The Development of Standards of Care for Individuals with a Male-to-Eunuch Gender Identity Disorder

Abstract

ABSTRACT Currently, the WPATH Standards of Care (SOC) provide guidelines for the treatment of male-to-female (MtF) transsexuals suffering from a gender identity disorder (GID). However, a large number of men with gender dysphoria who desire to be emasculated do not fit the classical pattern of MtF transsexualism. They loathe their manhood, but do not identify as, nor wish to be, female. Instead, they seek castration to become something outside the binary sexes. The formal term for such an individual is “eunuch,” which we here refer to as an MtE transgendered individual. The WPATH SOC, as currently written, are not applicable to these individuals. Indeed, neither the Diagnostic and Statistical Manual IV (DSM-IV) nor the International Classification of Diseases 10 (ICD-10) currently recognizes MtE transgenderism as a specific GID. The closest category into which MtE transgenderism fits in the DSM-IV is “GID Not Otherwise Specified” (GIDNOS). This vague diagnostic category has been a barrier for MtE individuals to receive treatment. An online survey posted at www.eunuch.org provided data on more than 300 individuals who have had voluntary genital ablations (as well as approximately 1,300 self-identified “eunuch wannabes”). More than half of the men who had surgery either did it themselves or resorted to medically unqualified underground “cutters.” This article offers a draft MtE SOC that outlines the criteria that we believe should be satisfied prior to surgical treatment. This draft MtE SOC is designed to initiate discussion of an unserved population of individuals with gender dysphoria, who are currently at risk of serious injury or death from the lack of medical care.