When a man loves being a woman

There was something strange about the reaction to the two men who this week admitted to undergoing sex changes; stranger than the sight of two burly males, a family doctor and a teacher, posing proudly in skirts and silk scarves. The coverage of their transsexuality, although inevitably intrusive, was largely positive. Yesterday's Daily Mail story, for example, was headlined "The New Look for Dr John Browne"; The Daily Telegraph: "Patients back GP who is to become a woman", noting that his surgery had been flooded with calls of support. Even the tabloids ventured nothing more sensational than the Star's "Sir tells kids: call me miss".

When newspapers best known for their adherence to the most traditional of family values - and their disgust for those who fall outside their parameters - begin covering such stories not just fairly but positively, there is something of a sea change going on.

The Nineties, it was predicted, would be the decade in which gender boundaries would finally dissolve, and to some extent this has been vindicated. There are an estimated 65,000 transsexuals in Britain, with a 50 per cent rise in demand for operations since the mid-Eighties. Appearances have become more androgynous, with long-haired men and shaven-headed women the norm, and merchandisers such as Calvin Klein capitalising on this with phenomenally successful androgynous scents.

Two of the most popular male entertainers of the moment wear women's clothes: the drag queen Lily Savage and the comedian Eddie Izzard, whose preferences for make-up and high heels are so established as to go largely unremarked upon. Their predecessors, Boy George and Julian Clary, are almost passe. These icons, together with increasing numbers of gay marriages and same-sex adoptions have helped blur the boundaries and foster a more widespread acceptance that gender differences are not limited to those between man and woman.

A more sympathetic view towards transsexuality may also stem from recent scientific claims that this condition could have a physiological origin. It has been noted that transsexuals may have an extra X chromosome, while Nature magazine reported that in transsexuals the stria terminalis, a region of the brain, was more like a woman's.

But perhaps the biggest factor has been the growth of the cult of self- fulfilment. Imported from the United States, fostered by a thousand talk shows, this movement proposes that everyone has a right to feel personally fulfilled, whatever the cost. By this reasoning, Diane Blood has a moral right to have a baby by her dead husband. A patient has the right to plastic surgery on the NHS because their appearance makes them chronically depressed. Transsexuals have the right to change their birth certificate in order that they can feel properly female, and perhaps even adopt. In the face of such personal unhappiness, who would be churlish enough to deny them?

The problem is that personal fulfilment often comes at a cost - often someone else's personal fulfilment. The wife of Dr John Browne, Shirley, said yesterday that she felt bereaved by his change of gender. "I have suffered a loss. We were happily married with five wonderful children. Now, here I am on my own," she said. She added that if she could "press a magic button" and get back the man she married, she would.

The feelings of their five children are unreported, but in 1993, St George's Hospital in London opened a clinic for children suffering gender identity disorders - including those undergoing trauma from suddenly acquiring two "mummies" or "daddies".

Finite resources for the health service mean that sex-change operations for transsexuals cannot but draw resources from other areas of medicine. While it is unlikely that other patients will die as a result, health trusts are likely to have to weigh up requests for sex-change operations against, for example, hip replacements: a transsexual's right to fulfilment against a pensioner's right to mobility. Many trusts have already done this, cancelling all "non-essential" surgery.

Sometimes the frenetic search for self-fulfilment may ultimately prove misguided. According to studies in America and Holland, around one in 20 post-operative transsexuals changes his or her mind after surgery, and around one in 10 never adjusts and often becomes deeply depressed.

This may be for a number of reasons; many people who approach clinics about gender reassignment ultimately realise that their problems stem from something other than their sexual status. And others have unrealistic expectations of how happy gender reassignment is going to make them.

Unfortunately, the majority of male-to-female sex-change cases are always going to look just that: sex-change cases. Large hands and feet, broad shoulders and coarse skin create physically unconvincing women, as do the exaggerated versions of femininity that many choose to become: less Jessica Lange than Tootsie.

And while they might see themselves as fully female, such enlightened views do not always extend to the public at large. Jacquie Gavin, a recently married transsexual, told last year how, as she sat in a pub with her husband, one man, followed by his friend and then their wives, approached simply to stare at her.

Stephanie Lloyd, a transsexual and the director of the Albany Gender Identity Clinic in Manchester, is among those who have gone on record to say that sex-change surgery should actually be more difficult to obtain, rather than easier. A very small proportion of those who approach the clinic for help go ahead with full surgery once they know the full facts.

Mike Evert, a factory worker and a father of three, would agree. He reversed his operation after suffering a nervous breakdown. He said afterwards: "It's one thing to want to become a woman - but a completely different thing to do it. I wouldn't recommend it to anyone. You end up destroying your life and those of the people close to you. The world doesn't accept you. You always remain a misfit."

Women might actually ask why, without the benefits of childbirth, men would want to be women anyway. They are voluntarily choosing a lifestyle where they are more likely to be in low-status, low-satisfaction employment, where they will probably earn less than their male colleagues, and run the risk of being sexually harassed. They will have to learn that their short skirts and feminine high heels will put them at risk after dark, and that if they fail to heed these rules there will be little sympathy. Perhaps they should note that in surveys where respondents were asked if they would like to change sex - just for a day - while the vast majority of women said yes, the vast majority of men said no.

Once the first euphoric flush of femininity has died away, transsexuals may find that being a woman, let alone a constructed one, is not all it's cracked up to be. If this proves the case for Dr Browne and Mr Bradley, let's hope the sympathy that is currently propelling them through the difficult process of gender reassignment remains in place to help pick up the pieces.