An uncomfortable truth is that many surveys, including a Swedish study , indicate that suicide rates remain high after sex-reassignment surgery the Swedish study reports that people who have had sex-reassignment surgery are 19 times more likely to die by suicide than is the general population ; and the National Center for Transgender Equality reported in that 40 percent of people who identify as transgender have attempted suicide. But I am also aware of the empowering realization that I alone control how I perceive the world. Djordjevic expresses concern about the psychiatric evaluation and counseling that take place prior to the gender reassignment surgery. Census doesn't record this data, and neither does any other organization — at least, officially. It is a condition I need to treat in order to live and be healthy. Many people regard the term "sex change" as factually inaccurate. He wants the National Institute for Clinical Excellence, which decides what treatments should be available on the NHS, to draw up guidelines on gender reassignment. But in the center of this storm of indignation and boasting of perseverance is the steady and quiet realization that these people are extremely insecure. Andrew McCulloch, chief executive of the Mental Health Foundation, has written to the mental health minister, Rosie Winterton, requesting a "thorough assessment" of the long-term effects of sex change operations. It seems far more reasonable to recognize that the physical sex at birth is the standard by which internal perception should be aligned. According to GLAAD, the term "transgender" is used to describe people whose gender identity is different from the one they were assigned at birth. But as she wrote in her own suicide note before jumping in front of a tractor trailer this week, there was no hope attached to those possibilities — no trust that it could, in fact, get better. If the ideal state is one of homeostasis, in which gender and sex are the same, then why would trans people dedicate their entire lives to forcing their bodies to adapt to conditions they cannot maintain on their own?