What’s Next for Caitlyn Jenner? Understanding Sex Reassignment Surgery

Caitlyn Jenner made her debut on the cover of Vanity Fair on Monday, but her transition may not be over.

The 65-year-old, who said goodbye to Bruce with the help of hormones, facial feminization surgery and breast implants, recently revealed she will fully transition within the next year, however, she has not specified whether that includes full genital reassignment surgery.

In order to understand how an individual prepares for sex reassignment surgery, ExtraTV.com spoke with Dr. Lawrence Genen, an L.A. psychiatrist.

Genen, who has never worked with Caitlyn, emphasized that each person's journey is different, and that some people choose hormones, various different surgeries or not to change their appearance at all.

The World Professional Association for Transgender Health defines sex reassignment surgery not only as procedures such as genital reassignment surgery, bilateral mastectomy and chest reconstruction, but also non-genital surgical procedures such as subcutaneous mastectomy, facial feminization and breast augmentation. It should also be noted that a transgender person is who they say they are regardless of any medical procedures.

If a person does choose surgery, it is important to understand that it is a treatment for gender dysphoria, which is "discomfort or distress caused by a discrepancy between a person's gender identity and that person's sex assigned at birth.”

Before becoming eligible for sex reassignment surgery, Genen says a patient must obtain referrals from two mental health professionals, undergo hormone therapy and live as the other gender for at least a year.

Dr. Genen said, “If an individual is undergoing significant surgery, typically they will have to undergo 12 months of continuous hormone therapy as recommended under the supervision of a physician. Any co-occurring mental health conditions, there are many, including anxiety and depression… should be treated in advance.”

While undergoing hormone therapy, many choose to begin living as the other gender to fulfill their one-year requirement.

Dr. Genen said, “That is incredibly important for those 12 months, because when you consider what is entailed with gender reassignment surgery, it is irreversible… it is critical that they get the best approximation of what life will truly be like for them to live life where the rest of the world, their friends, family and society in general really view them externally as they have always viewed themselves internally.”

He added, “Ongoing follow-up care is absolutely critical” after the surgery as well.

For anyone trying to understand what it means to be transgender, Genen explains it this way, “I think Caitlyn's story, and transgender issues, in general, help shed light on the biological and genetic basis for facets of our individual identity.”

“It seems clear that we have a gender identity, sexual identity and an external physical identity… if you think about these three facets of identity as having a separate and unique genetic basis, it helps everything make a lot more sense.”

The doctor added, “We are used to all three of these characteristics presenting with a typical pattern -- for instance, an individual identifies himself as a man, is sexually attracted to women and has the external physical characteristics of a man -- that's the typical way we think of a heterosexual male.”

“However, for each of these three unique facets of identity there are a variety of combinations, which speaks to the inherent diversity afforded to us by our own genetics and nature.“