It is sometimes required even before hormone therapy, but this is not always possible; transsexual men frequently cannot "pass" this period without hormones. The requirements for chest reconstruction surgery are different for transmen and transwomen. In the International Classification of Diseases the diagnosis is known as transsexualism . Complications are common, especially in procedures that involve extending the urethra into the neophallus.
Some satisfactory outcomes were reported, but the magnitude of benefit and harm for individual surgical procedures cannot be estimated accurately using the current available evidence. However, some successful patients who wish to blend into the community as men or women do not make themselves available for follow-up. The government of Iran , however, pays for such surgery because it is believed to be valid under Shi'ite Belief. Risk factors for return to original gender role include history of transvestic fetishism , psychological instability, and social isolation. Many prepubescent children with cross-gender identities do not persist with gender dysphoria. The EMR may tie procedures and insurance reimbursement to a binary gender, making it difficult to order tests and obtain reimbursement for gender binary diagnoses such as prostate cancer or pregnancy. On May 30, , HHS announced that the categorical exclusion was found by the DAB to not be valid "under the 'reasonableness standard,'" allowing for Medicare coverage of sex reassignment surgery to be decided on a case-by-case basis. Most trans women also require facial hair removal, voice training or voice surgery , and sometimes, facial feminization surgery , to be passable as females; these treatments are usually provided upon request with no requirements for psychotherapy or "cross-living". In cases of comorbid psychopathology , the standards are to first manage the psychopathology and then evaluate the patient's gender dysphoria. Therefore, many surgeons are willing to perform some or all elements of sex reassignment surgery without a real-life test. Providers should consider the role of partners and chosen family in healthcare decision making. As with cisgender women, there is a limit on the size of implant that may be used, depending on the amount of pre-existing breast tissue. Other procedures[ edit ] Facial feminization surgery FFS is a form of facial reconstruction used to make a masculine face appear more feminine. However, almost all surgeons practicing in North America and Europe who perform genital reassignment surgery require letters of approval from two psychotherapists; most Standards of Care recommend, and most therapists require, a one-year real-life test prior to genital reassignment surgery, though some therapists are willing to waive this requirement for certain patients. Sex reassignment surgery Sex reassignment surgery SRS refers to the surgical and medical procedures undertaken to align intersex and transsexual individuals' physical appearance and genital anatomy with their gender identity. A study made a longer-term evaluation of the effectiveness of this approach, looking at young transgender adults who had received puberty suppression during adolescence. As of February , the most recent version of the standards is Version 7. Two non-homosexual male-to-female transsexuals expressed regrets. This treatment is controversial as the use of puberty blockers involves a small risk of adverse physical effects. There are significant medical risks associated with SRS that should be considered before undergoing the surgery. The vast majority functioned quite well psychologically, socially and sexually. Transgender patients may view mental health assessments as an important gateway to accessing surgeons, endocrinologists, and legal changes. As Medicaid and private insurers often take their cues from Medicare on what to cover, this may lead to coverage of sex reassignment therapy by Medicaid and private insurers. Other frequent requirements are regular psychological counseling and letters of recommendation for this surgery. In other countries, such as the United States , no national health plan exists and the majority of private insurance companies do not cover SRS.
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