Gender identity and sexual preference aren't necessarily related, Dr. Bowers says. "Generally, if you consider yourself female, you're attracted to males, and vice versa…but not necessarily."
Dr. Bowers says she feels like people are often born in the wrong body. "When I interview patients coming in for surgery, better than 90 percent feel that they had cross-gender feelings from the very earliest of age—less than age 7," she says. "And that really suggests that it's something biological."
In order to have reassignment surgery, Dr. Bowers says patients must complete a series of steps. "You're required to go through psychotherapy to make sure there aren't other mental issues and it also plays a very important supportive role—but it's not a psychiatric illness, I don't believe," she says. "However, that psychiatric diagnosis is necessary in order for a person to get treatment. And then, of course, they have to go on hormones for a year and then live as their desired gender for a year before going on to surgery."