Gender reassignment surgery (SRS) for MtF transgender persons & FtM transsexuals is dependent on the referral of mental health professionals to the surgeon.
The surgeon only executes MtF GRS or FtM SRS surgical procedures which have been approved as appropriate by mental health professionals who have diagnosed and documented the person's case.
The late Dr Sava Perovic and Dr Rados Djinovic, Chairman of the Sava Perovic Foundation, have always required psychiatric approval before they will do any gender reassignment surgery.
Whether FtM surgery or MtF transgender surgery, they have long adhered to The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders.
The Standards have existed more than three decades. The association is now called World Professional Association for Transgender Health Inc. (WPATH)
These guidelines for psychiatric, psychological, medical, and surgical management of gender identity disorders aim to ensure transsexuals get all the health care they need and only the health care that is right for each individual.
They protect the best interests of the patient.
They are not barriers to completing transition.
They are designed to make life better, not more difficult.
Their stated goal is: “lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment.”
Worldwide, more than 1,500 persons who got sex change surgery later decided they had made a mistake.
Following the Standards of Care can help ensure that does not happen to anyone else.
The Standards have been revised and updated about six times.
Recommended reading for any person considering gender reassignment surgery are chapters 4, 9, and 12 of the Standards.
Chapter Four is about The Mental Health Professional and particularly The Mental Health Professional’s Documentation Letter which is a mandatory requirement for all patients from developed nations who want surgery from Dr Rados Djinovic
Chapter Nine is about the patient's “Real-life Experience” which is described as “adopting a new or evolving gender role or gender presentation in everyday life.”
Chapter Twelve is about “Genital Surgery”, particularly: a) Eligibility Criteria; and b) Readiness Criteria. They apply to both male to female surgery or a female to male operation gender change.
In real terms, a surgeon's adherence to the Standards means any person considering medical tourism for affordable surgery abroad needs to locate two local doctors who can provide advice and treatment.
For hormonal treatment it would need to be a endocrinologist experienced with gender reassignment.
For the psychiatric approval it would need to be a psychiatrist experienced with gender disorders and another highly qualified mental health profession, not necessarily a psychiatrist, to confirm the psychiatrist's diagnosis.
When the mental health professionals have documented the pre-operative transition from female to male or male to female and approve the next step of surgery, the patient can send to the surgeon of choice a digital copy of the actual signed letter (a Microsoft Office Word file copy of the letter is NOT sufficient) on the mental heath professional's official stationary.
An appropriate letter will enable a patient to schedule an appointment to get surgery from the Sava Perovic Foundation.
Dr Djinovic wants prepared and suitable patients to hand-deliver to him their signed, original letters on official stationary when they meet him in Belgrade for surgery.
The Standards require a psych evaluation approving surgery to cover seven major points:
“The Mental Health Professional’s Documentation Letter for Hormone Therapy or Surgery Should Succinctly Specify:
- The patient's general identifying characteristics;
- The initial and evolving gender, sexual, and other psychiatric diagnoses;
- The duration of their professional relationship including the type of psychotherapy or evaluation that the patient underwent;
- The eligibility criteria that have been met and the mental health professional’s rationale for hormone therapy or surgery;
- The degree to which the patient has followed the Standards of Care to date and the likelihood of future compliance;
- Whether the author of the report is part of a gender team;
- That the sender welcomes a phone call to verify the fact that the mental health professional actually wrote the letter as described in this document.
The organization and completeness of these letters provide the hormone-prescribing physician and the surgeon an important degree of assurance that mental health professional is knowledgeable and competent concerning gender identity disorders.
“One Letter is Required for Instituting Hormone Therapy, or for Breast Surgery.
“One letter from a mental health professional, including the above seven points, written to the physician who will be responsible for the patient’s medical treatment, is sufficient for instituting hormone therapy or for a referral for breast surgery (e.g., mastectomy, chest reconstruction, or augmentation mammoplasty).
“Two Letters are Generally Required for Genital Surgery.
“Genital surgery for biologic males may include orchiectomy, penectomy, clitoroplasty, labiaplasty or creation of a neovagina; for biological females it may include hysterectomy, salpingo-oophorectomy, vaginectomy, metoidiopscrotoplasty, urethroplasty, placement of testicular prostheses, or creation of a neophallus.
“It is ideal if mental health professionals conduct their tasks and periodically report on these processes as part of a team of other mental health professionals and non-psychiatric physicians.
“One letter to the physician performing genital surgery will generally suffice as long as two mental health professionals sign it.
“More commonly, however, letters of recommendation are from mental health professionals who work alone without colleagues experienced with gender identity disorders.
“Because professionals working independently may not have the benefit of ongoing professional consultation on gender cases, two letters of recommendation are required prior to initiating genital surgery.
“If the first letter is from a person with a master's degree, the second letter should be from a psychiatrist or a PhD clinical psychologist, who can be expected to adequately evaluate co-morbid psychiatric conditions.
“If the first letter is from the patient's psychotherapist, the second letter should be from a person who has only played an evaluative role for the patient.
“Each letter, however, is expected to cover the same topics and at least one of the letters should be an extensive report.
“The second letter writer, having read the first letter, may choose to offer a briefer summary and an agreement with the recommendation.”
Some psychiatrists don't trust the patients who hire them to safely hand-deliver the psychiatric approval for surgery to the surgeon.
In such cases, the patient should do his/her utmost to convince that mental health professional to use UPS courier service or FedEx or other highly reliable courier to deliver the invaluable, mandatory original documents to the Sava Perovic Foundation.
NEVER should such important documents sent though the postal system.
A digital copy of the original should ALWAYS be sent to the Case Manager for inclusion in the patient's case file for an advanced review and pre-approal by Dr Djinovic.