Gender identity disorder or gender dysphoria is a condition that has been known to the general public for quite some time. Its essence lies in the fact that a person does not feel himself in the biological field in which he was born, but identifies with the opposite one; At the same time, a person strives to behave according to his perceived gender, as well as to surgically change his gender to the opposite. Most often this manifests itself from an early age, when a boy avoids violent games, is soft, timid in character, likes to study or play more “girly” games, or when a girl has a fighting character, likes short hair and no dresses with bows, determined, risky "tomboy". Of course, all children are different, and it is not at all necessary that such external signs will necessarily be the initial signs of a discrepancy between the biological sex and the psychological one. But more often, if you delve into the family history of a transsexual, you will find similar signs. As usual, there are debates about the reasons and there are many points of view on this matter, but for me, as a psychologist with a medical education, it is important to bring to the attention of clients that there are purely medical reasons for not accepting one’s own gender, when the gender is really “not quite female or male” ". This is possible in a number of endocrine disorders, when a woman has an excess of male sex hormones in her body, and a man has an excess of hormones, respectively. And an even deeper level of causes are chromosomal aberrations, in other words, a violation of the number or structure of chromosomes, which can be determined by the study of the karyotype - the chromosome set. That is, before starting psychological work or a psychiatric examination, in some cases it is necessary to be examined by other doctors (endocrinologist, gynecologist, andrologist, geneticist). In the case of an adult client with gender dysphoria against the backdrop of establishing a therapeutic relationship, it is useful to understand the possible psychiatric basis, that is, when the existing symptoms, and this, by the way, are intense experiences and sometimes daily suffering, are built into the structure of a mental disorder. Then, even if you go through all the circles and overcome all the difficulties associated with changing biological sex, a “happy ending” does not happen, since mental suffering develops according to its own laws. But of course, those who seriously thought about the “transition”, and this is what the process is called “bringing the soul into harmony with the body” (is this possible with the help of surgery?), they know very well all the milestones of that monstrously difficult path, which in their opinion is the key to a happy future. Naturally, there are online resources with step-by-step practical instructions. The process of preparing for the “transition” can take a year or several; you need a decent amount of money, a lot of patience and perseverance. Thank God, not a single medical clinic that deserves respect will undertake sex reassignment surgery without the conclusion of a medical commission (psychiatrists, psychologists, testing and observation) that there is no mental pathology with the exception of transsexualism itself. Next we will talk about hormone replacement therapy , which is a “rehearsal” for getting used to changes in the body, and also prepares the body for sex reassignment surgery, long-term hormone replacement therapy has a very detrimental effect on the body, which is otherwise taken for granted by transsexuals. The operation itself is a multi-stage process, in addition to the main points, such as phalloplasty, vaginoplasty, mammoplasty or mastectomy (the main stage is 7-9 hours of surgical intervention), there is a set of additional options for feminization or masculinization and a period of biological and psychological rehabilitation, when the desired change of documents occurs. The entire process of transition and progress towards it - This is an extremely difficult and painful stage in life. Feeling not in his body, the transsexual painfully experiences everything, from reflection in.