- The person should be above 18 years of age.
- They should have the mental capacity to make fully informed decisions.
- The person should not be married and if married, should be legally divorced or spouse should also be counselled and assessed for willingness to accept the gender reassignment.
- The person should not have any minor children.
- The person should meet the criteria for the diagnosis of 'true' gender dysphoria, including:
- A sense of estrangement from one's own body, so that any evidence of one's own biological sex is regarded as repugnant
- A desire to live and be accepted as a member of the opposite sex and wishes to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment
- A stable transsexual orientation evidenced by a desire to the rid of one's genitals and to live in the society as a person of the other sex for at least 2 years, that is, not limited to periods of stress
- Absence of physical inter-sex of genetic abnormality
- Not gaining sexual arousal from cross-dressing
- Life-long sense of belonging to the opposite sex and of having been born into the wrong sex, often since childhood
- Not due to another biological, chromosomal or associated psychiatric disorder, such as schizophrenia
- Clinically significant impairment of social and occupational functioning
Once a person has completed the program of transgender identity treatment as evidenced by the following:
- A qualified psychiatrist* who has been acquainted with the person for at least 18 months recommends sex reassignment surgery documented in the form of a written comprehensive evaluation**
- For genital surgical sex reassignment, a second concurring recommendation by another qualified, independent psychiatrist* must be documented in the form of a written expert opinion.
- For genital surgical sex reassignment, the person has undergone a urological examination for identifying and perhaps treating abnormalities of the genitourinary tract, since genital surgical sex reassignment includes the invasion of and the alteration of the genitourinary tract (urological examination is not required for a person not undergoing genital reassignment)
- Person has demonstrated an understanding of the proposed male-to-female or female-to-male sex reassignment surgery with its attendant costs, required lengths of hospitalisation, likely complications and post surgical rehabilitation requirements of the planned surgery.
- Psychotherapy is not an absolute requirement for the surgery unless the psychiatrist’s initial assessment leads to a recommendation for psychotherapy that specifies the goals of treatment, estimate its frequency and duration throughout the real-life experience (usually a minimum of 3 months);
- For genital surgical sex reassignment, the person has successfully lived and worked within the desired gender role full-time for at least 12 months (so-called real-life experience), without periods of returning to the original gender.
- For genital surgical sex reassignment, the person has received at least 12 months of continuous hormonal sex reassignment therapy recommended by a psychiatrist and carried out by an endocrinologist (which can be simultaneous with the real-life experience), unless medically contraindicated.
* At least one of the two psychiatrists making a favourable recommendation for surgical (genital) sex reassignment.
** Either two separate letters or one letter with two signatures is acceptable. One is from the treating psychiatrist. The other can be from a psychiatrist who does a document review of the process and does one final patient assessment and thereafter signs the form. All counselling sessions need to be video recorded. If one of the psychiatric opinions is conflicting, then the patient should be referred to a third psychiatrist and the majority decision should prevail.