The third sex

A recent development in the pattern of patients presenting clinically are those with a transgendered identity, popularly known as 'the third sex'. These males or females do not request 'sex change'. Rather, they want, if male, to be demasculinized and, if female, to be defeminized. Thus males want castration and penectomy but no oestrogen treatment and no neovagina, and females want mastectomy, perhaps hysterectomy, but no androgen treatment and no neophallus.

These patients pose a dilemma for clinicians. The crux of patient management for gender identity disorder is the 'Real Life Test' (see above), including cross-sex hormonal treatment, the prelude to possible surgical alteration. Reversible procedures precede those that are irreversible in this management strategy. But with these third-sex patients, no 'Real Life Test' is possible. They do not have a trial period. Guidelines for testing the rationality and stability of their requests need to evolve from the body of clinicians currently attempting management of this unique population.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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