Caitlyn Jenner and everything you need to know about sex changes

Caitlyn Jenner and everything you need to know about sex changes
By Kateryna Khinkulova
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Caitlyn Jenner, formerly Bruce Jenner, one of the Kardashian-Jenner socialite clan, made Twitter history by getting more than one million followers in just a few hours. She beat Barack Obama, previously holder of the Guinness World Record.


Ms Jenner’s Twitter account was launched as she appeared as a transgender woman on the cover of Vanity Fair magazine, photographed by Annie Leibovitz.

Kardashian-Jenners have long been in the centre of media and public attention with twists and turns of their family and love lives, closely followed by a reality TV show, Keeping Up with the Kardashians.

The transformation of Bruce Jenner – an Olympic gold medalist – into a woman marks a new peak in the attention on the family. But it is stimulated by curiosity, rather than obsession with Kardashians themselves, and an interest in answers to questions like: why does a man want to become a woman? What is sex reassignment, or sex change? Why does it become necessary and how is it carried out? Euronews reporter Kateryna Khinkulova tried to find out.

What is gender? Biology versus the mind

Fifty years ago, the John Hopkins Hospital in New York became the first institution in the US to carry out sex change operations. The hospital set up a Gender Identity Clinic to help people who, as plastic surgeon Dr John Hoopes, the clinic’s chairman, put it, were “physically normal” but “psychologically the opposite sex”.

The condition is described by psychotherapists and surgeons as gender dysphoria: people who are born with physical attributes of one gender but identify with the opposite sex.

Statistics on how many humans are transgender aren’t precise. In the USA the World Professional Association for Transgender Health estimates around one in every 12,000 males and one in every 30,000 females are born with gender dysphoria.

Not every man or woman who feels uncomfortable with their biological sex transforms into the opposite gender. Even in developed Western countries – where the issue of sex transformation is not subject of cultural or social taboos – therapy, treatment and surgery necessary for complete gender change do not automatically follow. If, however, a person feels strongly that they have been born into the wrong biological sex, options are available to cope with the condition.

Causes of gender dysphoria: X or Y?

There is no common opinion within the medical profession whether gender dysphoria is a psychiatric or biological condition. It is accepted that it is not a mental illness. A person’s gender is determined by chromosomes. Every one of us has two sex chromosomes, one from each parent. In the early stages of pregnancy all babies are female, as only the X chromosome, the one inherited from the mother, is active. At the 8th week of gestation the chromosome inherited from the father becomes active. It could either be X (female) or Y (male).

If the foetus inherits an X chromosome from the father, the baby continues to develop as a female, if it inherits a Y chromosome, it develops as a male. At the point when the second chromosome is inherited the foetus will receive a surge of either female hormones, in which case it will continue to develop as a female, or male hormones and it will develop as a male. The hormones will work on the brain, reproductive organs and genitals and will make an unborn baby into a male or a female.

In some cases the hormones may not work properly and a mismatch between biological sex (genitals and reproductive organs) and gender identity (a function in the brain) may appear and cause gender dysphoria in the human after he or she is born. The degree of mismatch may vary as will the degree of discomfort caused by having to live with one’s biological gender. Some people with gender dysphoria may choose to reassign their biological gender to the opposite one later in life.


Gender dysphoria is a condition which may be treated with sex reassignment, but it has to be diagnosed first.

Non-surgical sex reassignment

Sex reassignment may reach various stages, and may or may not involve surgery. Often help with gender dysphoria may be aimed at reducing the sense of distress caused by the mismatch between biological sex and gender identity. Psychotherapists believe that for some people dressing and living as their preferred gender may suffice.

In other cases a person may choose to undergo hormone therapy in the course of which they will become more like someone of their preferred gender. A transgender man (a person with female biological sex and male identity) will take testosterone as part of hormone therapy and will notice more body and facial hair, more muscle, periods becoming infrequent or stopping, changes in shape and appearance of genitals and increased libido. A transgender woman (a man, like Bruce Jenner, with male sex and female identity) taking oestrogen will notice less muscle, more fat on hips, increase in breast size and decrease in penis and testicles, less body and facial hair.

Hormone therapy is often sufficient to relieve the stress of living with the wrong gender. Physical sex reassignment procedures are costly and can be highly invasive, therefore the person undergoing them has to be certain of their decision to go through with them.

Sex change surgery

Surgery takes transformation of a person to their identified gender to the next stage as it makes up for what cannot be achieved with social experiences or hormone therapy. Surgery takes care of transforming a transgender person’s body to look and feel like their identified gender, primarily, genitals, chest and sometimes face. This may include breast implants or breast removal, genital removal and/or reconstruction, hysterectomy, facial surgery, hair implants.


Research into the possibility of sex reassignment dates back to the early 20th century. A German, Dr Magnus Hirschfeld, pioneered much of these studies at his Institute for Sexual Science. The institute is thought to have performed sex reassignment operations as early as 1912. The first known case of genital transformation was performed in the course of several operations in the 1920s on Dorchen Richter, a man uncomfortable with his gender who had been living as a woman for a while. An operation performed by the institute, which received a lot of publicity, was carried out in 1931 in Berlin on a Danish artist named Einar Wegener. He underwent a male to female operation to become Lili Elbe. Elbe had four more operations, eventually dying after an unsuccessful uterus transplant.

In the latter part of the 20th century sex change operations became more common and much safer. Thailand now performs more sex change operations than any other country in the world: this may be due to the country’s vibrant sex industry and wider social acceptance of transgender people. Second after Thailand is, somewhat unexpectedly, Iran: here a large number of sex-reassignment is linked to the fact that same-sex relationships are illegal and some men choose to change their gender to be able to have a relationship with another man.

Even if ways to approach gender dysphoria are numerous and treatments available are both invasive and non-invasive, the condition itself remains a mystery. It is not clear if it is hormonal or originates elsewhere. It is not known how difficult it is to live with and to what extent it is suppressed or encouraged by external factors.

Perhaps this mystery is responsible for the fascination around all things transgender. Last year a bearded songstress Conchita Wurst won Eurovision, this year a former Olympic gold medalist turned reality show star Bruce Jenner became Caitlyn, and back in 1999 a Spanish director Pedro Almodovar made a whole film, All About My Mother, about conflicting identities of transgender people and dedicated it, among others, “to men who act and become women”.

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