Gandy, 1973
Gender Identity Program, Stanford University School of Medicine, Stanford, CA, USA

The congress speech of the director of the Gender Identity Program of the Stanford University School of Medicine very globally approaches the question if surgical procedures help to improve the quality of life of certain patients with gender dysphoria. The gender dysphoria syndrome is laid out very broadly and includes six groups: "(A) classical transsexualism (indicated by history of prenatal programming of the brain and the behavior of the opposite sex); (B) selected effeminate homosexuals who have greater ability to adjust as females than males; (C) selected transvestites who have drifted into a situation similar to transsexuals, but do not have a lifelong history; (D) individuals with delusions regarding their sexual identity; (E) persons with neurotic thought impulses toward their own genitalia; (F) sociopaths and psychopaths" (p. 228). While gender reassignment surgery was only considered for the first three groups in other institutions, the Stanford team seemed to have been oriented mainly towards the successful life in the other gender role to indicate surgery. The purpose of the Stanford treatment program was to offer "efficient, comprehensive, and responsible patient care without high cost, without performing surgery on demand, and with the encumbrance of multiple diagnostic testing maneuvres. The goal of our program is complete patient rehabilitation" (p. 227).

• Sample
• Results
• Suicide Attempts
• Author´s Conclusion
• Indication Recommendations
• Remarks

Results
"Postoperative scores were significantly higher than preoperative scores when all diagnostic groups were combined. No patient was significantly harmed by the surgery with the exception of one patient first operated on elsewhere. No patient felt that the operation was a mistake or express subjective unhappiness postoperatively" (p. 227), disregarding the circumstance that surgical complications happened frequently.

Suicide Attempts
The author says about one patient who committed suicide after surgery that he said a few weeks before his death, during their last talk, that he was extraordinarily happy and that his situation was -- also objectively -- much better than before the operation.

Author´s Conclusion
The data shows that not only classical transsexuals are the diagnostic category for whom surgery is indicated as treatment. Also effeminate homosexuals who profit just as much from it and for transvestites who change the least by the operation, this treatment can be considered. It is not demonstrated at the present time that surgery is "the proven treatment for gender dysphoria syndrome or for classic transsexualism" (p. 229).

Indication Recommendations
More important than any diagnostic classification is probably the evaluation of the economic, social, psychological and sexual coping of the patient during a one to three-year-long pre-surgical pre-treatment phase. To avoid errors in the decision for surgery, only patients who have lived successfully before in the other gender role should be accepted for surgery. Treatment success can be improved if the patients are supported by an ample therapeutic rehabilitation program. A program of this type should have counseling and assistance for labor-related questions, for legal problems and for the hormone treatment. It is also useful if patients live already with (those already) operated and are offered voice and behavior training, for example, body-building for FMTs, cosmetic and comportment classes for MFTs.

Remarks
This publication is notable because it discusses sex reassignment surgery more or less apart from the diagnosis transsexualism. The transmitted results are so vague that it cannot be evaluated which diagnostic groups have been treated by which method, nor what finally came of it.