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Less than half as many operations are requested by women as by men. According to Johns Hopkins Medical Psychologist John Money, the preponderance of men transexuals reflects the fact that men are far more vulnerable to psychosexual disorders than women. Moreover, female-to-male operations are more difficult, more lengthy and more costly (up to $12,000). Breasts are removed, a hysterectomy performed, and in some cases a miniature penis is created by freeing the clitoris from its connective tissue. In others, skin grafts and silicone forms are used to create a penis which may bring a sexual partner to orgasm but has no sensation in itself.
Their own sexual satisfaction, however, is often less important to transexuals than the desire to match their bodies to the gender with which they identify. The major psychological problem after surgery, according to Dr. Fisk, is that in spite of careful counseling, "expectations are often way out of line with reality." For those who want to keep their operation a secret, there is also the chronic tension that goes along with the fear of discovery and exposure.
Keeping a job or getting a new one is also difficult. When Rachelle McAdam appeared before school authorities in a dress, she was given two options: "Resign or be fired." She resigned. Many transexuals marry and adopt children, but there are often legal difficulties, especially in states that forbid sex changes on birth certificates.
Even so, more Americans want transexual surgery than are accepted by U.S. hospitals; many of them have gone abroad for operations. In Casablanca, more than 700 sex-change operations on patients from 17 to 70 have been performed over the past 15 years by Dr. Georges Burou, who specializes in the male-to-female type. Most of his patients have usually lived as women long before they go to Casablanca to take what he calls "the last, irrevocable step." But, insists Dr. Burou, a plain-speaking Frenchman: "I don't change men into women. I transform male genitals into genitals that have a female aspect. All the rest is in the patient's mind."
*Jorgensen, 47, now lives near Los Angeles and lectures on transexuality at colleges across the U.S.