[The physician, The French judiciary and transsexuals in 1986. II. Three basic questions: treatment, legal change of sex and possible recourse to the legislator].

The authors, having taken a general view of French jurisprudence and law and having compared western and European law about transsexualism, now attempt to reply to three essential questions that specialist doctors and the judiciary should direct themselves to on this subject; As far as medical and surgical treatment is concerned this can only be decided on after a very careful diagnosis of transsexualism authenticated by thorough observation over a period of months that may even extend to 2 or 3 years. The patient should have access to a team of several disciplines, including a psychiatrist, an endocrinologist and a surgeon. This seems to be the minimum size of the team to decide what the hormonal treatment should be and, later, what the surgical treatment may be. The economic repercussions of the whole of the treatment for a transsexual are not negligible and are important to be taken into account. This includes the prevention of legal action against the doctors if the treatment fails or if the transsexual later is disillusioned or regrets what has been done. As far as the law is concerned the chronology of the legal decisions for a legal change of sex a opposed to an anatomical change of sex, achieved by hormone treatment and surgery, is far from being solved. The Conseil National de l'Ordre des Médecins are insisting that a legal change of sex should precede surgical intervention whereas the lawyers, following the lead given by those in Scandinavia and in other European countries, say that tests of medical and surgical procedures to change the person should be undertaken before the law changes the gender of the person. Finally, there is the problem that has been raised by an attempt to replace the legal position that has already been tried. This plan, both medical and legal, has hardly been supported by the majority of French authors who have been consulted. They tend to take up the position of the Académie Nationale de Médecine which was frightened that changing the law would give too much importance socially to transsexualism. This phenomenon is still fairly limited in France but would become more widespread if a new liberal law was passed. Although the authors cannot give positive answers to the main questions raised by this difficult problem they think that these problems should not be avoided, although they are so complex, by doctors and jurists who have to take serious decisions when handling authentic transsexuals.