The thesis presents the processes of gender role transition and sex reassignment from the perspectives of psychology, medicine, and sociology. Its main focus is on the various aspects influencing the psyche of a person undertaking transition. The thesis investigates why trans identity is commonly viewed as a pathology and the impact of pathologization on the self-perception of trans people. Furthemore, the traditional outline of the transition process in Czech sexology is compared to some current international approaches. A section of the text addresses psychotherapy as a key factor in transition. A significant component of the thesis is that it takes a sociocultural viewpoint on gender identity and gender roles. One of the goals is to understand how medical experts dealing with trans identity conceptualize transition and how trans people themselves conceptualize it. The overall aim is to investigate how both of these sides influence each other and what psychological aspects enter the processes of gender role transition and sex reassignment. Key words: transsexuality, transgender, sex reassignment, gender identity, gender role.

Few bodies consistently portray natural or unaltered forms. Instead, humans inhabit bodies imbued with sociocultural meanings about what is attractive, appropriate, functional, and presentable. As such, embodiment is always gendered. The social, extra-corporeal body is a central locus for expressing gender. Surgical body modifications represent inherently gendered technologies of the body. But psychomedical institutions subject people who seek gender-crossing surgeries to increased surveillance, managing and regulating cross-gender embodiment as disorderly. Using mixed research methods, this research systematically compared transgender and cisgender (non-transgender) people’s experiences before, during, and after surgical body modification. I conducted a content analysis of 445 threads on a message board for an online cisgender surgery community, an analysis of 15 international protocols for transgender-specific surgeries, and 40 in-depth interviews with cisgender and transgender people who had surgery. The content analysis of the online community revealed similar themes among cisgender and transgender surgery users. However, detailed protocols existed only for transgender consumers of surgery. Interview findings showed that transgender and cisgender people reported similar presurgical feelings toward their bodies, similar cosmetic and psychological motivations for surgery, and similar benefits of surgery. For both cisgender and transgender people, surgery enhanced the inner self through improving the outer gendered body. Despite these similar embodied experiences, having a cisgender gender status determined respondents’ abilities to pursue surgery autonomously and with institutional support. Ultimately, this research highlights inequalities that result from gender status and manifest in psychomedical institutions by identifying the psychosocial impacts of provider/consumer or doctor/patient interactions, relating gendered embodiment to regulatory systems of authority, and illuminating policy implications for clinical practice and legal classifications of sex and gender.

Patients suffering from transsexualism (TS) who apply for sex reassignment surgery (SRS) go through a complex evaluation process before being accepted for treatment. In general, the results from SRS are satisfying. However, further knowledge is needed to clearly delineate transsexualism from other related gender identity disorders (GID) and to improve the selection of candidates for SRS. Personality has for a long time been considered as the key concept for that purpose but systematic studies using reliable instruments are lacking. The present study aims at improving the assessment procedure, validating the concept of transsexualism and studying the outcome of SRS and important prognostic factors. Two methodological studies deal with the development and validation of two self-report instruments based on DSM-III-R: SCID screen covering Axis II personality disorders/traits and Global Assessment of Functioning (GAF-scale, Axis V). SCID screen diagnoses of personality disorders (PD) were compared with diagnoses from independent structured interviews by means of the SCID-II. The overall kappa in identifying a PD was 0.78 varying from 0.34 to 0.81 for the specific PDs when cut-off was adjusted. When applied to a group of GID-patients SCID screen diagnoses agreed well with clinical diagnoses (kappa 0.77). Self-report of the GAF also proved to be a reliable (overall Pearson r=0.62) and useful method and the study lends further support to the validity of Axis V. In three papers a group of 19 transsexuals was studied by means of a) SCID screen to examine their personality in a dimensional and traditional categorical way, b) the GAF-scale to study psychosocial functioning, c) Structural Analysis of Social Behavior (SASB) to examine self-image and d) Defense Mechanism Test (DMT) to analyze psychological defense structures from a psychodynamic perspective. Patients with atypical gender identity disorders (GIDAANT) and patients with borderline personality disorders as well as healthy subjects were used as contrast groups. Among the transsexuals 10 out of 19 had an additional axis I disorder and 37% had at least one PD, predominantly within cluster B. When analyzed dimensionally according to SCID screen, frequent subthreshold personality pathology was found and biological women fulfilled more axis II criteria than men. TS had less axis I and II pathology compared with GIDAANT and psychiatric patients. According to SASB, TS had a positive self-image with both self-control and spontaneous self and predominating self-love. They appeared significantly more healthy on self-image measures than GIDAANT patients. The DMT revealed a different pattern; TS patients were more disturbed in several areas than patients with borderline personality disorder. TS showed no ”emotional investment” and poorer reality orientation in contrast to both healthy controls and the borderline group but shared a similar pregenital pathology with the borderline patients. Finally, five-year outcome was studied among the transsexuals from a multidimensional approach (e.g. work, interpersonal relations, partnership, subjective opinion) and related to index- measurements on DSM-III-R, SCID screen, GAF, SASB and DMT. Based on combined outcome variables, 68% of the subjects were judged to have improved and 16% had an unsatisfactory outcome. One single case regretted the sex change. SCID screen pathology and SASB disturbances emerged as significant predictors for negative outcome, as well as male biological sex and lack of partnership. It was concluded, that although outcome is in general very favorable, the instruments under investigation, in particular SCID screen and SASB, revealed valuable prognostic information and they are suggested to become part of the future routine assessment of candidates for SRS. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 6 uppsatser.</p> / digitalisering@umu

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Refletindo sobre a emergência da categoria da transexualidade como a conhecemos na atualidade e seus desdobramentos sociais, políticos e subjetivos, especialmente a partir da segunda metade do século XX, procuramos nessa dissertação discutir o contexto que possibilitou o fenômeno da medicalização tecnológica dessa categoria. Ao desenvolvê-lo, essa pesquisa aponta atores da categoria médica e da militância que compuseram uma relação de negociação entre a demanda do indivíduo transexual e as possibilidades técnicas, legais e discursivas da biomedicina. Inicialmente, buscamos compreender como os profissionais médicos, psiquiatras e psicanalistas, pertencentes à ciência da sexologia a partir do fim do século XIX, incluíram em seus discursos e práticas os comportamentos sexuais considerados desviantes na época. O homossexualismo e o travestismo, representantes dessas perversões, constituíram categorias diagnósticas e identitárias de fundamental importância para a inauguração da transexualidade enquanto categoria nosológica médico-psiquiátrica e enquanto tipo humano, ou seja, uma forma subjetiva de experiência e identidade de gênero. Diante disso, e considerando o contexto sociocultural e o desenvolvimento biotecnológico hormonal e cirúrgico na época, temos a hipótese que a criação dessa categoria só foi possível devido à incorporação em indivíduos transexuais de procedimentos tecnocientíficos que possibilitaram que suas transformações anatomobiológicas construíssem o gênero desejado. A medicalização da transexualidade e sua regulação médico-jurídica, ao mesmo tempo em que são vetores de patologização e de estigma, possibilitaram o acesso à essas transformações corporais. Essa pesquisa problematiza o acesso à essas tecnologias, condicionado à obtenção do diagnóstico psiquiátrico, e aborda a relação interativa entre os aspectos discursivos e práticos da categoria médica e dos indivíduos transexuais e militância, assim como seus efeitos que iluminam essa questão. Finalmente, com o objetivo de ilustrar e compreender a interação entre a tecnologia e o corpo transexual, descrevemos e discutimos brevemente os principais procedimentos aplicados em homens transexuais e mulheres transexuais na transição de gênero. / Reflecting on the emergence of the category of transsexuality as we know it today and its social, political and subjective consequences, particularly from the second half of the twentieth century, we tried in this dissertation to discuss the context that enabled the phenomenon of technological medicalization of this category. By developing it, this research presents physicians and activists actors who established a negotiation process between the demand of transsexual individuals and biomedicines technical, legal and discursive possibilities. Initially, we sought to understand how medical professionals, psychiatrists and psychoanalysts, belonging to the science of sexology from the late nineteenth century, included in their discourses and practices sexual behaviors considered deviant at the time. Homosexuality and transvestism, representatives of these "perversions", were diagnostic and identity categories of fundamental importance for the inauguration of transsexuality as a medical and psychiatric nosological category and as a "human kind", in other words, a subjective form of gender experience and identity. Therefore, and considering the socio-cultural context and the hormonal and surgical biotechnological development at the time, we have the hypothesis that the creation of this category was only possible due to the embodiment in transgender individuals of technoscientific procedures that enabled the se anatomic and biological transformations to build the desired gender. The medicalization of transsexuality and its medical-legal regulation, while they are vectors of pathologization and stigma, allowed access to these body changes. This research discusses the access to these technologies, subject to obtaining the psychiatric diagnosis, and addresses the interactive relationship between the discursive and practical aspects of the medical category and transsexual activists and individuals, as well as its effects that illuminate this issue. Finally, in order to illustrate and understand the interaction between technology and the transsexual body, we describe and briefly discuss the main procedures applied in transsexual men and transsexual women in gender transition.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Refletindo sobre a emergência da categoria da transexualidade como a conhecemos na atualidade e seus desdobramentos sociais, políticos e subjetivos, especialmente a partir da segunda metade do século XX, procuramos nessa dissertação discutir o contexto que possibilitou o fenômeno da medicalização tecnológica dessa categoria. Ao desenvolvê-lo, essa pesquisa aponta atores da categoria médica e da militância que compuseram uma relação de negociação entre a demanda do indivíduo transexual e as possibilidades técnicas, legais e discursivas da biomedicina. Inicialmente, buscamos compreender como os profissionais médicos, psiquiatras e psicanalistas, pertencentes à ciência da sexologia a partir do fim do século XIX, incluíram em seus discursos e práticas os comportamentos sexuais considerados desviantes na época. O homossexualismo e o travestismo, representantes dessas perversões, constituíram categorias diagnósticas e identitárias de fundamental importância para a inauguração da transexualidade enquanto categoria nosológica médico-psiquiátrica e enquanto tipo humano, ou seja, uma forma subjetiva de experiência e identidade de gênero. Diante disso, e considerando o contexto sociocultural e o desenvolvimento biotecnológico hormonal e cirúrgico na época, temos a hipótese que a criação dessa categoria só foi possível devido à incorporação em indivíduos transexuais de procedimentos tecnocientíficos que possibilitaram que suas transformações anatomobiológicas construíssem o gênero desejado. A medicalização da transexualidade e sua regulação médico-jurídica, ao mesmo tempo em que são vetores de patologização e de estigma, possibilitaram o acesso à essas transformações corporais. Essa pesquisa problematiza o acesso à essas tecnologias, condicionado à obtenção do diagnóstico psiquiátrico, e aborda a relação interativa entre os aspectos discursivos e práticos da categoria médica e dos indivíduos transexuais e militância, assim como seus efeitos que iluminam essa questão. Finalmente, com o objetivo de ilustrar e compreender a interação entre a tecnologia e o corpo transexual, descrevemos e discutimos brevemente os principais procedimentos aplicados em homens transexuais e mulheres transexuais na transição de gênero. / Reflecting on the emergence of the category of transsexuality as we know it today and its social, political and subjective consequences, particularly from the second half of the twentieth century, we tried in this dissertation to discuss the context that enabled the phenomenon of technological medicalization of this category. By developing it, this research presents physicians and activists actors who established a negotiation process between the demand of transsexual individuals and biomedicines technical, legal and discursive possibilities. Initially, we sought to understand how medical professionals, psychiatrists and psychoanalysts, belonging to the science of sexology from the late nineteenth century, included in their discourses and practices sexual behaviors considered deviant at the time. Homosexuality and transvestism, representatives of these "perversions", were diagnostic and identity categories of fundamental importance for the inauguration of transsexuality as a medical and psychiatric nosological category and as a "human kind", in other words, a subjective form of gender experience and identity. Therefore, and considering the socio-cultural context and the hormonal and surgical biotechnological development at the time, we have the hypothesis that the creation of this category was only possible due to the embodiment in transgender individuals of technoscientific procedures that enabled the se anatomic and biological transformations to build the desired gender. The medicalization of transsexuality and its medical-legal regulation, while they are vectors of pathologization and stigma, allowed access to these body changes. This research discusses the access to these technologies, subject to obtaining the psychiatric diagnosis, and addresses the interactive relationship between the discursive and practical aspects of the medical category and transsexual activists and individuals, as well as its effects that illuminate this issue. Finally, in order to illustrate and understand the interaction between technology and the transsexual body, we describe and briefly discuss the main procedures applied in transsexual men and transsexual women in gender transition.

Den här studien handlar om olika diskurser kring genitala ingrepp på personer som upplever att de har en annan könsidentitet än den juridiska könstillhörigheten, och vill genomföra en juridisk könsändring. Syftet med uppsatsen var att genom analyser av dessa diskurser försöka förstå hur genitalierna är kopplade till den sociala konstruktionen av kön och genus. Intervjuer har gjorts med personer som finns med i utrednings- och beslutsprocess eller har verkställighetsfunktion som berör de genitala ingreppen. Det har inneburit psykiatriker, kirurger och jurister. Intervjuer har även gjorts med föreningsrepresentanter för transsexuella, före detta transsexuella och transpersoner. Flertalet inom professionen uttrycker att genitalierna har en avgörande betydelse för bestämmande av kön och genus. Även om de har en uppfattning om att könet ”sitter i huvudet” måste detta överensstämma med känslan för genitalierna. Det finns en skillnad i resonemanget för KtM (Kvinna-till-man-transsexuella) och MtK (Man-till-Kvinna-transsexuella). Penis ses som den mest avgörande könsmarkören och flertalet av de intervjuade inom professionen hade svårt att förstå att en person som vill behålla sin penis kan ha en könsidentitet som kvinna. Vaginan uttrycktes inte ha samma status som könsmarkör men livmoder och äggstockar och dess reproduktiva funktion uttrycktes nästan ha samma betydelse som könsmarkör som penis. De inom professionen hade därmed svårt att förstå hur en gravid person skulle kunna ha en könsidentitet som man.De som representerade transsexuella, före detta transsexuella och transpersoner uttryckte olika syn på kön och definition av kön. Det gavs både uttryck för att hela kroppen inklusive genitalierna skulle ha stor betydelse för kön men det gavs även uttryck för att kroppen och genitalierna inte i sig skulle ha betydelse för kön utan att ”könet i huvudet” var det viktigaste för bestämmande av kön. / The aim of this thesis was to, through the analyses of different discourses surrounding sex reassignment try to understand how the genitals are linked to the social construction of sex and gender. I have interviewed psychiatrists, surgeons and people dealing with the laws surrounding sex reassignment surgery. I also interviewed people from organizations who represent transgender persons, transsexuals and former transsexuals. Most of the professionals indicate in the interviews that the genitals have an essential meaning in the decision-making regarding sex and gender. Even if they have an idea that the gender is “in the head”, it has to match the feelings for the genitals. There is a difference between the reasoning for FtM (Female-to-male-transsexual) and MtF (Male-to-female-transsexual). The penis is seen as the most essential sex marker and most of the professionals that were interviewed had difficulties in understanding how a person who wanted to keep the penis could have a gender identity as a woman. The vagina did not have the same status as a sex marker but instead the reproductive function from the ovaries and the uterus had almost the same status as a sex marker as the penis. For this reason the professionals that where interviewed had difficulties in understanding that a pregnant person could have a gender identity as a man. People from organizations who represented transgender persons, transsexuals and former transsexuals had some differing views. One considered that the whole body including the genitals was important for the feeling about ones gender while the other person expressed that the gender “in the head” was more vital for the decision and feelings of sex and gender.

A presente dissertação tem o escopo analisar o transexualismo em seus aspectos históricos, culturais, científicos, médicos, jurídicos e bioéticos, em especial quanto à submissão à cirúrgica da transgenitalização, como manifestação do princípio da dignidade da pessoa humana, do direito de isonomina e do direito à saúde, garantias fundamentais previstas na Constituição Federal. O progresso da medicina permite, há décadas, a mudança de sexo, adequando a genitália do transexual ao seu sexo psicológico, inconciliáveis e antagônicos. Entretanto, o transexual se depara com a falta de dispositivo legal que regulamente o ato cirúrgico de mudança de sexo e a retificação do registro civil, adequando o nome e o sexo do transexual operado à nova situação. O percurso dos interessados na mudança de sexo é difícil, repleto de obstáculos de diversas ordens, onde muitas vezes, o judiciário representa a consolidação do sofrimento e da exclusão social. O exercício pleno da cidadania exige o reconhecimento do direito à redesignação sexual e retificação do nome e do sexo no registro civil, além do direito à família, especificamente, ao casamento e à filiação. O presente estudo tem como objetivo demonstrar que a cirurgia de transgenitalização, bem como a correspondente alteração do registro civil do transexual são formas de concretização de direitos fundamentais, do direito à saúde e meios de proteção à dignidade da pessoa humana. / This thesis has as its main objective to analyze transsexualism in its historical, cultural, scientific , medical, legal and bioethical aspect, especially regarding the performance of the Sex Reassignment Surgery (RSR) as a manifestation of the human dignity principle, the right to isonomy and the right to health, and to fundamental guarantees provided for in the Federal Constitution . Medical advances have made the Sex Reassignment Surgery (SRS) possible for decades, thus adapting the genitalia of the transsexual to his/her psychological gender, which is irreconcilable and antagonistic. However, the transsexual is faced with the lack of legal provisions to regulate sex change operations and to ratify civil registry records, adjusting the name and the gender of the operated transsexual to the new situation. The ones interested in sex change operations have a long way to go; they will have to overcome all sorts of obstacles, where quite often the judiciary is the consolidation of suffering and social exclusion. The full and effective exercise of citizenship requires a recognition of the right to the Sexual Reassignment Surgery (SRS) and to name and gender rectification in civil registries, besides the right to family, more specifically, the right to marriage and to affiliation. This study has as its main objective to demonstrate that the Sex Reassignment Surgery (SRS) as well as the corresponding modification of the transgender civil registry are embodiments of fundamental rights, and of health rights and they also are safeguards of human dignity.

Made available in DSpace on 2016-04-26T20:30:29Z (GMT). No. of bitstreams: 1 Livia Cristina Rocha.pdf: 815766 bytes, checksum: 82635d5039ae0bb942d92f31298e9467 (MD5) Previous issue date: 2010-06-16 / This study aims to analyze the many issues raised in relation to the reassignment of sex in their ways: neocolpovulvoplastia and neofaloplastia. Among them: surgical inefficiency and the possibility of repentance, the body naturally created; finding injury of serious nature, and especially the consequences brought by this surgery in the legal world. The reassignment of sex is only compatible with the figure of the transsexual, except for his help in other cases the behavioral states of sexuality (intersex, hermaphroditism, homosexuality, bisexuality and transvestism). The transsexual is defined as the person who experience an ongoing conflict between their physical sex and psychological, in other words, their mental gender identity does not match with the biological, which leads the transsexual vehemently deny their sexual organs, and in some cases the injured themselves or commit suicide. Thus, the reassignment of sex is shown as the only proper means to repair the suffering of transsexuals and is the only effective treatment. She is the extent of body-mind balance and essential to the preservation of life, health, health (physical and mental) and well-being of the patient. Once accomplished, brings with anatomical transformation for the transsexual, but how it reflects the legal world? Currently, the transsexual surgery is recognized the right to change the first name and sex in its civil register. Emphasized that it is not a unanimous position. At this point, the course includes the three main current jurisprudence, the first one in favor of changing the civil registry and its dual knowledge (first name and gender), the second most favorable only to registration under the justification of preserving rights of third parties and continuity of existing Public and, finally, one that begs the insertion of the term "transsexual" in the cartouche would register, so it would be acting under the aegis of the veracity of public record. Beyond these points, see that the only way to promote social inclusion of transsexuals will be with the completion of the process begun with the reassignment of sex, which is just a phase, complemented with the conclusion of the civil registry change that, because only thus can preserve and realize the much-trumpeted principle of human dignity / O presente trabalho tem como objetivo analisar as questões suscitadas em relação à cirurgia de redesignação de sexo em suas modalidades: neocolpovulvoplastia e neofaloplastia. Dentre elas: ineficácia cirúrgica; possibilidade de arrependimento; naturalidade do órgão criado; constatação de lesão corporal de natureza grave; e, especialmente, os reflexos trazidos pela realização dessa cirurgia no mundo jurídico. A cirurgia de redesignação de sexo apenas é compatível com a figura do transexual, excluindo de seu amparo os demais casos de estados comportamentais da sexualidade (intersexualismo; hermafroditismo; homossexualismo; bissexualismo e travestismo). O transexual é definido como aquela pessoa que vivencia um conflito permanente entre seus sexos físico e psíquico, em outras palavras, sua identidade sexual psíquica não corresponde com a biológica, o que leva o transexual recusar veemente seus órgãos sexuais, chegando em alguns casos a lesionar-se ou suicidar-se. Destarte, a cirurgia de redesignação de sexo se mostra como o único meio hábil para reparar o sofrimento do transexual, constituindo a única forma de tratamento efetivo. Ela é o alcance do equilíbrio corpo-mente e essencial à preservação da vida, da saúde, da integridade (física e psíquica) e do bem-estar do paciente. Uma vez realizada, traz relevante transformação anatômica para o transexual, mas como isso reflete no mundo jurídico? Atualmente, ao transexual operado é reconhecido o direito à alteração do prenome e do sexo em seu registro civil. Ressalta que não é uma posição unânime. Neste ponto, serão estudadas as três principais correntes jurisprudências, a primeira delas favorável à alteração do registro civil e seu duplo conhecimento (prenome e sexo); a segunda delas favorável apenas à averbação, sob a justificativa de preservar direito de terceiros e a continuidade do registro público; e, por último, aquela que suplica pela inserção da denominação transexual na cártula registrária, assim estaria agindo sob a égide da veracidade do registro público. Ultrapassados esses pontos, verá que o único modo de promover a inclusão social do transexual será com a completude do processo iniciado com a cirurgia de redesignação de sexo, que é apenas uma fase, sendo complementada com a efetivação da alteração do registro civil daquele, pois, somente assim poderá preservar e efetivar o tão proclamado princípio da dignidade humana

A presente dissertação analisa a implementação do Processo Transexualizador no âmbito do Sistema Único de Saúde (SUS), à luz do ideário do Movimento de Reforma Sanitária e de uma perspectiva histórica da política de saúde pública brasileira, detendo-se nas particularidades do Estado do Rio de Janeiro. Discutem-se alguns aspectos da transexualidade relacionados à esfera pública e à efetiva materialização dos direitos da população LGBT, em particular o acesso à saúde de pessoas transexuais. O recorte temporal compreende o período de 1970, quando se iniciam as primeiras cirurgias de transgenitalização no Brasil, a 2008, ano das portarias que instituíram o referido processo. Como instrumentos e técnicas de investigação qualitativa, foram privilegiados o trabalho de campo e a entrevista semiestruturada, tendo sido entrevistados(as) profissionais que atuaram em instituições de saúde que dispunham de programas voltados especificamente à população transexual no Estado do Rio de Janeiro e usuários(as) atendidos(as) por estas instituições. Diante do cenário de discriminação e estigma, muitas vezes fruto do desconhecimento e de informações deturpadas sobre transexualidade, pretende-se conferir maior visibilidade às demandas por direitos de pessoas transexuais, evidenciando a complexidade de tais demandas, bem como as fragilidades do modelo de atenção à saúde subjacente aos mencionados programas. Pretende-se, ainda, contribuir para o fomento da produção acadêmica do Serviço Social, relativamente limitada nesta área. / This dissertation examines the implementation of the sex reassignment process in the Unified Health System (SUS), from the ideals of the Health Reform Movement and a historical perspective of the Brazilian public health policy, focusing on the particularities of the State of Rio de Janeiro. Some aspects of transsexuality related to the state's sphere and to the effective realization of the rights of the LGBT population are discussed, particularly the access to health care for transsexual people. The time frame covers the period from 1970, when the first reassignment surgeries were started in Brazil, and 2008, when such process was officially instituted. The applied methodology favored, as tools and techniques of qualitative research, were fieldwork and semi structured interview with professionals who have worked in the health institutions that had programs geared specifically to transsexual population in the State of Rio de Janeiro and users of health services of these programs. In this scenario of discrimination and stigma, often the result of ignorance and misrepresented information about transsexuality, it is intended to give greater visibility to the health demands of transsexuals, showing the complexity of such demands as well as the weaknesses of the model of healthcare behind the aforementioned programs. It is also intended to contribute to the fomentation of academic production of Social Work, which is relatively limited in this area.

Objectif et problématique : Le transsexualisme ainsi que son traitement par la transformation hormonale et chirurgicale (THC) sont des phénomènes au carrefour de toutes les limites : corps, subjectivité, société, psyché… Face au constat de cette complexité, partant des approches structurale et déconstructiviste, cette thèse a pour objectif de définir et proposer une nouvelle approche « transversale » du transsexualisme, et dans la continuité de celle-ci de l’identité sexuée, avec les éléments de la théorie psychanalytique que sont la pulsion sexuelle de mort, la troisième topique de l’Inconscient clivé, la réalisation pulsionnelle par la perception et la clinique de l’extrême et de l’ordinaire.Matériel et méthode : Sur un échantillon de six sujets transsexuels masculin vers féminin ayant actuellement recours ou ayant eu recours à la THC depuis plus de deux ans, nous avons analysé les résultats à un entretien clinique inspiré de l’approche structurale, aux tests projectifs du rorschach et du TAT selon l’école projectiviste de Paris Descartes, ainsi qu’au MMPI-2. Nos trois hypothèses sont que la problématique identitaire transsexuelle renverrait à la pulsion sexuelle de mort, à l’Inconscient amential et à la clinique de l’extrême, puis que la THC aurait le potentiel d’agir telle une réalisation pulsionnelle par la perception.Résultats : Les résultats valident les deux premières hypothèses sur la pulsion sexuelle, l’Inconscient amential et la clinique de l’extrême, mais pas celle sur la réalisation pulsionnelle par la perception.Conclusion et discussion : Ces résultats montrent l’intérêt d’une approche transversale pour appréhender un phénomène limite comme le sont le transsexualisme et l’identité sexuée qui se voient éclairés par les éléments théoriques transversaux proposés (pulsion sexuelle de mort, Inconscient amential et clinique de l’extrême). Concernant, les effets de la THC au niveau psychique, il semble nécessaire de poursuivre notre investigation, la réalisation pulsionnelle par la perception ayant été validée chez un de nos deux sujets ayant terminé la THC depuis plus de deux ans, mais exclue chez l’autre. / Objective and problematic: the transsexualism as well as its treatment by the hormonal and surgical sex reassignment are phenomena in the crossroads of all the limits: body, subjectivity, society, psyche … In front of this complexity, running with the approaches structural and deconstructivist, this thesis has for objective to define and to propose a new "transversal" approach of the transsexualism, and in the continuity of this one of the sexed identity, with the elements of the psychoanalytical theory that are the sexual death drive, the third topical of the splited Unconscious, the impulsive realization by the perception and the clinical of the extreme and the ordinary.Material(Equipment) and method: on sample of six subjects transsexuals male to female resorting at present or having resorted to the sex reassignment for more than two years, we analyzed the results in a clinical interview inspired by the structural approach, in the projective tests of the rorschach and the TAT according to the projectivist method of Paris Descartes, as well as in the MMPI-2. Our three hypotheses are that the transsexual identity problematic would send back to the sexual death drive, to the amential Unconscious and to the clinical of the extreme, then that the sex reassignment would have the potential to act such as an impulsive realization by the perception.Results: the results validate both first ones hypothesis on the sex drive, the amential Unconscious and the clinical of the extreme, but not that one on the impulsive realization by the perception.Conclusion and discussion: these results show the interest of a transversal approach to dread a phenomenon borderline as are it the transsexualism and the sexed identity which see each other lit by the transversal theoretical proposed elements (sexual death drive, amential Unconscious and private hospital of the extreme). Concerning, the effects of psychic sex reassignment at the level, it seems necessary to pursue our investigation, the impulsive realization by the perception has been validated to one of our subject but excluded to the other one.