| "Standards Of Care For Gender Identity Disorders", The Harry Benjamin Gender Dysphoria Association, January 1990 4.1.4 |
| 4.1.4: | Standard 1. Hormonal and/or surgical sex reassignment on demand (i.e., justified simply because the patient has requested such procedures) is contraindicated. It is herein declared to be professionally improper to conduct, offer, administer or perform hormonal sex reassignment and/or surgical sex reassignment without careful evaluation of the patient's reasons for requesting such services and evaluation of the beliefs and attitudes upon which such reasons are based. |
| 3.1: | The standards of care, as listed below, are minimal requirements and are not to be construed as optimal standards of care. It is recommended that professionals involved in the management of sex reassignment cases use the following as minimal criteria for the evaluation of their work. It should be noted that some experts on gender identity recommend that the time parameters listed below be doubled, or tripled |
| 3.5.5: | The Behavioral scientists recommending sex reassignment surgery and hormone therapy and the physician and surgeon(s) who accept those recommendations share the responsibility for certifying that the recommendations are made based on competency indicators as described above |
| Stephen Levine, "Letter to the Editor", Archives of Sexual Behavior, 13:3 1984 |
| | (Regarding the suicide of 'Ruth') How many other Ruths are there who remain undetected because of the lack of follow-up or the method used in the follow-up studies? |
| Laura Roberto, "Issues in Diagnosis and Treatment of Transsexualism", Archives of Sexual Behavior, 12:5 1983, p. 445 |
| | In a small group of transsexuals who show early-onset cross-gender identity, social skill in the opposite gender role, and intact judgement and cognitive functioning, surgery has appeared to successfully confirm the internal gender identity. However, it is clear that the lack of diagnostic precision in current practice is responsible for many misassignments to surgery. |
| | Return to an extremely conservative position regarding when to grant sex reassignment surgery is advocated. Surgery should be performed only at hospitals under the auspices of well planned gender identity research projects and no surgery should be performed without a detailed plan of follow-up. |
| Ray Blanchard, Betty Steiner, "Gender Reorientation and Psychosocial Adjustment in Male-to-Female transexuals", Archives of Sexual Behavior, 12:6 1983, p. 503 |
| | Gender reorientation is associated with better psychological and social adjustment in male-to-female transsexuals. |
| Thomas Lindgren, Ira Pauly, "A Body Image Scale for Evaluating Transsexuals", Archives of Sexual Behavior, 4:6 1975, p. 639 |
| | Not all patients who have undergone sex-reassignment procedures have been pleased at the outcome. Some have regretted it altogether, while others have become insistent on further cosmetic procedures. |
| Ray Blanchard, "Typology of Male-to-Female Transsexualism", Archives of Sexual Behavior, 14:3, p. 1985247 |
| | Surgical outcome studies have shown that "transvestitic" or "secondary" transsexuals may profit as well from sex reassignment as the idealized "true" or "primary" transsexual (Bentler, 1976; Laub and Fisk, 1974). The implications of the above findings, therefore, are for etiological research rather than clinical management. |