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Dr Russell Reid has been one of the United Kingdom's experts in the field of transsexualism. A consultant psychiatrist specialising in gender disorders, his work with the London Institute Of Human Sexuality has helped many find peace in their sexuality. He knows better than most what make a TG tick, and he shares the benefit of his experience with us. See also the tribute to Russell Reid
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Forum: What is the difference between a transvestite and a pre- operative transsexual?
Dr Reid: Well, pre-operative transsexual means a person who is in the middle stage of the sex change process. There may be some visible form of breast enlargement whilst still retaining male genitals.
Forum: Would a pre-op TS be able to enjoy an orgasm through the genital area?
Dr Reid: It depends. They would have been taking female hormones for quite some time, so their sex drive is obviously diminished. They have much less interest in having sexual relations or inducing orgasm.
Forum: Would it be more fair to say, then, that the prospective TS becomes disinterested in the remains of his/her masculinity?
Dr Reid: Yes, it could very much indeed: the phallectomy, or gender reassignment operation, is really the final step in altering one's sex, and usually until such an operation is performed, the TS will feel as if they are incomplete or in a state of sexual limbo.
Forum: So in what specific ways does the post-op TS differ from the pre-op following the successful completion of the operation? For example, have they actually been given a fully functional vagina?
Dr Reid: Yes, in fact they have. The surgeon will cut down the length of the penis and clean it out, then 'reverse' it inwards, as it were, in order to create a functional pseudo-vaginal passage.
Forum: Presumably, then, the TS will be able to enjoy comparable sexual satisfaction to a biological female?
Dr Reid: Well, they won't have the clitoral sensitivity available to a woman, although the nerve endings from the glans penis may be reconstructed to create a sensitive pseudo-clitoris which should afford some degree of sexual pleasure when stimulated by either digital or penile friction. Additionally, biological males can learn to derive pleasure from anal stimulation of the prostate gland. Finally, of course, sexual pleasure is as much mental as physical, and erotic sensitivity obviously varies from individual to individual.
Forum: What is the first thing a person should consider if they are contemplating a sex change?
Dr Reid: They should seriously question whether or not it is necessary, then either get further information from one of the self-help groups or go to one of the functions put on by a TV/TS group, and see if they are really ready. Obtain a bit of practical field experience first, then, if they still feel the need, go to their GP, and perhaps be referred to a gender identity clinic or a psychiatrist knowledgeable in the field of gender and sexuality.
Forum: Do you accept NHS patients?
Dr Reid: Yes, since I am an NHS consultant psychiatrist, although asmost of the gender disordered patients live outside my NHS area I see them privately.
Forum: What sort of things should a male be prepared for as a pre-op TS, psychologically?
Dr Reid: They must be reasonably stable in themselves, both emotionally and socially, and be prepared for at least a year of exclusive of cross-gendered living. Hormones are prescribed, lessons in speech therapy, and grooming may be arranged, as well as electrolysis. In other words, they need to get used to what it is like living completely in the opposite sex role in the real world. This is called the 'one year real life test' an is the minimal prerequisite before gender reassignment surgery can be considered.
Forum: How can you tell the difference between a person who genuinely wants to change sex and one who is perhaps fantasising about being a woman and can convince a psychiatrist that he needs to be a woman?
Dr Reid: There are a number of people out there who suffer from gender anguish who have never cross-dressed a day in their lives because they don't consider themselves transvestites. They would be what I would call 'cerebral' gender dysphoric patients. In other words, they think they want to be a woman, but haven't got to first base of changing gender role in any practical sense. Nevertheless, some of these people make a determined effort to prepare themselves with hormones, electrolysis etc. and are sometimes quite successful.
Forum: What is meant by gender dysphoria?
Dr Reid: It means quite simply those who are unhappy or dissatisfied about their sense of gender.
Forum: If they are not happy about their gender, once it has been changed, will that create more stability and peace of mind? Or is there no guarantee?
Dr Reid: No, you are quite right. There are a number of persons with horrendous personality problems and an element of gender dysphoria who think if only they could change their sex, everything would become wonderful. But at the same time, it has to be the person's choice. It is not my job, or any doctor's, to tell someone how to behave or how to live their lives.
Forum: What is your role?
Dr Reid: I suppose my role is to improve their self-awareness or catalyse their sense of identity. 'Who is the real me', so to speak.
Forum: Are there words of advice for reader who might thinking about gender reassignment?
Dr Reid: Yes, I think if a person does have plans or is thinking of changing their sex, they must be prepared for an uphill battle and have a very thick skin, because it is all very well to have this powerful inner urge or need, yet it is quite another thing to be happy when you look in the mirror after a year or two of taking hormones. Are you going to have fine, feminine features, or are you going to look grotesque?
Forum: That's a significant point; what would you recommend if a six foot seven inch bricklayer with a hunky body walks in and says, "I'm a woman trapped in a man's body, help me"?
Dr Reid: I would try to tell them to be sensible and accept the reality of their biological sex. I have done that once or twice in my early days, but have mostly been proven wrong. They will say to you, "I'll show you that I can, be a successful and attractive woman," and see it as a challenge, and then jolly well become one. Now, I usually say, 'If that's what you want, then go for it.'
Forum: Wouldn't it be harder for some to really pass as a woman?
Dr Reid: Yes. You have to be able to live in the real world and if people accept you, that's fine, but if they throw things at you, or a little child in the supermarket says, "Mummy, is that a man or a woman?", you have to be able to deal with that sort of reaction.
Forum: Have you ever rejected someone you've felt wasn't mentally strong enough?
Dr Reid: I have done, yes. Few of them took any notice of what I said and went ahead and did it anyway.
Forum: Surely it must be very difficult to mentally evaluate someone for such a change?
Dr Reid: One of the most important not to give people advice; if you do give advice and it backfires, you are then held accountable yourself rather than the patient. I tell the patient, "You take responsibility; you make the decision whether or not to change over. You take the credit if it goes well, and the blame if it doesn't."
Forum: Do people often come to you hoping that you will give advice as to what they should do?
Dr Reid: I suppose I have certain ideas about what is right or wrong for transsexuals and I am sometimes accused of being sexist and having stereotypes about how a woman should or shouldn't look. As I say, it doesn't bother me how they turn up; if they want to look androgynous or unisex that's fine. I'm accused more, I think, of being a materialist if I tell them to go and get a job and be self-supporting and successful. Basically, the nature of the condition is very much a narcissistic, egocentric, self-occupying problem; it is a form of obsession. The treatment after all, if it is successful, is to relieve that gender obsession, where they are no longer bothered because they are self-actualised.
Forum: So that they can carry on?
Dr Reid: Yes, it's very satisfying and is one of the few conditions in psychiatry where you have an unhappy patient coming in, totally distressed and dysfunctional, and at the end of a year or two, you get someone going out who's come to terms with their problem and overcome it.
Forum: So are you concluding that once a dysfunctional person has altered his or her sex they will hopefully become stable, happy and less self-obsessed?
Dr Reid: Yes, that's right. It should be the case that they don't have to worry about their gender so much once they are in their new role, taking hormones and getting on with their lives. The gender problems should fade into the background.
Forum: Say, for example, a patient has been taking hormones for two years and dressing as a woman every day, yet still isn't satisfied or content with themselves, would this be more of a self-hate than a gender problem?
Dr Reid: That can be the case, yes.
Forum: Well, what would be the ratio of those who are unhappy?
Dr Reid: About half of the gender disordered new patients I see don't proceed with changing gender role, or if they do they drop out during their 'real life test' as women. Of those who do have surgery, 10 per cent regret it later and either become reclusive, withdrawn and depressed, or they revert back to their male role (minus their male genitals). A few, less than 3 per cent, commit suicide. Their track record is important; if they have a relatively good, healthy social relationship, job record etc., you know at the end of the day they will be highly functional people.
Forum: But there is a percentage of people who aren't very functional as far as society is concerned. What happens to them?
Dr Reid: Yes, there are a number of people with gender problems with massive personality problems, who have never had a relationship nor a job, or are into crime. Sadly, the vast majority of them do very poorly afterwards.
Forum: So for some it could be a form of escapism?
Dr Reid: Yes, sometimes treating the gender disorder can compound their personality problems if they are not properly assessed by a competent psychiatrist, and dissuaded from undergoing treatment.
Forum: How many sex-change operations does the NHS currently perform on average?
Dr Reid: There are more operations done on the NHS now than there were before the health reforms two years ago, about twice as many. There are usually one or two NHS operations performed weekly, and one or two a week being done privately so I would say three or four are being done per week.