safeguard for both caregivers and consumers. For the physician or mental health professional, their principles and standards provide consensual guidelines for hormonal and surgical treatment. Following the guidelines protects caregivers to some extent from malpractice claims by making them aware of and prohibiting poor practice. For instance, Standard 7 requires peer review before sex reassignment surgery, and standard 12 makes it unethical to overcharge. For the consumer, the Standards place some restrictions on treatment. Most importantly, they provide a clear path to sex reassignment surgery, progressing from physically non intrusive treatments such as therapy through more intrusive (and dangerous) treatments, with the irreversible procedure of sex reassignment surgery being at the end of the treatment process, after a period during which the individual must have lived and worked or gone to school full-time in the chosen gender for a minimum of one year.
By following this path, it is possible for the individual, at any point up until the final surgery, to return to the gender of original assignment with the least possible disruption and the fewest possible irreversible physical changes. For instance, an individual in therapy can decide prior to initiating hormonal treatment to remain in the original gender with all physical characteristics intact. A genetic male who has taken female hormones for some time can return to the original gender role with at worst some residual breast development which can be disguised by clothing or removed surgically. Hormonal therapy causes a number of permanent physical changes in genetic females, but even so, it is generally possible to return to the female role. Until the individuals
actually anaesthetized for sex reassignment surgery, it is possible to return to the original gender role. And perhaps more importantly, it is possible to halt the process at any point before going under the knife. In other words, the Standards of Care allow a variety of transgenderal alternatives short of complete sex reassignment. They allow the individual to explore these alternative methods of expression, progressing as he or she sees fit, and stopping at any point in which he or she feels comfortable.
Most importantly, by their requirement for a period of full-time living, the Standards acknowledge that it is not genitals which make men and women, but gender identity and gender role. Men and women are not created by the surgeons lancet, but by their life circumstances as men and women.
Surgery and hormonal treatment are merely options which some people choose to help them by altering their bodies to conform with their chosen gender roles. Surgery, or lack of it, does not affect the ability to perform in a gender role in any important way other than sexually. The genital area is, after all, customarily covered by clothing, and the genitalia of others is taken as a matter of faith. Unless we are changing the diapers of other individuals, or are intimately involved with them, we assume they have a particular set of genitals which correspond with their gender role. It is for this reason that Donald Laud has called sex reassignment surgery gender confirma