1. Only those who have undergone full [Sex Reassignment Surgery–SRS] (including phallosplasty/vaginoplasty) are to be considered as having changed their sex status, and recognized so by Jewish Law.
2. A person who has undergone partial SRS is not deemed to have changed their sex status.
3. A brit or hatafat dam brit is not required for one who has had a phalloplasty.
4. A get is not necessary if one spouse undergoes SRS since the qiddushin are automatically annulled. However in the case of an MTF (male-to-female) person a get should be given before the SRS is completed.
5. Recognition by the civil authorities of the new sex status is required in order to marry a person who has undergone SRS. This will prevent us from performing same sex marriages according to civil law.
6. A new name should be given to the person with a new sexual status by means of a me shebarach.
Is SRS Permissible…?
SRS can be justified on the following arguments which are based on treatment for a mental condition. However, for these arguments to be considered, reliable medical studies must verify that SRS is letovat haholeh – is beneficial for people suffering from gender dysphoria.
The major objection to SRS is the prohibition against…castration, which is a biblical prohibition, and sterilization which is also prohibited but not punishable. It is considered a mutilation of the body and is clearly forbidden. While it is possible to argue that a male who has fulfilled the mitzvah…of procreation, is no longer obligated to perform that mitzvah, and women are not obligated, nevertheless mutilation is prohibited. However according to some authorities, if the castration or sterilization caused by the removal of the sexual organs is due to disease or trauma, then it is considered to be a case of … a heavenly act, and the person is permitted to marry.
It would seem that the people undergoing the long process of SRS as stated in the Standards Of Care, are doing so because they are suffering from gender dysphoria, and SRS is treating the patient with gender dysphoria. Their pain and anguish is great and there is no doubt that they are suffering. This has led them to undergo the long and difficult procedures outlined in the standards of care. For them SRS is being done…for the patient’s betterment and health, and therefore would be permissible, just as it would be permissible to help treat a physical ailment. We have permitted other procedures for mental ailments and have said that the mental illness is to be treated in the same way as a physical one. Therefore SRS may be permissible and the prohibition against castration can be overridden in this case.
The same would apply to the question of…causing harm to oneself by undergoing an operation.
Hormonal treatment would also be permitted and would not transgress the prohibition of wearing the garments of the other sex or changing that which was created, since it is a case of…for the good of the patient, and…there are no restrictions on what type of medicine may be used to heal a person.
However due to the lack of studies about the long term effectiveness of SRS in dealing with gender identity disorder, we would recommend at this time that we counsel those who ask us for the halakhic opinion concerning this type of treatment, to consider the lack of sufficient studies that document the beneficial results of this treatment, and how this relates to our halakhic decisions. This in no way changes our conclusions concerning those people who have undergone SRS. They are to be considered as having changed their sex status as stated in the conclusions to this teshuva.