German Standards for the Treatment and Diagnostic Assessment of Transsexuals

Introduction

Transsexuality is characterized by an enduring inner certainty that one belongs to the opposite sex. This includes the refusal to acknowledge the physical characteristics of the sex of birth and the role associated with the biologically designated sex, the wish to change the body’s physical form as much as possible through surgical and hormonal measures into the gender of identification, and the desire to live a life socially and legally accepted in the gender of choice. The current system of diagnostic classification views transsexuality as a special form of Gender Identity Disorder.

The causes and developmental factors in Gender Identity Disorders are to a large extent not yet understood, and are the subject of varying theories. A persistent transsexual desire is the result of sequential, influential factors which may or may not be cumulative. Because these factors are closely tied to psychosexual development, there are different developmental pathways which can lead to the expression of transsexual desires.

Due to the far-reaching and irreversible results of hormonal and/or surgical transformational measures, a careful diagnosis and differential diagnosis is absolutely vital to the patient’s best interest. In and of themselves, a patient’s self-diagnosis and the intensity of his desire for sex reassignment cannot be viewed as reliable indicators of transsexuality. A dependable judgement is only possible within the frame of long-term diagnostic therapy. A vital part of this process is the so-called real-life experience, in which the patient lives as a member of the desired sex continually and in all social spheres in order to accumulate necessary experience. Methods of treatment have to be handled case-by-case, based on each patient’s individual development. With that in mind, the ostensible alternative of "physical treatment" versus "psychotherapeutic treatment" has to be discarded in order to establish an integrative concept.

The patient will be informed that he will have to clarify the conditions of payment for psychotherapy, medical treatments, and diagnostic assessment.

The following standards for treating and diagnostically assessing transsexuals are to be viewed as minimum requirements. Deviations from these standards must be recorded in the patient’s medical file.