In certain cases, and due to the genetic make-up that governs the male hormonal receptors of certain male persons, these are born with feminine attitudes and sensibility as well as a total identification with the female sex. With the onset of development and sexual maturity, these individuals are attracted to male individuals from the beginning, rejecting any sexual contact with the feminine sex. This condition has been recognized by medical science as a “gender dysphoria”, which is a state totally different from homosexuality and bisexuality, and is a legitimate biological, psychological and sexual disorder that is successfully treated with gender reassignment surgery. For this purpose it is necessary to employ a  team approach consisting of psychologists, endocrinologists, urologists and plastic surgeons confirming the diagnosis of gender dysphoria by means of an established protocol designed to help the transexual patient attain the most important goal in his life-that of being a woman in every sense of the word. 1. Psychological evaluation 2. Endocrine therapy with anti-androgens and later estrogens, to prepare the body for the physical and mental effects of the new hormonal balance as well as to develop a start for mammary augmentation. 3. Mammary implant surgery: this surgery should be performed before GRS in accordance to the management guidelines established by the Harry Benjamin Gender Dysphoria Association. However, in selected cases where the patient has been dressing, working and living as a woman for a minimum of two years, it can be done at the same time of the sex-change operation. 4. Gender Reassignment Surgery:  this consists of orchiectomy (testicular removal)  emasculation (removal of the erectile tissues of the penis) and construction of a neovagina using the skin of the penis and the empty scrotum  to fashion the labia. A sensate clitoris is constructed by microsurgical dissection of nerves and blood vessels to ensure genital and clitoridian sensation, as well as a feminine urethral meatus for urination. All these steps are performed in the same stage. 5. Feminization surgery:  in certain cases it is necessary to refine the facial features, removing the bony tissue over the eyebrows, increasing the cheekbones, reducing the nose and the chin and even eliminating the Adam´s apple by means of condrolaringoplasty.