A literature review by Rachlin (2002) found that the incidence of post-operative regret is generally very small, perhaps only 1%. This is very fortunate, because the effects of hormone therapy and gender reassignment surgey are extremely difficult (and often impossible) to reverse.

Gender reversions may be due to a number of dfferent reasons, such as secondary to religious beliefs, breakdown of a family or long-term relationship, or following a hasty assessment prior to starting treatment. Reversion, whilst is an extremely difficult process (both practically and emotionally), is not impossible, but prevention in the first place is far more desirable.

Therefore a prolonged and careful period of assessment and treatment is vital, with regular reviews and opportunities to slow things down, or even suspend treatment, if necessary.

Research indicates a number of negative prognostic factors which need to be identified and addressed before permanent changes are sought. Psychological readiness and stability, poor emotional support and social isolation are all associated with a poor outcome.

1. Seek referral to see a local psychiatrist and the specialist gender services at the earliest opportunity, to discuss your options at your own pace, without any pressure.

2. Don't be afraid to disclose any mental health problems, such as depression or anxiety, or drug and alcohol problems before transition. These can then be treated initially or at the same time to ensure you feel as emotionally stable as possible for the journey ahead.

3. Decide a Real Life Experience period that is right for you, at your own pace. There is no reason why it can't be extended if you feel you need the extra time.

4. Always be honest with the specialist services about any concerns you have. You won't be denied treatment just for being unsure.

5. Do not start treatments unless you are receiving full medical support. In particular, never take hormones unless they are medically supervised. Do not be tempted to seek treatments elsewhere, including buying pharmaceuticals from the internet.

6. Research all the options yourself about surgery, the different types and the different stages. Ask to see the surgeon as many times as you need. It's OK to have doubts and fears about the operation.

7. Be proactive about seeking emotional support in preparation for the changes ahead. Get in touch with the transgender community, attend social events and consider some local counselling, even if you feel you are coping OK alone.

8. Reduce the risks of post-operative complications and misery by addressing known risk factors for surgery early. Stop smoking, lose excess weight and get regular physical health checks from your local doctor.

9. Discuss the potential pitfalls early on with family and your partner. Try to involve them in the decisions and get them onboard from the beginning. Although it is difficult to do so, it is better to discuss possible negative consequences of transition before you actually do it, including how you would manage a temporary or permanent relationship breakdown.

10. Finally, don't be afraid to express regret at any stage along your journey. The sooner people are aware, the better the options available and ultimately, the happier you will be!

Have you or anyone you know changed their mind about gender change? We would welcome your own views in our Blog.