A resource for speech pathologists
 The Journey
The journey that an individual who reassigns their gender takes is not a uniform one. Each individual will present with a unique history and at different stages in life. This will affect the path that they take on the way to gender reassignment. The unifying factor will be the lifelong conviction that the individual belongs to the opposite sex.
The process of formally reassigning one’s gender commences with a mental health assessment. This may occur at a specialised gender dysphoria clinic. The assessment process establishes whether an individual has gender identity disorder or another condition that has gender dysphoria symptoms.16 This diagnosis is made using the DSM-IV-TR (pdf) criteria for gender identity disorder.10
Once a diagnosis of gender identity disorder is made, the individual is required to live full-time for a minimum of 12 months in the desired gender before gender reassignment can occur.43 The minimum length of this period will vary between regions. For example, at the Monash Gender Dysphoria Clinic in Melbourne, the minimum is 18 months. This period is often called the real life test and allows an individual to adjust to his or her new gender.16 It may take time before an individual is able to commence this stage as there are numerous practical implications that must be overcome. Either before or during this period, hormones are prescribed under the guidance of an endocrinologist.10 Genital reconstructive surgery will only be performed after successful completion of this stage. It should be noted, however, that some individuals may decide not to undergo this surgery.10
Each individual will progress through the gender reassignment journey differently and this is reflected in the differing stages at which they seek the services of a speech pathologist. An individual may present for voice and communication therapy after diagnosis and the prescription of hormones, before or while living full-time in their desired gender.13
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