Sex change: anatomy of a dilemma for society

DR LYDIA Annice Foy, formerly Dr Donal Mark Foy, may have opened an unusually complex can of worms - medical, ethical and legal - by her High Court action this week.

The 49 year old former dentist, who was born physically male but after surgery is now female, was given leave to challenge a refusal by the registrar to change her birth certificate entry.

Dr Foy, now unemployed and living in a terraced council house in Athy, Co Kildare, claims she has lost friends and family (she fathered two children before her operation) because of her decision.

While there has been a small number of high profile cases in Ireland, transsexualism remains a largely unexplored area here. One medical definition describes a transsexual as "a post pubertal individual suffering from deep and persistent dissatisfaction with his or her anatonical sex and wishing to undergo a sex change for more than two years".

Statistically, it is estimated that one in every 10,000 males and 30,000 females experience gender dysphoria, the term used to describe a gender identity crisis. Gender Realignment Surgery (GRS), the kind undergone by Dr Foy five years ago, is expensive and drawn out, but for many struggling with the frustration of conflicting physical and psychological feelings, it is the only option.

According to a Department of Health spokeswoman, funding for GRS can be provided by health boards if medical opinion supports the belief that gender dysphoria has rendered the individual suicidal. In recent years only four people have got funding (usually amounts between £3,000 and [£4,000), including Dr Foy and a man from the North Western Health Board region.

Dr Don Montgomery has been a consultant psychiatrist with the Gender Identity Clinic at Charing Cross Hospital in London for the past 10 years. He says during his time there he has come across "just three or four" cases from the Republic and "quite a few more than that" from Northern Ireland.

According to the doctor, many of the people who reach this stage are "suicidal, depressed or alcoholics". They may or may not have already started hormone therapy. Usually, he says, "a lifetime of thought" has gone into the decision.

In accordance with an internationally recognised code of practice, Dr Montgomery insists on a minimum of two years counselling before surgery is carried out. This includes a one year "real life test" where the patient must prove he/she can live and work in the chosen gender role. An individual could spend more than £1,500 on counselling and hormone treatments during this period.

For those who decide to continue 200 new patients are referred to the clinic each year but 75 per cent eventually choose not to undergo surgery - the next step is costly. The basic operation on male genitalia, which is known as vaginaplasty, costs £10,000 on the National Health Service and a similar sum privately". A 10 day hospital stay is required.

"There are other options, such Adam's apple, and breast augmentation, but many feel these are unnecessary," says Dr Montgomery.

"First and foremost the clinic performs a diagnostic service. We counsel people. The important thing to remember is that many transsexuals can be helped to live in whatever gender they choose without undergoing surgery," he says.

In relation to the current legal action taken by Dr Foy, Dr Montgomery makes the point that allowing birth certs to be changed may cut out malpractice, which he insists is rife within the industry. "If transsexuals are obliged to present proof that surgery was carried out at a bona fide centre in order to get their papers changed, it would mean that patients would stop attending disreputable clinics," he says.

There were 61 cases of gender reassignment in Britain last year, although 11 of those were performed on babies and young children born of indeterminate gender. Half were sought by persons between the ages of 20 and 44.

In recent decades transsexual people have gained various levels of recognition through the courts in countries such as the Netherlands, Spain, Belgium and Switzerland.

Almost half the states in the US and, last month, the government of Western Australia have introduced legislation allowing transsexuals to correct the sex on their birth certificates following GRS.

Two weeks ago the European Commission on Human Rights ruled by 15 votes to one that a refusal of a British court to recognise a woman's gender reassignment constituted a lack of respects for her private life as set down in Article 8 of the European Human Rights Convention. The case will now be heard in the European Court of Human Rights.

Aside from the issue of birth certificates, the transsexual community here is treated more fairly than its UK counterparts, says law graduate Louise Tormey, who wrote her master's thesis on the equality issues affecting transsexuals.

"There is a procedure in place where transsexuals can change the gender specifications on their passport. Exceptions are made here, which is not the case in the UK," she says.

"Transsexualism is often mistakenly linked with homosexual and transvestite behaviour, and this causes more problems for transexuals," she adds.

The absence of an official support group here is due, says Ms Tormey, to an unwillingness on the part of the transsexuals to settle down in this country.