GENDER IDENTITY DISORDER (GID) is a unique human condition that is classified behaviorally and treated medically with hormones and surgery in the severe form. This condition has been and still somewhat remains controversial by religious belief, social institutions and health care delivery systems. We described the surgical management of transsexuals, so called SEX REASSGINMENT SURGERY (SRS) and showed the team for gender treatment, GENDER CLINIC. A gender treatment team composing staff members from the Psychiatric, Plastic Surgery, Urology, Obstetric/Gynecological Surgery, and the Social Service, was established at the Hospital of Okayama University Medical schools in 1999. Female-to-Male procedures include mastectomy, phalloplasty, Phalloplasty are completion and an appurtenance, something pleasing to others. Male-to-Female program includes the genital surgery. The genital change surgery consists of the penile inversion, orchiectomy, vaginoplasty. Other prodedures include reduction thyroid chondroplasty, hair transplant, voice change, laryngeal surgery, epilation with the laser. SRS is the only effective treatment available today in the management of GID. The aesthetic and functional results achievable from various procedures are generally satisfactory and are acceptable to the patients. On the other hand, we should remember that the numerous steps of information for SRS will be required.