he main goal of a sex change is to help an individual live comfortably in his/her body. But it's a lot more complicated than grabbing a scalpel and a needle; before undertaking something as extreme as a sex change, the patient must consider all of the options. That's where the HBIGDASCGID comes in.

The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders (HBIGDASCGID) is a document that was first drawn up in 1979 and last revised in 1998. It seeks to help manage gender identity disorders and the treatment for them. So to get started in the sex change process and aid the transition, the document suggests that male to female transsexual activities may include:

  1. Manner of dress: crossdressing unobtrusively with undergarments, dressing unisexually, or dressing in a feminine fashion.

  2. Body modification: changing the body through hair removal (e.g., electrolysis, body waxing) as well as minor plastic cosmetic surgical procedures.

  3. Practice: increasing grooming, wardrobe, and vocal expression skills.

    And for both genders may include:

  4. Education: learning about transgender phenomena from support groups and gender networks, communication with peers through the Internet, and reading relevant lay and professional literature about legal rights pertaining to work, relationships, and public cross-dressing.

  5. Activities: involvement in recreational activities of the desired gender.

  6. Lifestyle: episodic cross-gender living.

The Association also suggests some internal processes that an individual might go through to help begin the transition. These include:

  1. Acceptance of personal homosexual or bisexual fantasies and behaviors (orientation) as being completely distinct from gender role aspirations.

  2. Acceptance of the need to maintain a job, provide for the emotional needs of children, honor a spousal commitment, and to not distress a family member as currently having a higher priority than the personal wish for constant cross-gender expression. (This doesn't mean that you can't do what you want; just that you should realize that your decisions affect a lot more people than merely yourself.)

  3. Integration of male and female gender awareness into daily living.

  4. Identification of the triggers for increased cross-gender yearnings and effectively attend to them; for instance, develop better self-protective, self-assertive, and vocational skills to advance at work and resolve interpersonal struggles to strengthen key relationships.

  5. Seeking spiritual comfort.

All of these options should be considered by any individual thinking about going through with the procedures of a sex change operation. They should certainly be thought about before any other permanent steps are taken.