German Standards for the Treatment and Diagnostic Assessment of Transsexuals

Standards of Diagnostic Assessment according to the Code for Transsexuals (TSG)

• Diagnostic Assessment according to Paragraph 1 (§ 1) of the Code for Transsexuals (TSG)
• Diagnostic Assessment according to Paragraph 8 (§8) of the TSG

The assessment for legal changes of name and sex must be established through the regulations stated in the TSG. The assessor must be aware that the Diagnostic Assessment for Changes of First Name, paragraph 1 (§1) is considerably more significant (abuse can lead to demands for an operation) than the Diagnostic Assessment for Change of Sex, paragraph 8 (§ 8) after the sex reassignment surgery.
  

Diagnostic Assessment according to Paragraph 1 (§ 1) of the Code for Transsexuals (TSG)

The diagnostic assessment’s goal is to reconstruct the development of the gender identity’s history and disorder (keeping in mind the differences between male to female and female to male transsexuals). This development should be seen within the context of psychosocial surroundings and specific influential factors in successive times of life. The expert should procure additional information when necessary; in this information assertions from important figures of trust (extraneous anamnesis) and psychological-medical diagnoses are of special significance. The assessment must be based on the Diagnostic and Differential Diagnostic Standards (see section 2.1 and 2.2) and present them in detail. The evaluation should be scientifically based and include a critical discussion which assimilates the information. A simple summary of the reports dealing with the subject or patient’s subjective perception or a rendering of the patient’s interpretation of his personal history is not a professional assessment. A critical alertness for the objective aspects of transsexual behavior is just as important as empathy for the subjectivity of transsexual conviction.

The evaluation must convincingly portray the existence of the prerequisites for change of first name. The prerequisites laid out in the TSG should be interpreted as follows:

• Transsexual "imprinting" is not to be understood according to it’s definition in behavioral biology ; instead, it should be seen as a step-by-step, multi-factored development of transsexuality which can only be critically appraised through reconstruction.
• "Compulsion" lasting at least for three years means the impossibility of reconciliation with the sex of birth, and the persistent inner assurance of belonging to the opposite sex (if possible, the stability of the inner assurance should be appraised from the course of the real life experience).
• The prognosis about the "high" probability that the patient’s feeling of belonging to the other sex will remain unchanged should refer to current medical knowledge. This prognosis should arise from diagnostic, anamnestic, and situational evidence that shows an irreversible transsexual development.

If the results of the diagnostic assessment show that the requirements have not been fulfilled, then this should be recorded. If necessary, a follow-up assessment can be suggested.

An assessment’s suggestion to motion for a change of name according to paragraph 1 (§1) of the TSG is not a recommendation for somatic treatment. This should be clearly and distinctly expressed in the evaluation. Paragraph 4 (§4) of the TSG, however, presents the possibility for recommending or not recommending of somatic treatment within a prognostic framework.
  

Diagnostic Assessment according to Paragraph 8 (§8) of the TSG

According to Paragraph 8 (§8) of the TSG, the diagnostic assessment of legal changes of sex should clarify whether certain prerequisites have been realized. These include a fulfillment of the criteria in Paragraph 1 (§1) (see Diagnostic Assessment according to Paragraph 1 (§1) of the TSG), permanent infertility, and "a substantial approximation of the physical appearance of the opposite sex". The fulfillment of the latter requirement is governed by the state of medical knowledge (see section 5.2, Standards for Sex Reassignment Surgery) and jurisdiction.