Problems in the evaluation of persons who request sex-change surgery

Not all individuals who seek an evaluation for sex-change surgery are true, primary transsexuals. Evaluations need to be thorough and evaluators need to commit themselves to working with a difficult, demanding client population. Problems are related to the state of imperfection in nosology, diagnosis, and scientific knowledge. There is a great need for controlled research, long-term follow-up and consistency in procedural protocols.