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Sex change is a process by which a living being changes sex – that is, by which female sexual characteristics are substituted for male ones or vice versa. Sex change may occur naturally, as in the case of the sequential hermaphroditism observed in some species. Most commonly, however, the term is used for sex reassignment therapy, including sex reassignment surgery, carried out on humans. It is also sometimes used for the medical procedures applied to intersex people. The term may also be applied to the broader process of changing gender role ("living as a woman" instead of living as a man, or vice versa), including but not necessarily limited to medical procedures.
Some species exhibit sequential hermaphroditism. In these species, such as many species of coral reef fishes, sex change is a normal anatomical process.[1] Clownfish, wrasses, moray eels, gobies[2] and other fish species are known to change sex, including reproductive functions. A school of clownfish is always built into a hierarchy with a female fish at the top. When she dies, the most dominant male changes sex and takes her place.[3] In the wrasses (the family Labridae), sex change is from female to male, with the largest female of the harem changing into a male and taking over the harem upon the disappearance of the previous dominant male.
Natural sex change, in both directions, has also been reported in mushroom corals. This is posited to take place in response to environmental or energetic constraints, and to improve the organism's evolutionary fitness; similar phenomena are observed in some dioecious plants.[4]
Chickens can sometimes undergo natural sex changes. Normally, female chickens have just one functional ovary, on their left side. Although two sex organs are present during the embryonic stages of all birds, once a chicken's female hormones come into effect, it typically develops only the left ovary. The right gonad, which has yet to be defined as an ovary, testes, or both (called an ovotestis), typically remains dormant. Certain medical conditions can cause a chicken's left ovary to regress. In the absence of a functional left ovary, the dormant right sex organ may begin to grow; if the activated right gonad is an ovotestis or testes, it will begin secreting androgens. The hen does not completely change into a rooster, however. This transition is limited to making the bird phenotypically male.[5][6] The condition could also be caused by mycotoxins that can develop when animal feed is stored, and these have the same effect as synthetic hormones.[7] In about 10 percent of cases, if eggs fertilized with male chromosomes are cooled by a few degrees for three days after laying, the relative activity of the sex hormones will favour development of female characteristics. The sex chromosomes work by coding for enzymes that affect the bird's development in the egg and during its life. This cooling will produce a chicken with a fully functioning and reproductively fertile female body-type; even though the chicken is genetically male.[8]
Several medical conditions can result in an apparent sex change in humans, where the appearance at birth is somewhat, mostly, or completely of one sex, but changes over the course of a lifetime to being somewhat, mostly, or completely of the other sex[citation needed]. Overwhelming majority of natural sex changes are from a female appearance at birth to a male appearance after puberty, due to either 5-alpha-reductase deficiency (5alpha-RD-2) or 17-beta-hydroxysteroid dehydrogenase deficiency (17beta-HSD-3).[9][10]
Genetic females (with two X chromosomes) with congenital adrenal hyperplasia lack an enzyme needed by the adrenal gland to make the hormones cortisol and aldosterone. Without these hormones, the body produces more androgens. This causes male sex characteristics to appear early (or inappropriately).[11][12][13]
Genetic males (with one X and one Y chromosome) with androgen insensitivity syndrome (AIS) are resistant to androgens. As a result, the person has some or all of the physical characteristics of a female, despite having the genetic makeup of a male. The degree of sexual ambiguity varies widely in persons with incomplete AIS. Incomplete AIS can include other disorders such as Reifenstein syndrome which is associated with breast development in men.[14]
The term "sex change" to refer to sex reassignment surgery, that is, a set of medical procedures undergone by transgender people to alter their sexual characteristics from male to female or from female to male, is considered offensive and inaccurate by many in the transgender community.[15] The term is also sometimes used for the medical procedures intersex people undergo, or, more often, are subjected to as children.
The term "sex change" is sometimes also used for the whole process of changing gender role ("living as a woman" instead of living as a man, or vice versa), not limited to medical procedures. (This process is often much more important to transgender people than the medical procedures themselves, although medically induced changes and surgeries may be needed to make a change of gender role possible, both socially and legally; they can also have a very significant impact on the person's well-being.)
Many people regard the term "sex reassignment surgery" as preferable to "sex change".[16] Sex in humans is usually determined by four factors:
Not all of these factors can be changed:
Sex reassignment is usually preceded by a period of feminization or masculinization. This is accomplished through hormone replacement therapy, where, for those transitioning to female, estrogens and antiandrogens and sometimes progestogens are prescribed. For those transitioning to male, androgens are prescribed. The most common minimum waiting period before gender reassignment surgery is two years, as specified by the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. Hormone replacement therapy is normally started after sufficient counseling, and/or after a period of living 'full-time' (in the target gender) typically for a minimum of six months. This waiting period may vary depending on local regulations and is sometimes nonexistent. Many trans people become medical tourists, as gender reassignment surgery is typically less expensive, less regulated, and sometimes performed by much more experienced surgeons in countries such as Thailand. People who undergo sex reassignment surgery reversal are said to have detransitioned.
^ Black, MP; Grober, MS (2003). "Group sex, sex change, and parasitic males: Sexual strategies among the fishes and their neurobiological correlates". Annual Review of Sex Research. 14: 160–84. PMID 15287162.
^ Lorenzi, V; Earley, R.L.; Grober, M.S. (2006). "Preventing behavioural interactions with a male facilitates sex change in female bluebanded gobies, Lythrypnus dalli". Behavioral Ecology and Sociobiology. 59 (6): 715–722. doi:10.1007/s00265-005-0101-0. S2CID 18416862.
^ "Nemo Meets Neuroscience" (Article). Beckman Institute. Retrieved 2020-12-23.
^ Yossi Loya and Kazuhiko Sakai, "Bidirectional sex change in mushroom stony corals", Proceedings of the Royal Society B, 22 October 2008
^ Remy Melina (31 March 2011). "Sex-Change Chicken: Gertie the Hen Becomes Bertie the Cockerel". Live Science.
^ Shaikat, Amir Hossan (2015). "Investigation of Sex Reversal in Layer Chickens in Bangladesh" (PDF). Advances in Animal and Veterinary Sciences. 3 (4): 245–252. doi:10.14737/JOURNAL.AAVS/2015/3.4.245.252. S2CID 10764239. Retrieved 26 February 2020.
^ "'Sex-change' chicken shocks Cambridgeshire owner". BBC News. 31 March 2011.
^ Luis Villazon (24 September 2009). "Can chickens really change gender?". BBC Focus magazine.
^ Cohen-Kettenis, Peggy T. (2005). "Gender Change in 46,XY Persons with 5α-Reductase-2 Deficiency and 17β-Hydroxysteroid Dehydrogenase-3 Deficiency". Archives of Sexual Behavior. 34 (4): 399–410. doi:10.1007/s10508-005-4339-4. PMID 16010463. S2CID 146495456.
^ Bertelloni, Silvano; Maggio, M. Cristina; Federico, Giovanni; Baroncelli, Giampiero; Hiort, Olaf (2006). "17β-Hydroxysteroid dehydrogenase-3 deficiency: A rare endocrine cause of male-to-female sex reversal". Gynecological Endocrinology. 22 (9): 488–94. doi:10.1080/09513590600921358. PMID 17071532. S2CID 45138108.
^ pmhdev. "Congenital Adrenal Hyperplasia - National Library of Medicine". PubMed Health.
^ Bostwick, J. M.; Martin, K. A. (2007). "A Man's Brain in an Ambiguous Body: A Case of Mistaken Gender Identity". American Journal of Psychiatry. 164 (10): 1499–505. doi:10.1176/appi.ajp.2007.07040587. PMID 17898338.
^ "Frequently Asked Questions". www.isna.org.
^ "Androgen insensitivity syndrome: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov.
^ Ennis, Dawn (4 February 2016). "10 Words Transgender People Want You to Know (But Not Say)". The Advocate. Retrieved 16 February 2021.
^ Pfäfflin F, Junge A (2003). Sex reassignment thirty years of international follow-up studies after sex reassignment surgery: a comprehensive review, 1961–1991. International journal of transgenderism. Symposion: Düsseldorf. OCLC 244295488.[page needed]
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The pursuit of calm can itself become a major stressor, especially if you've already tried the standard prescriptions. But there is a path through this conundrum.
Posted August 12, 2017 | Reviewed by Lybi Ma
This post is in response to
What Sex Really Means to Women By Laurie J Watson LMFT, LPC
Over my career as a sex therapist, I have had the opportunity to sit with thousands of men as they've discussed their sexual feelings, sex lives, and fantasies. Obviously, I don’t know what it feels like to be a man, but I have had the honor of listening to the male perspective on sexual relationships. And while every man is different, of course, there are some common themes:
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While women’s desire for sex may be prompted by their mind, memory, or emotional feelings of connection, for men desire is physical. Men have massive amounts of testosterone coursing through their bodies, pushing and driving them toward sexual expression. Erections spring at the slightest provocation in young men. And for an adult man, seeing his wife or partner coming out of the shower naked causes his body to react. It is hard to overestimate the way his body chemistry directs his mind’s psychology toward the sexual.
Yes, he wants to be full. But his craving for sex is like a craving for chocolates: Each sexual episode holds the exquisite possibility of a surprise-filled confection — maybe creamy smooth, or buttery rich, perhaps a little raw and bittersweet, or silky sweet. His mind is captivated by the thought of an opportunity to feel delighted and surprised. A day is hardly complete without dessert. Yet, the context of the relationship — for instance, a fight with his wife — can still spoil his appetite.
Sexuality infuses a man’s intimate relationships with potential and excitement. The hormonal energy gives him the drive and aggression to pursue his life’s purpose and work and to pursue his partner. He pushes through daily monotony, tantalized by the fantasy of a sexual reward at the end of a hard day.
It’s life most thrilling adventure. His body is a great pleasure machine that he’d like to enjoy at full throttle. Since orgasm is usually reliable and easy, a variety of sexual acts, positions, and rhythms seem to be a fantastic way to explore and elevate his gratification. Every flirtation, smile, innuendo, shapely figure, or sexual image, whether fantasized or real, is a hit on the male brain. His brainwaves spike with elation just at the hint of something or someone reminding him of sex.
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The moment his partner gets turned on is often the moment men describe as most sexually satisfying. It’s baffling to men when they are called selfish because of their preference for sexual connection. In their hearts, there is an expectation of mutual, exquisite bodily pleasure. He often concocts and fantasizes about how to make it better for her, begging for information about her erotic desires, just so he can improve as a lover.
Sexual release makes men feel like they are finally home. After the world’s hurts and challenges, sex embodies love and care and provides soothing and support. While he may be accused of “only wanting sex,” most men want and feel a much more emotional connection than a simple bodily release. Making love literally creates a deep feeling of attachment to his partner and spurs relational generosity, faith, and optimism. Being desired by his partner can be the single most reassuring part of his relationship.
While most women may wish for an emotional connection before having a physical connection, for men sexual connection is often necessary to feel safe enough for emotional vulnerability. Ultimately, male sexual drive in a relationship is a gift — it’s another path toward love.
Laurie Watson is an AASECT certified sex therapist and the podcast host of FOREPLAY - Radio Sex Therapy on iTunes. She lectures at Duke and UNC’s medical schools and can be reached at AwakeningsCenter.org.
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The pursuit of calm can itself become a major stressor, especially if you've already tried the standard prescriptions. But there is a path through this conundrum.

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