligned documents among transgender patients seeking surgery. Alternative local standards of care exist, such as in the Netherlands, Germany, and Italy. Much of the criticism surrounding the WPATH/HBIGDA-SOC applies to these as well, and some of these SOCs (mostly European SOC) are actually based on much older versions of the WPATH-SOC. Other SOCs are entirely independent of the WPATH. The criteria of many of those SOCs are stricter than the latest revision of the WPATH-SOC. Many qualified surgeons in North America and many in Europe adhere almost unswervingly to the WPATH-SOC or other SOCs. However, in the United States many experienced surgeons are able to apply the WPATH SOC in ways which respond to an individual's medical circumstances, as is consistent with the SOC.</p> <p>Many medical professionals and numerous professional associations have stated that surgical interventions should not be required in order for transsexual individuals to change sex designation on identity documents.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span>[</span>12<span>]</span></a></sup> However, depending on the legal requirements of many jurisdictions, <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transsexual" title="Transsexual" class="mw-redirect">transsexual</a> and <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Transgender" title="Transgender">transgender</a> people are often unable to change the listing of their sex in public records unless they can furnish a physician's letter attesting that sex reassignment surgery has been performed, in other instances legal gender change is prohibited even after genital or other surgery or treatment without recourse, while in other cases, such statutes may specify that genital surgery has been completed.</p> <h2><span class="editsection">[<a href="/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&action=edit&section=6" title="Edit section: History">edit</a>]</span> <span class="mw-headline" id="History">History</span></h2> <p>The earliest identified recipient of male to female sex reassignment surgery was 'Rudolf (Dora-R),<sup id="cite_ref-Dora-R_12-0" class="reference"><a href="#cite_note-Dora-R-12"><span>[</span>13<span>]</span></a></sup> "He took the first step towards changing his sex in 1921, when he had himself castrated, As a result his sexual instinct was enfeebled, but the homosexual tendency, as well as his own feelings, remained the same. This step, however, was not sufficient for him, and he tried to obtain a still greater degree of femininity in his sexual parts. Finally, in 1930, the operation which he himself had attempted at the age of six was performed upon him, that is, the removal of his penis, and six months afterwards the transformation was completed by the grafting of an artificial vagina."</p> <p>This was followed by <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Lili_Elbe" title="Lili Elbe">Lili Elbe</a> in Berlin during 1930-1931. She started with the removal of the male sex organs, the operation(s) supervised by Dr. <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Magnus_Hirschfeld" title="Magnus Hirschfeld">Magnus Hirschfeld</a>. Lili went on to have four more subsequent operations that included an unsuccessful <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Uterus" title="Uterus">uterine</a> <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Organ_transplant" title="Organ transplant" class="mw-redirect">transplant</a>, the rejection of which resulted in death. An earlier known recipient of this was <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Magnus_Hirschfeld" title="Magnus Hirschfeld">Magnus Hirschfeld</a>'s <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Housekeeper_(servant)" title="Housekeeper (servant)">housekeeper</a>,<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span>[</span>14<span>]</span></a></sup> but her identity is unclear at this time.</p> <p>Filmmaker <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Tanaz_Eshaghian" title="Tanaz Eshaghian">Tanaz Eshaghian</a> discovered that the Iranian government's "solution" for homosexuality is to endorse, and fully pay for, sex reassignment surgery.<sup id="cite_ref-SexChange_14-0" class="reference"><a href="#cite_note-SexChange-14"><span>[</span>15<span>]</span></a></sup> The leader of Iran's <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Islamic_Revolution" title="Islamic Revolution" class="mw-redirect">Islamic Revolution</a>, <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Ayatollah_Ruhollah_Khomeini" title="Ayatollah Ruhollah Khomeini" class="mw-redirect">Ayatollah Ruhollah Khomeini</a>, issued a <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Fatwa" title="Fatwa" class="mw-redirect">fatwa</a> declaring sex reassignment surgery permissible for "diagnosed transsexuals."<sup id="cite_ref-SexChange_14-1" class="reference"><a href="#cite_note-SexChange-14"><span>[</span>15<span>]</span></a></sup> Eshaghian's documentary, <i><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Be_Like_Others" title="Be Like Others">Be Like Others</a></i>, chronicles a number of stories of <a href="/web/20120513072327/http://en.wikipedia.org/wiki/LGBT_rights_in_Iran" title="LGBT rights in Iran">Iranian gay men</a> who feel transitioning is the only way to avoid further persecution, jail and/or execution.<sup id="cite_ref-SexChange_14-2" class="reference"><a href="#cite_note-SexChange-14"><span>[</span>15<span>]</span></a></sup> The head of Iran's main transsexual organization, <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Maryam_Khatoon_Molkara" title="Maryam Khatoon Molkara">Maryam Khatoon Molkara</a>—who convinced Khomeini to issue the fatwa on transsexuality—confirmed that some people who undergo operations are gay rather than transsexual.<sup id="cite_ref-Guardian_15-0" class="reference"><a href="#cite_note-Guardian-15"><span>[</span>16<span>]</span></a></sup></p> <p><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Kathoey" title="Kathoey">Thailand</a> performs the most sex reassignment surgeries, followed by <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Iran" title="Iran">Iran</a>.<sup id="cite_ref-Guardian_15-1" class="reference"><a href="#cite_note-Guardian-15"><span>[</span>16<span>]</span></a></sup></p> <p>On June 12 2003, <a href="/web/20120513072327/http://en.wikipedia.org/wiki/European_Court_of_Human_Rights" title="European Court of Human Rights">European Court of Human Rights</a> judged human rights violation for Van Kück, a German transsexual woman to be refused the pay for gender reassignment surgery as well as <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Hormone_replacement_therapy_(male-to-female)" title="Hormone replacement therapy (male-to-female)">hormone replacement therapy</a> relating the <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Article_6_of_the_European_Convention_on_Human_Rights" title="Article 6 of the European Convention on Human Rights">Article 6 of the European Convention on Human Rights</a> as well as the <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Article_8_of_the_European_Convention_on_Human_Rights" title="Article 8 of the European Convention on Human Rights">Article 8</a>. This affair is called "<b>Van Kück vs Germany</b>"<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span>[</span>17<span>]</span></a></sup></p> <h2><span class="editsection">[<a href="/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&action=edit&section=7" title="Edit section: See also">edit</a>]</span> <span class="mw-headline" id="See_also">See also</span></h2> <ul> <li><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Baptist_Medical_Center_sex_reassignment_surgery_controversy" title="Baptist Medical Center sex reassignment surgery controversy">Baptist Medical Center sex reassignment surgery controversy</a></li> <li><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Reproductive_health" title="Reproductive health">Reproductive health</a></li> <li><a href="/web/20120513072327/http://en.wikipedia.org/wiki/The_Yogyakarta_Principles" title="The Yogyakarta Principles" class="mw-redirect">The Yogyakarta Principles</a></li> <li><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Healthcare_and_the_LGBT_community" title="Healthcare and the LGBT community">Healthcare and the LGBT community</a></li> </ul> <h2><span class="editsection">[<a href="/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&action=edit&section=8" title="Edit section: References">edit</a>]</span> <span class="mw-headline" id="References">References</span></h2> <div class="reflist" style="list-style-type: decimal;"> <ol class="references"> <li id="cite_note-0"><span class="mw-cite-backlink"><b><a href="#cite_ref-0">^</a></b></span> <span class="reference-text">see WPATH "Clarification on Medical Necessity of Treatment, sex Reassignment, and Insurance Coverage in the U.S." available at: <a rel="nofollow" class="external free" href="https://web.archive.org/web/20120513072327/http://www.wpath.org/documents/Med%20Nec%20on%202008%20Letterhead.pdf">http://www.wpath.org/documents/Med%20Nec%20on%202008%20Letterhead.pdf</a></span></li> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text">See discussion of insurance exclusions at: <a rel="nofollow" class="external free" href="https://web.archive.org/web/20120513072327/http://www.hrc.org/issues/transgender/9568.htm">http://www.hrc.org/issues/transgender/9568.htm</a></span></li> <li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text">AMA Resolution 122 "Removing Financial Barriers to Care for Transgender Patients". see: <a rel="nofollow" class="external free" href="https://web.archive.org/web/20120513072327/http://www.ama-assn.org/ama1/pub/upload/mm/15/digest_of_actions.pdf">http://www.ama-assn.org/ama1/pub/upload/mm/15/digest_of_actions.pdf</a></span></li> <li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text">See WPATH Clarification Statement</span></li> <li id="cite_note-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-4">^</a></b></span> <span class="reference-text">APA Policy Statement Transgender, Gender Identity, and Gender Expression Non-Discrimination. See online at: <a rel="nofollow" class="external free" href="https://web.archive.org/web/20120513072327/http://www.apa.org/pi/lgbc/policy/transgender.pdf">http://www.apa.org/pi/lgbc/policy/transgender.pdf</a></span></li> <li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text">NASW Policy Statement on Transgender and Gender Identity Issues, revised August 2008. See www.socialworkers.org</span></li> <li id="cite_note-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-6">^</a></b></span> <span class="reference-text">See WPATH Standards of Care, also WPATH Clarification. www.wpath.org</span></li> <li id="cite_note-7"><span class="mw-cite-backlink"><b><a href="#cite_ref-7">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20120513072327/http://www.saukvalley.com/articles/2007/01/23/features/health_and_medical/288035642038177.txt">Doctors plan uterus transplants to help women with removed, damaged wombs have babies</a> - Associated Press</span></li> <li id="cite_note-Fageeh2002-8"><span class="mw-cite-backlink"><b><a href="#cite_ref-Fageeh2002_8-0">^</a></b></span> <span class="reference-text"><span class="citation Journal">Fageeh W, Raffa H et al. (March 2002). "Transplantation of the human uterus". <i>International Journal of Gynaecology and Obstetrics</i> <b>76</b> (3): 245–51. <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="https://web.archive.org/web/20120513072327/http://dx.doi.org/10.1016%2FS0020-7292%2801%2900597-5">10.1016/S0020-7292(01)00597-5</a>. <a href="/web/20120513072327/http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier" class="mw-redirect">PMID</a> <a rel="nofollow" class="external text" href="//web.archive.org/web/20120513072327/http://www.ncbi.nlm.nih.gov/pubmed/11880127">11880127</a>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Transplantation+of+the+human+uterus&rft.jtitle=International+Journal+of+Gynaecology+and+Obstetrics&rft.aulast=Fageeh+W%2C+Raffa+H+et+al.&rft.au=Fageeh+W%2C+Raffa+H+et+al.&rft.date=March+2002&rft.volume=76&rft.issue=3&rft.pages=245%E2%80%9351&rft_id=info:doi/10.1016%2FS0020-7292%2801%2900597-5&rft_id=info:pmid/11880127&rfr_id=info:sid/en.wikipedia.org:Sex_reassignment_surgery"><span style="display: none;"> </span></span></span></li> <li id="cite_note-Priore2007-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-Priore2007_9-0">^</a></b></span> <span class="reference-text"><span class="citation Journal">Del Priore G, Stega J et al. (January 2007). "Human uterus retrieval from a multi-organ donor". <i>Obstetrics and Gynecology</i> <b>109</b> (1): 101–4. <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="https://web.archive.org/web/20120513072327/http://dx.doi.org/10.1097%2F01.AOG.0000248535.58004.2f">10.1097/01.AOG.0000248535.58004.2f</a>. <a href="/web/20120513072327/http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier" class="mw-redirect">PMID</a> <a rel="nofollow" class="external text" href="//web.archive.org/web/20120513072327/http://www.ncbi.nlm.nih.gov/pubmed/17197594">17197594</a>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Human+uterus+retrieval+from+a+multi-organ+donor&rft.jtitle=Obstetrics+and+Gynecology&rft.aulast=Del+Priore+G%2C+Stega+J+et+al.&rft.au=Del+Priore+G%2C+Stega+J+et+al.&rft.date=January+2007&rft.volume=109&rft.issue=1&rft.pages=101%E2%80%934&rft_id=info:doi/10.1097%2F01.AOG.0000248535.58004.2f&rft_id=info:pmid/17197594&rfr_id=info:sid/en.wikipedia.org:Sex_reassignment_surgery"><span style="display: none;"> </span></span></span></li> <li id="cite_note-Nair2008-10"><span class="mw-cite-backlink"><b><a href="#cite_ref-Nair2008_10-0">^</a></b></span> <span class="reference-text"><span class="citation Journal">Nair A, Stega J et al. (April 2008). "Uterus Transplant: Evidence and Ethics". <i>Annals of the New York Academy of Sciences</i> <b>1127</b> (1): 83–91. <a href="/web/20120513072327/http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="https://web.archive.org/web/20120513072327/http://dx.doi.org/10.1196%2Fannals.1434.003">10.1196/annals.1434.003</a>. <a href="/web/20120513072327/http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier" class="mw-redirect">PMID</a> <a rel="nofollow" class="external text" href="//web.archive.org/web/20120513072327/http://www.ncbi.nlm.nih.gov/pubmed/18443334">18443334</a>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Uterus+Transplant%3A+Evidence+and+Ethics&rft.jtitle=Annals+of+the+New+York+Academy+of+Sciences&rft.aulast=Nair+A%2C+Stega+J+et+al.&rft.au=Nair+A%2C+Stega+J+et+al.&rft.date=April+2008&rft.volume=1127&rft.issue=1&rft.pages=83%E2%80%9391&rft_id=info:doi/10.1196%2Fannals.1434.003&rft_id=info:pmid/18443334&rfr_id=info:sid/en.wikipedia.org:Sex_reassignment_surgery"><span style="display: none;"> </span></span></span></li> <li id="cite_note-11"><span class="mw-cite-backlink"><b><a href="#cite_ref-11">^</a></b></span> <span class="reference-text">See WPATH Clarification Statement, APA Policy Statement, and NASW Policy Statement</span></li> <li id="cite_note-Dora-R-12"><span class="mw-cite-backlink"><b><a href="#cite_ref-Dora-R_12-0">^</a></b></span> <span class="reference-text">Encyclopaedia of Sexual Knowledge by Norman Haire (1930), Encyclopaedic Press, London.<a rel="nofollow" class="external text" href="https://web.archive.org/web/20120513072327/http://www.transgenderzone.com/features/sex_change.htm">First Sex Change</a></span></li> <li id="cite_note-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-13">^</a></b></span> <span class="reference-text"><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Magnus_Hirschfeld" title="Magnus Hirschfeld">Magnus Hirschfeld</a>, <i>Zeitschrift für Sexualwissenschaft</i>, 1908</span></li> <li id="cite_note-SexChange-14"><span class="mw-cite-backlink">^ <a href="#cite_ref-SexChange_14-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-SexChange_14-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-SexChange_14-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20120513072327/http://www.cbc.ca/arts/film/story/2008/08/26/f-homosexuality-iran-sex-change.html">Iran's gay plan</a>, Matthew Hays, <i><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Canadian_Broadcasting_Corporation" title="Canadian Broadcasting Corporation">Canadian Broadcasting Corporation</a></i>, August 26, 2008; accessed September 20, 2008.</span></li> <li id="cite_note-Guardian-15"><span class="mw-cite-backlink">^ <a href="#cite_ref-Guardian_15-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Guardian_15-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20120513072327/http://www.guardian.co.uk/frontpage/story/0,,2177277,00.html">Sex change funding undermines no gays claim</a>, Robert Tait, <i><a href="/web/20120513072327/http://en.wikipedia.org/wiki/The_Guardian" title="The Guardian">The Guardian</a></i>, September 26, 2007; accessed September 20, 2008.</span></li> <li id="cite_note-16"><span class="mw-cite-backlink"><b><a href="#cite_ref-16">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20120513072327/http://www.menschenrechte.ac.at/orig/03_3/Kuck.pdf">The Case Van Kück vs Germany, June 12 2003</a></span></li> </ol> </div>   </div>   <div class="printfooter"> Retrieved from "<a href="https://web.archive.org/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&oldid=486548909">http://en.wikipedia.org/w/index.php?title=Sex_reassignment_surgery&oldid=486548909</a>" </div>   <div id="catlinks" class="catlinks"><div id="mw-normal-catlinks" class="mw-normal-catlinks"><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Special:Categories" title="Special:Categories">Categories</a>: <ul><li><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Category:Gender_transitioning" title="Category:Gender transitioning">Gender transitioning</a></li><li><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Category:Surgical_procedures" title="Category:Surgical procedures">Surgical procedures</a></li><li><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Category:Transgender_and_medicine" title="Category:Transgender and medicine">Transgender and medicine</a></li></ul></div><div id="mw-hidden-catlinks" class="mw-hidden-catlinks mw-hidden-cats-hidden">Hidden categories: <ul><li><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Category:Articles_needing_additional_references_from_February_2009" title="Category:Articles needing additional references from February 2009">Articles needing additional references from February 2009</a></li><li><a href="/web/20120513072327/http://en.wikipedia.org/wiki/Category:All_articles_needing_additional_references" title="Category:All articles needing additional references">All articles needing additional references</a></li></ul></div></div>  <div class="visualClear"></div>   </div>  </div>   <div id="mw-head" class="noprint">  <div id="p-personal" class=""> <h5>Personal tools</h5> <ul> <li id="pt-login"><a href="/web/20120513072327/http://en.wikipedia.org/w/index.php?title=Special:UserLogin&returnto=Sexual+reassignment+surgery" title="You are encouraged to log in; 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