Programme of the event:

1. Gender theory. Russian conception (Golubeva-Belkin). Terminological basis: western and soviet traditions.

2. Sex reassignment in international standards. DSM IV, ICD-10, SoC-6. Revision of DSM IV: «Goal 2012». Capabilities of the ICD.

3. LGBT movement. History of the movement in USA, Western, and Eastern Europe. Present problems and successes.

4. Heteronormativity and marginalisation.

5. Emotional experiences of transsexuals and consulting particularities of transsexuals prior sex reassignment. Reasons of high suicidal risk.

6. Emotional experiences of transsexuals and consulting particularities of transsexuals during sex reassignment. Behavioural patterns. Role of the positive example.

7. Emotional experiences of transsexuals and consulting particularities of transsexuals after sex reassignment. Renewal of goals and values.

     The conference became a logical continuation of "FtM Phoenix" Group's work giving an opportunity to generalize in one speech materials of the author's seminar "From transsexualism to transsexuality", knowledge received during the "Loosening the Grip of Heteronormativity: How students can make a change" study session at the Council of Europe and the thesis "Making the transition in transgender medicine: from research to quality care" presented at the XIX World WAS Congress in Gothenburg.

     After the presentation, the audience was able to ask questions that included some quite sharp.

Question: Are there any methodologies enabling to cure patient from transsexualism, i.e. to get him rid of morbid conviction in belonging to the opposite sex?

Answer: One citation comes to mind: "Efforts to explain the pathogenesis of transsexualism from explicitly psychiatric positions are currently left once and for all [Kalinchenko S. Yu., Transsexualism. Possibilities of hormonal therapy. Moscow, Practical Medicine, 2006, p. 9]". As far back as 1966, Harry Benjamin in his book showed that transsexuals do not have other aberrations than feeling of their belonging to the opposite sex. Nevertheless, to treat, first, homosexualism – transsexualism was considered a kind of – in last century were used different methodologies. For example, behaviouristic when doctors offered patient to look at the picture of the person he loved and in this moment they were using electroshock or medical preparations to cause the vomiting reflex. Another example – neurosurgical interventions into brain. Needless to explain how complicated and risky are those interventions. In the end, medicine had to admit an absolute weakness of all tried methodologies.

Question: In practice, in hospital, I have observed cases of obvious comorbidity [combination of transsexualism with other mental diseases – Kirill Sabir]. Is it possible to consider sex reassignment in such cases?

Answer: There are explicit diagnostic criteria and contraindications for sex reassignment. One of those contraindications is presence of mental diseases. The strategy of work with the patient in this case, I think, is obvious: at first, we treat from mental disease, then consider the sex change. Of course, we are talking about need to get rid of in principle curable mental diseases.

Question: There is a girl in my practice whose parents wished a lot to have a boy and, thus, foster their daughter in the opposite sex. What help does the child need?

Answer: In this case, serious help is required for parents rather. I wouldn't be in a hurry to talk about transsexualism of the girl – are there enough grounds? Wrong models of behaviour are being imposed on her but they will, more likely, pass themselves as she grows, decisive importance has puberty as far as it is a period when a person realises who he is and how will he live further.

Question: What is your attitude to the story with an African runner that was deprived of her medal when they found out she belongs to the "third sex"?

Answer: It is about South-African athlete Caster Semenya. First, we should not mix intersexuality with transsexualism. Journalists lump everything together, call the "third sex" because they still do not know much about these matters. The case with Caster Semenya is generally, as they say, for students. If you have watched her on TV, her intersexuality is obvious: low voice, big, brawny shoulders... by the way, no signs of breasts are seen. Thus, secondly, begs a question: is it true that South-African Federation of Athletics did not know about their athlete's intersexuality? Or there was just a medal required? The situation when intersex people are deprived from medals seems to me unfair and unjust: a person was training, let to international competitions... But where to get to later on, when sport is closed for a such person?

Commentary of Appenyanskiy A.I., Chairman of MUP: Today Paralympics take place; it isn't surprising for anybody. Perhaps, one day Games for intersex people will take place.

Commentary of Kirill: Maybe. But does intersex people need those kind of games? It is doubtful. We are rather talking about tolerant attitudes of the two-sexed society towards trans people [intersex people, transsexuals etc.]. And about need for timely diagnostics, qualified assistance in sex change to those who need it.

Question: What is the percentage of patients who had underwent surgical correction of sex and are satisfied with its results?

Answer: Different authors give different numbers but positive values, anyway, are high. For example, group of Dutch authors – Smith, van Goozen, Kuiper, Cohen-Kettenis – in 2005 have got in their research the following numbers: 91.6 % subjects were satisfied with results of surgeries, the rest 8.4 % were neutral in their assessments; there were no unsatisfied. The group of Swedish authors in 1999 came to the slightly different conclusion: 3.8 % of questioned transsexuals had regrets about surgeries but as reason of their regrets, they indicated lack of family support and dissatisfaction with surgical results. It is necessary to stress here that quality of surgeries is, actually, not always at the top because far from all surgeons technically can or are simply psychologically ready to achieve high functional and aesthetic result in sex correction.

Question: What is the psychotherapeutic result of sex reassignment, i.e. how well is patients' life after sex change?

Answer: In 2007, a group of British experts undertook the most interesting Transgender EuroStudy, which currently gives the most complete answer to this question. According to data of the study, 82 % of respondents had received obligatory secondary education that is higher than numbers given by Eurostat for the population in general (77.7 %). Higher education or an academic degree had received 48.2 % of respondents (in comparison with 27-30 % of national averages). At the same time, a high percentage of dismissed on the early stages of afterschool studies was observed. The latter tendency can be explained well by the maximal conflict of transsexuals' experiences with the external world exactly in this period and, consequently, the active search for possibilities to solve it. Extremely interesting looks the ratio between educational level and level of employment + financial security of the questioned. The level of unemployment in Europe is lower than basic, however, on average only 38 % of transsexuals have paid work. Actually, this number demonstrates why sex correction surgeries and concomitant treatment are such a heavy financial burden for this group of patients. To a considerable degree it explains also a family status of transsexuals: 37 % of respondents most of the time live alone, 20 % live with a partner without registered marriage, 12 % are in registered marriage, 9 % live apart from partner but regularly see each other, and, finally, 8 % of respondents most of the time live with parents. Unconditionally, number 37 does not look very optimistically and it is an explicit signal to the need to improve the state of transsexuals.

     In Russia, unfortunately, any statistics on transsexualism lacks though, if desired, it can be obtained. The question is only in interest of Minpubhealthsocdevelopment. Currently we are working in this direction.

Question: Where do you recommend sending patients suffering from transsexualism?

Answer: In Moscow the only State professional institution, solving the question of sex change is Research Institute of Psychiatry. However, the way a number of employees there treat patients, unfortunately, does not let to give positive references to this institution. Though it is possible to receive a permit there, the complete unofficial list of places where else you can go in Russian Federation can be found at http://ftmperehod.com/psih_centrs.htm. On its part, our Group is ready to render any necessary assistance to all people who address us.

"FtM Phoenix" Group thanks Appenyanskiy Alexander Ivanovich, Chairman of IPO "Professional medical union of psychotherapeutists, psychologists and social workers" for organising the conference