Virginia, USA
— Clinical psychologist Jeffrey C. Fracher has
spent more than 25 years working with people who feel
like their anatomy and internal sense of gender do not
match.
He works with clients who
want to undergo gender-reassignment surgery. Accepted
medical protocols require that those clients first go
through a year of counseling during which time they live
and dress as the gender they want to become.
"Virtually
everyone I have worked with who has turned out to be
legitimately transgender will tell you from the
earliest memory they felt like they were in the wrong
body," said Fracher, who is in private practice in
Charlottesville and who is also a clinical assistant
professor at the University of Virginia.
"You hear enough of
that, and it can be pretty compelling."
Fracher said the
counseling helps clients deal with the many issues they
face as they transition.
"It's really to
sort of guide them through and help them anticipate
problems . . . and to make sure they know what they
are getting into, frankly.
"You don't want
someone psychologically fragile undergoing this type
of transition. The results can be
disastrous."
The guidelines were
developed 20 to 30 years ago after a number of bad
outcomes after sex-reassignment surgery, Fracher
said.
In some treatment
circles, there is discussion of intervening as early as
adolescence when there are gender-identity conflicts. In
that process, young people who express gender-identity
conflicts would be given hormones before adolescence to
stop the natural development of secondary sex
characteristics. For instance, a pre-adolescent girl who
identifies as a boy might be given anti-estrogen drugs so
that she does not develop breasts or a womanly
figure.
Fracher thinks such early
intervention is a bad idea.
"Gender is a
very dynamic process, certainly through adolescence,"
he said.
"I would not want to
intervene at that level. It's very
controversial."
