Issues in diagnosis and treatment of transsexualism.

Transsexualism involves incongruity between anatomy and gender identity in biological normal persons. The literature in this area indicates controversy in diagnosis and treatment. Current guidelines for assessment and treatment selection are critically reviewed. Outcome data suggest that sex reassignment surgery is variably effective and potentially deleterious. Child and adult interventions may be more viable than previously assumed. Recommendations for research include systematic follow-up, longitudinal studies of gender-deviant children, and studies of psychopathology. Until rigorous outcome data are available, return to a conservative position on sex reassignment, using highly exclusive diagnostic guidelines and restrictive selection criteria, is advocated.