Armour

From Wikipedia, the free encyclopedia

For other uses, see Armour (disambiguation).

Western Xia mail armour

Armour (Commonwealth English) or armor (American English; see spelling differences) is a covering used to protect an object, individual, or vehicle from physical injury or damage, especially direct contact weapons or projectiles during combat, or from a potentially dangerous environment or activity (e.g. cycling, construction sites, etc.). Personal armour is used to protect soldiers and war animals. Vehicle armour is used on warships, armoured fighting vehicles, and some mostly ground attack combat aircraft.

A second use of the term armour describes armoured forces, armoured weapons, and their role in combat. After the development of armoured warfare, tanks and mechanised infantry and their combat formations came to be referred to collectively as "armour".

Etymology

Portrait of a Gentleman in Armour with Two Pages by Paris Bordone

The word "armour" began to appear in the Middle Ages as a derivative of Old French. It is dated from 1297 as a "mail, defensive covering worn in combat". The word originates from the Old French armure, itself derived from the Latin armatura meaning "arms and/or equipment", with the root armare meaning "arms or gear".

Personal

Main article: Body armor

Armour has been used throughout recorded history. It has been made from a variety of materials, beginning with the use of leathers or fabrics as protection and evolving through chain mail and metal plate into today's modern composites. For much of military history the manufacture of metal personal armour has dominated the technology and employment of armour.

Armour drove the development of many important technologies of the Ancient World, including wood lamination, mining, metal refining, vehicle manufacture, leather processing, and later decorative metal working. Its production was influential in the industrial revolution, and furthered commercial development of metallurgy and engineering. Armour was the single most influential factor in the development of firearms, which in turn revolutionised warfare.

History

The Dendra panoply, Mycenaean Greek armour, c. 1400 BC

Significant factors in the development of armour include the economic and technological necessities of its production. For instance, plate armour first appeared in Medieval Europe when water-powered trip hammers made the formation of plates faster and cheaper. At times the development of armour has paralleled the development of increasingly effective weaponry on the battlefield, with armourers seeking to create better protection without sacrificing mobility.

Well-known armour types in European history include the lorica hamata, lorica squamata, and the lorica segmentata of the Roman legions, the mail hauberk of the early medieval age, and the full steel plate harness worn by later medieval and renaissance knights, and breast and back plates worn by heavy cavalry in several European countries until the first year of World War I (1914–1915). The samurai warriors of feudal Japan utilised many types of armour for hundreds of years up to the 19th century.

Early

Wooden statue of Guan Yu in mountain pattern armour, 16th c. Ming dynasty

Cuirasses and helmets were manufactured in Japan as early as the 4th century. Tankō, worn by foot soldiers and keikō, worn by horsemen were both pre-samurai types of early Japanese armour constructed from iron plates connected together by leather thongs. Japanese lamellar armour (keiko) passed through Korea and reached Japan around the 5th century. These early Japanese lamellar armours took the form of a sleeveless jacket, leggings and a helmet.

Armour did not always cover all of the body; sometimes no more than a helmet and leg plates were worn. The rest of the body was generally protected by means of a large shield. Examples of armies equipping their troops in this fashion were the Aztecs (13th to 15th century CE).

In East Asia, many types of armour were commonly used at different times by various cultures, including scale armour, lamellar armour, laminar armour, plated mail, mail, plate armour, and brigandine. Around the dynastic Tang, Song, and early Ming Period, cuirasses and plates (mingguangjia) were also used, with more elaborate versions for officers in war. The Chinese, during that time used partial plates for "important" body parts instead of covering their whole body since too much plate armour hinders their martial arts movement. The other body parts were covered in cloth, leather, lamellar, or Mountain pattern. In pre-Qin dynasty times, leather armour was made out of various animals, with more exotic ones such as the rhinoceros.

Mail, sometimes called "chainmail", made of interlocking iron rings is believed to have first appeared some time after 300 BC. Its invention is credited to the Celts; the Romans are thought to have adopted their design.

Gradually, small additional plates or discs of iron were added to the mail to protect vulnerable areas. Hardened leather and splinted construction were used for arm and leg pieces. The coat of plates was developed, an armour made of large plates sewn inside a textile or leather coat.

13th to 18th century Europe

Further information: Components of medieval armour and Armour in the 18th century

Child armour of Sigismund II Augustus, which was commissioned by Emperor Ferdinand I for his daughter's Elizabeth of Austria marriage with Sigismund II Augustus

Early plate in Italy, and elsewhere in the 13th–15th century, were made of iron. Iron armour could be carburised or case hardened to give a surface of harder steel. Plate armour became cheaper than mail by the 15th century as it required much less labour and labour had become much more expensive after the Black Death, though it did require larger furnaces to produce larger blooms. Mail continued to be used to protect those joints which could not be adequately protected by plate, such as the armpit, crook of the elbow and groin. Another advantage of plate was that a lance rest could be fitted to the breast plate.

The small skull cap evolved into a bigger true helmet, the bascinet, as it was lengthened downward to protect the back of the neck and the sides of the head. Additionally, several new forms of fully enclosed helmets were introduced in the late 14th century.

Heavily armoured riders and their barded war horses, 16th century

Probably the most recognised style of armour in the world became the plate armour associated with the knights of the European Late Middle Ages, but continuing to the early 17th century Age of Enlightenment in all European countries.

By 1400, the full harness of plate armour had been developed in armouries of Lombardy. Heavy cavalry dominated the battlefield for centuries in part because of their armour.

In the early 15th century, advances in weaponry allowed infantry to defeat armoured knights on the battlefield. The quality of the metal used in armour deteriorated as armies became bigger and armour was made thicker, necessitating breeding of larger cavalry horses. If during the 14–15th centuries armour seldom weighed more than 15 kg, then by the late 16th century it weighed 25 kg. The increasing weight and thickness of late 16th century armour therefore gave substantial resistance.

In the early years of low velocity firearms, full suits of armour, or breast plates actually stopped bullets fired from a modest distance. Crossbow bolts, if still in use, would seldom penetrate good plate, nor would any bullet unless fired from close range. In effect, rather than making plate armour obsolete, the use of firearms stimulated the development of plate armour into its later stages. For most of that period, it allowed horsemen to fight while being the targets of defending arquebusiers without being easily killed. Full suits of armour were actually worn by generals and princely commanders right up to the second decade of the 18th century. It was the only way they could be mounted and survey the overall battlefield with safety from distant musket fire.

The horse was afforded protection from lances and infantry weapons by steel plate barding. This gave the horse protection and enhanced the visual impression of a mounted knight. Late in the era, elaborate barding was used in parade armour.

Later

Elements of a Light-Cavalry Armor, c. 1510

Gradually, starting in the mid-16th century, one plate element after another was discarded to save weight for foot soldiers.

Back and breast plates continued to be used throughout the entire period of the 18th century and through Napoleonic times, in many European heavy cavalry units, until the early 20th century. From their introduction, muskets could pierce plate armour, so cavalry had to be far more mindful of the fire. In Japan, armour continued to be used until the late 19th century, with the last major fighting in which armour was used, this occurred in 1868. Samurai armour had one last short lived use in 1877 during the Satsuma Rebellion.

Though the age of the knight was over, armour continued to be used in many capacities. Soldiers in the American Civil War bought iron and steel vests from peddlers (both sides had considered but rejected body armour for standard issue). The effectiveness of the vests varied widely, some successfully deflected bullets and saved lives, but others were poorly made and resulted in tragedy for the soldiers. In any case the vests were abandoned by many soldiers due to their increased weight on long marches, as well as the stigma they got for being cowards from their fellow troops.

At the start of World War I, thousands of the French Cuirassiers rode out to engage the German Cavalry. By that period, the shiny metallic cuirass was covered in a dark paint and a canvas wrap covered their elaborate Napoleonic style helmets, to help mitigate the sunlight being reflected off the surfaces, thereby alerting the enemy of their location. Their armour was only meant for protection against edged weapons such as bayonets, sabres, and lances. Cavalry had to be wary of repeating rifles, machine guns, and artillery, unlike the foot soldiers, who at least had a trench to give them some protection.

Present

Today, ballistic vests, also known as flak jackets, made of ballistic cloth (e.g. kevlar, dyneema, twaron, spectra etc.) and ceramic or metal plates are common among police forces, security staff, corrections officers and some branches of the military.

The US Army has adopted Interceptor body armour, which uses Enhanced Small Arms Protective Inserts (ESAPIs) in the chest, sides, and back of the armour. Each plate is rated to stop a range of ammunition including 3 hits from a 7.62×51 NATO AP round at a range of 10 m (33 ft). Dragon Skin is another ballistic vest which is currently in testing with mixed results. As of 2019, it has been deemed too heavy, expensive, and unreliable, in comparison to more traditional plates, and it is outdated in protection compared to modern US IOTV armour, and even in testing was deemed a downgrade from the IBA.

The British Armed Forces also have their own armour, known as Osprey. It is rated to the same general equivalent standard as the US counterpart, the Improved Outer Tactical Vest, and now the Soldier Plate Carrier System and Modular Tactical Vest.

The Russian Armed Forces also have armour, known as the 6B43, all the way to 6B45, depending on variant. Their armour runs on the GOST system, which, due to regional conditions, has resulted in a technically higher protective level overall.

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  Medieval German helmet.

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  Early Modern horse armour on display at Metropolitan Museum of Art in New York City, New York.

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  Plate armour

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  Riot police with body protection against physical impact. However, it does not provide very much protection against firearms.

Vehicle

Main article: Vehicle armour

The first modern production technology for armour plating was used by navies in the construction of the ironclad warship, reaching its pinnacle of development with the battleship. The first tanks were produced during World War I. Aerial armour has been used to protect pilots and aircraft systems since the First World War.

In modern ground forces' usage, the meaning of armour has expanded to include the role of troops in combat. After the evolution of armoured warfare, mechanised infantry were mounted in armoured fighting vehicles and replaced light infantry in many situations. In modern armoured warfare, armoured units equipped with tanks and infantry fighting vehicles serve the historic role of heavy cavalry, light cavalry, and dragoons, and belong to the armoured branch of warfare.

History

Ships

Further information: Warship and Naval armour

HMS Warrior during her third commission between 1867 and 1871

The first ironclad battleship, with iron armour over a wooden hull, Gloire, was launched by the French Navy in 1859 prompting the British Royal Navy to build a counter. The following year they launched HMS Warrior, which was twice the size and had iron armour over an iron hull. After the first battle between two ironclads took place in 1862 during the American Civil War, it became clear that the ironclad had replaced the unarmoured line-of-battle ship as the most powerful warship afloat.

Ironclads were designed for several roles, including as high seas battleships, coastal defence ships, and long-range cruisers. The rapid evolution of warship design in the late 19th century transformed the ironclad from a wooden-hulled vessel which carried sails to supplement its steam engines into the steel-built, turreted battleships and cruisers familiar in the 20th century. This change was pushed forward by the development of heavier naval guns (the ironclads of the 1880s carried some of the heaviest guns ever mounted at sea), more sophisticated steam engines, and advances in metallurgy which made steel shipbuilding possible.

The rapid pace of change in the ironclad period meant that many ships were obsolete as soon as they were complete, and that naval tactics were in a state of flux. Many ironclads were built to make use of the ram or the torpedo, which a number of naval designers considered the crucial weapons of naval combat. There is no clear end to the ironclad period, but towards the end of the 1890s the term ironclad dropped out of use. New ships were increasingly constructed to a standard pattern and designated battleships or armoured cruisers.

Trains

An armoured train from 1915

Armoured trains saw use from the mid-19th to the mid-20th century, including the American Civil War (1861–1865), the Franco-Prussian War (1870–1871), the First and Second Boer Wars (1880–81 and 1899–1902), the Polish–Soviet War (1919–1921), the First (1914–1918) and Second World Wars (1939–1945) and the First Indochina War (1946–1954). The most intensive use of armoured trains was during the Russian Civil War (1918–1920).

Armoured fighting vehicles

Main articles: Vehicle armour and Armoured fighting vehicle

Ancient siege engines were usually protected by wooden armour, often covered with wet hides or thin metal to prevent being easily burned.

Medieval war wagons were horse-drawn wagons that were similarly armoured. These contained guns or crossbowmen that could fire through gun-slits.

The first modern armoured fighting vehicles were armoured cars, developed circa 1900. These started as ordinary wheeled motor-cars protected by iron shields, typically mounting a machine gun.

During the First World War, the stalemate of trench warfare during on the Western Front spurred the development of the tank. It was envisioned as an armoured machine that could advance under fire from enemy rifles and machine guns, and respond with its own heavy guns. It used caterpillar tracks to cross ground broken up by shellfire and trenches.

Aircraft

With the development of effective anti-aircraft artillery in the period before the Second World War, military pilots, once the "knights of the air" during the First World War, became far more vulnerable to ground fire. As a response, armour plating was added to aircraft to protect aircrew and vulnerable areas such as engines and fuel tanks. Self-sealing fuel tanks functioned like armour in that they added protection but also increased weight and cost.

Present

The US Military's M1 Abrams MBT uses composite, reactive, and cage armour

Tank armour has progressed from the Second World War armour forms, now incorporating not only harder composites, but also reactive armour designed to defeat shaped charges. As a result of this, the main battle tank (MBT) conceived in the Cold War era can survive multiple rocket-propelled grenade strikes with minimal effect on the crew or the operation of the vehicle. The light tanks that were the last descendants of the light cavalry during the Second World War have almost completely disappeared from the world's militaries due to increased lethality of the weapons available to the vehicle-mounted infantry.

The armoured personnel carrier (APC) was devised during the First World War. It allows the safe and rapid movement of infantry in a combat zone, minimising casualties and maximising mobility. APCs are fundamentally different from the previously used armoured half-tracks in that they offer a higher level of protection from artillery burst fragments, and greater mobility in more terrain types. The basic APC design was substantially expanded to an infantry fighting vehicle (IFV) when properties of an APC and a light tank were combined in one vehicle.

Naval armour has fundamentally changed from the Second World War doctrine of thicker plating to defend against shells, bombs and torpedoes. Passive defence naval armour is limited to kevlar or steel (either single layer or as spaced armour) protecting particularly vital areas from the effects of nearby impacts. Since ships cannot carry enough armour to completely protect against anti-ship missiles, they depend more on defensive weapons destroying incoming missiles, or causing them to miss by confusing their guidance systems with electronic warfare.

Although the role of the ground attack aircraft significantly diminished after the Korean War, it re-emerged during the Vietnam War, and in the recognition of this, the US Air Force authorised the design and production of what became the A-10 dedicated anti-armour and ground-attack aircraft that first saw action in the Gulf War.

High-voltage transformer fire barriers are often required to defeat ballistics from small arms as well as projectiles from transformer bushings and lightning arresters, which form part of large electrical transformers, per NFPA 850. Such fire barriers may be designed to inherently function as armour, or may be passive fire protection materials augmented by armour, where care must be taken to ensure that the armour's reaction to fire does not cause issues with regards to the fire barrier being armoured to defeat explosions and projectiles in addition to fire, especially since both functions must be provided simultaneously, meaning they must be fire-tested together to provide realistic evidence of fitness for purpose.

Combat drones use little to no vehicular armour as they are not manned vessels, this results in them being lightweight and small in size.

Animal armour

Horse armour

Main article: Barding

A 16th-century knight with a horse in full barding

Body armour for war horses has been used since at least 2000 BC. Cloth, leather, and metal protection covered cavalry horses in ancient civilisations, including ancient Egypt, Assyria, Persia, and Rome. Some formed heavy cavalry units of armoured horses and riders used to attack infantry and mounted archers. Armour for horses is called barding (also spelled bard or barb) especially when used by European knights.

During the late Middle Ages as armour protection for knights became more effective, their mounts became targets. This vulnerability was exploited by the Scots at the Battle of Bannockburn in the 14th century, when horses were killed by the infantry, and for the English at the Battle of Crécy in the same century where longbowmen shot horses and the then dismounted French knights were killed by heavy infantry. Barding developed as a response to such events.

Examples of armour for horses could be found as far back as classical antiquity. Cataphracts, with scale armour for both rider and horse, are believed by many historians to have influenced the later European knights, via contact with the Byzantine Empire.

Surviving period examples of barding are rare; however, complete sets are on display at the Philadelphia Museum of Art, the Wallace Collection in London, the Royal Armouries in Leeds, and the Metropolitan Museum of Art in New York. Horse armour could be made in whole or in part of cuir bouilli (hardened leather), but surviving examples of this are especially rare.

Elephant armour

Model of an armoured elephant at the Royal Armouries Museum

War elephants were first used in ancient times without armour, but armour was introduced because elephants injured by enemy weapons would often flee the battlefield. Elephant armour was often made from hardened leather, which was fitted onto an individual elephant while moist, then dried to create a hardened shell. Alternatively, metal armour pieces were sometimes sewn into heavy cloth. Later lamellar armour (small overlapping metal plates) was introduced. Full plate armour was not typically used due to its expense and the danger of the animal overheating.

Terminal ballistics

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Terminal_ballistics 

Bullet parts: 1 metal jacket, 2 lead core, 3 steel penetrator

Terminal ballistics (also known as wound ballistics) is a sub-field of ballistics concerned with the behavior and effects of a projectile when it hits and transfers its energy to a target.

Bullet design (as well as the velocity of impact) largely determines the effectiveness of penetration.

General

The concept of terminal ballistics can be applied to any projectile striking a target. Much of the topic specifically regards the effects of small arms fire striking live targets, and a projectile's ability to incapacitate or eliminate a target.

Common factors include bullet weight, composition, velocity, and shape.

Firearm projectiles

Classes of bullets

There are three basic classes of bullets:

• Those designed to maximize accuracy at varying ranges
• Those designed to maximize damage to a target (by penetrating as deeply as possible)
• Those designed to avoid over-penetration of a target. This is done by deformation (to control the depth to which the bullet penetrates) which, as a by-product, causes more damage inside the wound. This class may limit penetration by either expanding or fragmenting.

Target shooting

.32 ACP full metal jacket, .32 S&W Long wadcutter, .380 ACP jacketed hollow point

For short-range target shooting, typically on ranges up to 50 meters, or 55 yards, with low-powered ammunition like a .22 long rifle, aerodynamics is relatively unimportant, and velocities are low compared to velocities attained by full-powered ammunition.

As long as a bullet's weight is balanced, it will not tumble; its shape is thus unimportant for purposes of its aerodynamics. For shooting at paper targets, bullets that will punch a perfect hole through the target —called wadcutters— are preferred. They have a very flat front, often with a relatively sharp edge along the perimeter, which punches out a hole equal to or almost equal to its diameter, thus enabling unambiguous scoring of the target. Since cutting the edge of a target ring will result in a higher score, accuracy to within fractions of an inch is desirable.

Magazine-fed pistols tend not to reliably feed wadcutters because of their angular shape. To address this, the semi-wadcutter is often used. The semi-wadcutter consists of a conical section that comes to a smaller flat point and a thin sharp shoulder at the base of the cone. The flat point punches a hole, and the shoulder opens it up cleanly. For steel targets, the concern is to provide enough force to knock over the target while minimizing the damage to the target. A soft lead bullet, or jacketed hollow-point bullet, or soft-point bullet will flatten out on impact (if the velocity at impact is sufficient to make it deform), spreading the impact over a larger area of the target, allowing more total force to be applied without damaging the steel target.

There are also specialized bullets designed for use in long-range precision target shooting with high-powered rifles. The designs vary somewhat from manufacturer to manufacturer. Research in the 1950s by the U.S. Air Force discovered that bullets are more stable in flight for longer distances and more resistant to crosswinds if the center of gravity is biased to the rear of the center of pressure. The MatchKing bullet is an open-tip match design with a tiny aperture in the jacket at the point of the bullet and a hollow air space under the point of the bullet, whereas previous conventional bullets had a lead core that went all the way up to the point.

The U.S. military now issues ammunition to snipers that use bullets of this type. In 7.62×51mm NATO, M852 Match and M118LR ammunition are issued, both of which use Sierra MatchKing bullets; in 5.56×45mm NATO, those U.S. Navy and U.S. Marine snipers who use accurized M16-type rifles are issued the Mk 262 Mod 0 cartridge developed jointly by Black Hills Ammunition and Crane Naval Surface Warfare Center.

For ultra-long-range precision target shooting with high-powered rifles and military sniping, radically designed very-low-drag (VLD) bullets are available that are generally produced out of rods of mono-metal alloys on CNC lathes. The driving force behind these projectiles is the wish to enhance the practical maximum effective range beyond normal standards. To achieve this, the bullets have to be very long and normal cartridge overall lengths often have to be exceeded. Common rifling twist rates also often have to be tightened to stabilize very long projectiles. Such commercially nonexistent cartridges are termed "wildcats". The use of a wildcat-based (ultra) long-range cartridge demands the use of a custom or customized rifle with an appropriately cut chamber and a fast-twist bore.

Maximum penetration

For use against armored targets, or large, tough game animals, penetration is the most important consideration. Focusing the largest amount of kinetic energy and projectile mass on the smallest possible area of the target provides the greatest penetration. Bullets for maximum penetration are designed to resist deformation on impact and usually are made of lead that is covered in a copper, brass, or mild steel jacket (some are even solid copper or bronze alloy). The jacket completely covers the front of the bullet, although often the rear is left with exposed lead (this is a manufacturing consideration: the jacket is formed first, and the lead is swaged in from the rear).

For penetrating substances significantly harder than jacketed lead, the lead core is supplemented with or replaced with a harder material, such as hardened steel. Military armor-piercing small arms ammunition is made from a copper-jacketed steel core; the steel resists deformation better than the usual soft lead core leading to greater penetration. The current NATO 5.56mm SS109 (M855) bullet uses a steel-tipped lead core to improve penetration, the steel tip providing resistance to deformation for armor piercing, and the heavier lead core (25% heavier than the previous bullet, the M193) providing increased sectional density for better penetration in soft targets. For larger, higher-velocity calibers, such as tank guns, hardness is of secondary importance to density, and are normally sub-caliber projectiles made from tungsten carbide, tungsten hard alloy, or depleted uranium fired in a light aluminum or magnesium alloy (or carbon fiber in some cases) sabot.

Many modern tank guns are smoothbore, not rifled because practical rifling twists can only stabilize projectiles, such as an Armour-Piercing Capped Ballistic Cap (APCBC), with a length-to-diameter ratio of up to about 5:1 and also because the rifling adds friction, reducing the velocity and thus total force it is possible to achieve. To get the maximum force on the smallest area, modern anti-tank rounds have aspect ratios of 10:1 or more. Since these cannot be stabilized by rifling, they are built instead like large darts, with fins providing the stabilizing force instead of rifling. These subcaliber rounds, called Armor-Piercing Fin-Stabilized Discarding Sabot (APFSDS) are held in place in the bore by sabots. The sabot is a light material that transfers the pressure of the charge to the penetrator, then is discarded when the round leaves the barrel.

Controlled penetration

The final category of bullets is that intended to control penetration so as not to harm anything behind the target. Such bullets are used primarily for hunting and civilian antipersonnel use; they are not generally used by the military, since the use of expanding bullets in international conflicts is prohibited by the Hague Convention and because these bullets have less chance of penetrating modern body armor. These bullets are designed to increase their surface area on impact, thus creating greater drag and limiting the travel through the target. A desirable side effect is that the expanded bullet makes a larger hole, increasing tissue damage and speeding up incapacitation.

While a bullet that penetrates through-and-through tends to cause more profuse bleeding, allowing a game animal to be blood trailed more easily, in some applications, preventing exit from the rear of the target is more desirable. A perforating bullet can continue on (likely not coaxial to the original trajectory due to target deflection) and might cause unintended damage or injury.

Flat point

The simplest maximum disruption bullet is one with a wide, flat tip. This increases the effective surface area, as rounded bullets can allow tissues to "flow" around the edges. Flat points also increase drag during flight, which decreases the depth to which the bullet penetrates. Flat-point bullets, with fronts of up to 90% of the overall bullet diameter, are usually designed for use against large or dangerous games. They are often made of unusually hard alloys, are longer and heavier than normal for their caliber, and even include exotic materials such as tungsten to increase their sectional density.

These bullets are designed to penetrate deeply through muscle and bone while causing a wound channel of nearly the full diameter of the bullet. These bullets are designed to penetrate deeply enough to reach vital organs from any shooting angle and at a far enough range. One of the hunting applications of the flat point bullet is large game such as bear hunting with a handgun in a .44 Magnum or larger caliber. More common than hunting is its use in a defensive "bear gun" carried by outdoorsmen. The disadvantage of flat point bullets is the reduction in aerodynamic performance; the flat point induces much drag, leading to significantly reduced velocities at long range.

Expanding

More effective on lighter targets are the expanding bullets, the hollow-point bullet, and the soft-point bullet. These are designed to use the hydraulic pressure of muscle tissue to expand the bullet. The hollow point peels back into several connected pieces (sometimes referred to as petals due to their appearance) causing the bullet to create a larger area of permanent damage. The hollow point fills with body tissue and fluids on impact, then expands as the bullet continues to have matter pushed into it. This process is informally called mushrooming, as the ideal result is a shape that resembles a mushroom—a cylindrical base, topped with a wide surface where the tip of the bullet has peeled back to expose more area while traveling through a body. For the purposes of aerodynamic efficiency, due to the hollow-point not creating drag, the tip of the hollow-point will often be tipped with a pointed polymer 'nose' which may also aid in expansion by functioning as a piston upon impact pushing the hollow point open. A copper-plated hollow-point loaded in a .44 Magnum, for example, with an original weight of 240 grains (15.55 g) and a diameter of 0.43 inch (11 mm) might mushroom on impact to form a rough circle with a diameter of 0.70 inches (18 mm) and a final weight of 239 grains (15.48 g). This is excellent performance; almost the entire weight is retained, and the frontal surface area increased by 63%. Penetration of the hollow-point would be less than half that of a similar nonexpanding bullet, and the resulting wound or permanent cavity would be much wider.

It might seem that if the whole purpose of a maximum disruption round is to expand to a larger diameter, it would make more sense to start out with the desired diameter rather than relying on the somewhat inconsistent results of expansion on impact. While there is merit to this (there is a strong following of the .45 ACP, as compared to the .40 S&W and 0.355 in diameter 9×19mm, for just this reason) there are also significant downsides. A larger-diameter bullet is going to have significantly more drag than a smaller-diameter bullet of the same mass, which means long-range performance will be significantly degraded. A larger diameter bullet also means more space is required to store the ammunition, which means either bulkier guns or smaller magazine capacities. The common trade-off when comparing .45 ACP, .40 S&W, and 9×19mm pistols is a 7- to 14-round capacity in the .45 ACP vs. a 10- to 16-round capacity in the .40 S&W vs. a 13- to 19-round capacity in the 9×19mm. Although several .45-caliber pistols are available with high-capacity magazines (Para Ordnance being one of the first in the late 1980s) many people find the wide grip required uncomfortable and difficult to use. Especially where the military requirement of a nonexpanding round is concerned, there is fierce debate over whether it is better to have fewer, larger bullets for enhanced terminal effects, or more, smaller bullets for an increased number of potential target hits.

Fragmenting

Example photo of the over-penetration of a fragmenting projectile

This class of projectile is designed to break apart on impact whilst being of a construction more akin to that of an expanding bullet. Fragmenting bullets are usually constructed like the hollow-point projectiles described above, but with deeper and larger cavities. They may also have thinner copper jackets in order to reduce their overall integrity. These bullets are typically fired at high velocities to maximize their fragmentation upon impact. In contrast to a hollow-point which attempts to stay in one large piece retaining as much weight as possible whilst presenting the most surface area to the target, a fragmenting bullet is intended to break up into many small pieces almost instantly.

This means that all the kinetic energy from the bullet is transferred to the target in a very short period of time. The most common application of this bullet is the shooting of vermin, such as prairie dogs. The effect of these bullets is quite dramatic, often resulting in the animal being blown apart upon impact. However, in larger games fragmenting ammunition provides inadequate penetration of vital organs to ensure a clean kill; instead, a "splash wound" may result. This also limits the practical use of these rounds to supersonic (rifle) rounds, which have a high enough kinetic energy to ensure a lethal hit. The two main advantages of this ammunition are that it is very humane, as a hit almost anywhere on most small vermin will ensure an instant kill, and that the relatively low mass bullet fragments pose a very low risk of ricochet or of penetrating unintended secondary targets. Fragmenting bullets should not be confused with frangible bullets (see below).

Also used are bullets similar to hollow-point bullets or soft-point bullets whose cores and/or jackets are deliberately weakened to cause deformation or fragmentation upon impact. The Warsaw Pact 5.45×39mm M74 assault rifle round exemplifies a trend that is becoming common in the era of high velocity, small caliber military rounds. The 5.45×39mm uses a steel-jacketed bullet with a two-part core, the rear being lead and the front being steel with an air pocket foremost. Upon impact, the unsupported tip deforms, bending the bullet nose into a slight "L" shape. This causes the bullet to tumble in the tissue, thus increasing its effective frontal surface area by traveling sideways more often than not.

This does not violate the Hague Convention, as it specifically mentions bullets that expand or flatten in the body. The NATO SS109 also tends to bend at the steel/lead junction, but with its weaker jacket, it fragments into many dozens of pieces. NATO 7.62 mm balls manufactured by some countries, such as Germany and Sweden, are also known to fragment due to jacket construction.

Frangible

The last category of expanding bullets is frangible bullets. These are designed to break upon impact, which results in a huge increase in surface area. The most common of these bullets are made of small diameter lead pellets, placed in a thin copper shell, and held in place by an epoxy or similar binding agent. On impact, the epoxy shatters, and the copper shell opens up, the individual lead balls then spread out in a wide pattern, and due to their low mass-to-surface area ratio, stop very quickly. Similar bullets are made out of sintered metals, which turn to powder upon impact. These bullets are usually restricted to pistol cartridges and rifle cartridges intended for use at very short ranges, as the nonhomogenous cores tend to cause inaccuracies that, while acceptable at short ranges, are not acceptable for the long ranges at which some rifles are used.

By far the most common use of frangible ammunition is for training by shooting steel targets at close ranges, while one may be at risk of being injured by fragments of standard solid lead bullets at close ranges when shooting steel, the powder that frangible bullets disintegrate into upon impact poses a very low risk to the shooter. This becomes irrelevant when shooting at longer ranges because it is unlikely that fragments created by the impact of any type of bullet on a steel target will travel more than 50-100yds, in these long-range cases it is of more value to use bullets that fly identically to those to be used in real situations than to mitigate the possible risks of bullet fragments and ricochets so frangible bullets are typically not used. One interesting use of the sintered metal rounds is in shotguns in hostage rescue situations; the sintered metal round is used at near-contact range to shoot the lock mechanism out of doors. The resulting metal powder will immediately disperse after knocking out the door lock and cause little or no damage to the occupants of the room. Frangible rounds are also used by armed security agents on aircraft. The concern is not depressurization (a bullet hole will not depressurize an airliner), but over-penetration and damage to vital electrical or hydraulic lines, or injury to an innocent bystander by a bullet that travels through a target's body completely instead of stopping in the body.

Large caliber

The purpose of firing a large caliber projectile is not always the same. For example, one might need to create disorganization within enemy troops, create casualties within enemy troops, eliminate the functioning of an enemy tank, or destroy an enemy bunker. Different purposes of course require different projectile designs.

Many large caliber projectiles are filled with a high explosive which, when detonated, shatters the shell casing, producing thousands of high-velocity fragments and an accompanying sharply rising blast overpressure. More rarely, others are used to release chemical or biological agents, either on impact or when over the target area; designing an appropriate fuse is a difficult task that lies outside the realm of terminal ballistics.

Other large-caliber projectiles use bomblets (sub-munitions), which are released by the carrier projectile at a required height or time above their target. For US artillery ammunition, these projectiles are called Dual-Purpose Improved Conventional Munition (DPICM), a 155 mm M864 DPICM projectile for example contains a total of 72 shaped-charge fragmentation bomblets. The use of multiple bomblets over a single HE projectile allows for a denser and less wasteful fragmentation field to be produced. If a bomblet strikes an armored vehicle, there is also a chance that the shaped charge will (if used) penetrate and disable the vehicle. A negative factor in their use is that any bomblets that fail to function go on to litter the battlefield in a highly sensitive and lethal state, causing casualties long after the cessation of conflict. International conventions tend to forbid or restrict the use of this type of projectile.

Some anti-armor projectiles use what is known as a shaped charge to defeat their target. Shaped charges have been used ever since it was discovered that a block of high explosives with letters engraved in it created perfect impressions of those letters when detonated against a piece of metal. A shaped charge is an explosive charge with a hollow lined cavity at one end and a detonator at the other. They operate by the detonating high explosive collapsing the (often copper) liner into itself. Some of the collapsing liners go on to form a constantly stretching jet of material traveling at hypersonic speed. When detonated at the correct standoff to the armor, the jet violently forces its way through the target's armor.

Contrary to popular belief, the jet of a copper-lined shaped charge is not molten, although it is heated to about 500 °C. This misconception is due to the metal's fluid-like behavior, which is caused by the massive pressures produced during the detonation of the explosive causing the metal to flow plastically. When used in the anti-tank role, a projectile that uses a shaped-charge warhead is known by the acronym HEAT (high-explosive anti-tank).

Shaped charges can be defended against by the use of explosive reactive armor (ERA), or complex composite armor arrays. ERA uses a high explosive sandwiched between two, relatively thin, (normally) metallic plates. The explosive is detonated when struck by the shaped charge's jet, the detonating explosive sandwich forces the two plates apart, lowering the jets’ penetration by interfering with, and disrupting it. A disadvantage of using ERA is that each plate can protect against a single strike, and the resulting explosion can be extremely dangerous to nearby personnel and lightly armoured structures.

Tank fired HEAT projectiles are slowly being replaced for the attack of heavy armour by so-called "kinetic energy" penetrators. It is the most primitive (in-shape) projectiles that are hardest to defend against. A KE penetrator requires an enormous thickness of steel, or a complex armour array to protect against. They also produce a much larger diameter hole in comparison to a shaped charge and hence produce a far more extensive behind armour effect. KE penetrators are most effective when constructed of a dense tough material that is formed into a long, narrow, arrow/dart like projectile.

Tungsten and depleted uranium alloys are often used as the penetrator material. The length of the penetrator is limited by the ability of the penetrator to withstand launch forces whilst in the bore and shear forces along its length at impact.

Gender-affirming surgery

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Gender-affirming_surgery

Gender-affirming surgery is a surgical procedure, or series of procedures, that alters a person's physical appearance and sexual characteristics to resemble those associated with their identified gender. The phrase is most often associated with transgender health care and intersex medical interventions, however many such treatments are also pursued by cisgender and non-intersex individuals. It is also known as sex reassignment surgery, gender confirmation surgery, and several other names.

Professional medical organizations have established Standards of Care, which apply before someone can apply for and receive reassignment surgery, including psychological evaluation, and a period of real-life experience living in the desired gender.

Feminization surgeries are surgeries that result in anatomy that is typically gendered female, such as vaginoplasty and breast augmentation, whereas masculinization surgeries are those that result in anatomy that is typically gendered male, such as phalloplasty and breast reduction.

In addition to gender-affirming surgery, patients may need to follow a lifelong course of masculinizing or feminizing hormone replacement therapy.

Sweden became the first country in the world to allow transgender people to change their legal gender after "reassignment surgery" and provide free "reassignment" treatment in 1972. Singapore followed soon after in 1973, being the first in Asia.

Terminology

Gender-affirming surgery is known by numerous other names, including gender-affirmation surgery, sex reassignment surgery, gender reassignment surgery, and gender confirmation surgery. Top surgery and bottom surgery refer to surgeries on the chest and genitals respectively. It is sometimes called a sex change, though this term is usually considered offensive.

Some transgender people who desire medical assistance to transition from one sex to another identify as "transsexual".

Trans women and others assigned male at birth may undergo one or more feminizing procedures which result in anatomy that is typically gendered female. These include genital surgeries such as penectomy (removal of the penis), orchiectomy (removal of the testes), vaginoplasty (construction of a vagina), as well as breast augmentation, tracheal shave (reduction of the Adam's apple), facial feminization surgery, and voice feminization surgery among others.

Trans men and others assigned female at birth seeking surgery may undergo one or more masculinizing procedures, which include chest reconstruction, breast reduction, hysterectomy (removal of the uterus), oophorectomy (removal of the ovaries). A penis can be constructed through metoidioplasty or phalloplasty, and a scrotum through scrotoplasty.

As knowledge of non-binary genders expands in the medical community, more surgeons are willing to tailor operations to individual needs. Bigenital operations allow individuals to construct a penis or vagina and retain their original organs. Gender nullification is the removal of all external genitalia except the urethral opening, typically pursued by people assigned male at birth.

Gender-affirming surgery can also refer to operations pursued by cisgender people, such as mammaplasty, penile implant, or testicular implants following orchiectomy.

Gender-affirming surgery is often sensationalized and misrepresented by anti-trans activists through terminology such as Genital-mutilation surgery.

Surgical procedures

Main articles: Gender-affirming surgery (male-to-female) and Gender-affirming surgery (female-to-male)

Genital surgery

For trans women, genital reconstruction usually involves the surgical construction of a vagina, by means of penile inversion or the sigmoid colon neovagina technique; or, more recently, non-penile inversion techniques that make use of scrotal tissue to construct the vaginal canal. For trans men, genital reconstruction may involve construction of a penis through either phalloplasty or metoidioplasty.

Non-binary people often pursue genital surgeries, including the same operations as binary trans people of the same sex assignment, as well as bigenital or gender nullification surgeries. Bigenital operations include androgynoplasty, a procedure that retains the penis, or vagina-preserving phalloplasty.

Genital surgery may also involve other medically necessary ancillary procedures, such as orchiectomy, penectomy, mastectomy or vaginectomy. Complications of penile inversion vaginoplasty are mostly minor; however, rectoneovaginal fistulas (abnormal connections between the neovagina and the rectum) can occur in about 1–3% of patients. These require additional surgery to correct and are often fixed by colorectal surgeons.

Other surgeries

As underscored by WPATH, a medically assisted transition from one gender to another may entail any of a variety of non-genital surgical procedures which change primary and/or secondary sex characteristics, any of which are considered "gender-affirming surgery" when undertaken to affirm a person's gender identity. For trans men, these may include mastectomy (removal of the breasts) and chest reconstruction (the shaping of a male-contoured chest), or hysterectomy and bilateral salpingo-oophorectomy (removal of ovaries and Fallopian tubes). For some trans women, facial feminization surgery, hair implants, and breast augmentation are also aesthetic components of their surgical treatment.

Scope and procedures

The best known of these surgeries are those that reshape the genitals, which are also known as genital reassignment surgery or genital reconstruction surgery - or bottom surgery (the latter is named in contrast to top surgery, which is surgery to the breasts; bottom surgery does not refer to surgery on the buttocks in this context). However, the meaning of "sex reassignment surgery" has been clarified by the medical subspecialty organization, the World Professional Association for Transgender Health (WPATH), to include any of a larger number of surgical procedures performed as part of a medical treatment for "gender dysphoria" or "transsexualism". According to WPATH, medically necessary sex reassignment surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation ... including breast prostheses if necessary, genital reconstruction (by various techniques which must be appropriate to each patient ...)... and certain facial plastic reconstruction." In addition, other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial hair electrolysis.

Voice feminizing surgery is a procedure in which the overall pitch range of the patients voice is reduced.

Adam's Apple Reduction surgery (chondrolaryngoplasty) or tracheal shaving is a procedure in which the most prominent part of the thyroid cartilage is reduced.

There is also Adam's Apple Enhancement therapy, in which cartilage is used to bring out the Adam's apple in female to male patients.

History

Reports of people seeking gender-confirming surgery (vaginoplasty) go back to the 2nd century, such as the Roman Emperor Elagabalus. The first modern gender-confirming surgery was performed in the 20th century.

20th century

In the US in 1917, Alan L. Hart, an American tuberculosis specialist, became one of the first trans men to undergo hysterectomy and gonadectomy as treatment of what is now called gender dysphoria.

Dora Richter is the first known trans woman to undergo complete male-to-female genital surgery. She was one of several transgender people in the care of sexologist Magnus Hirschfeld at Berlin's Institute for Sexual Research. In 1922, Richter underwent orchiectomy. In early 1931, a penectomy, followed in June by vaginoplasty. Richter is presumed to have died in May 1933, when Nazis attacked the institute and destroyed its records, but her exact fate is not known.

Between 1930 and 1931, Lili Elbe underwent four sex reassignment surgeries, including orchiectomy, an ovarian transplant, and penectomy. In June 1931, she underwent her fourth surgery, including an experimental uterine transplant and vaginoplasty, which she hoped would allow her to give birth. However, her body rejected the transplanted uterus, and she died of post-operative complications in September, at age 48.

A previous sex reassignment surgery (SRS) patient was Magnus Hirschfeld's housekeeper, but their name has not been discovered.

Elmer Belt may have been the first U.S. surgeon to perform gender affirmation surgery, in about 1950.

In 1951, Harold Gillies, a plastic surgeon active in World War II, worked to develop the first technique for female-to-male SRS, producing a technique that has become a modern standard, called phalloplasty. Phalloplasty is a cosmetic procedure that produces a visual penis out of grafted tissue from the patient.

Following phalloplasty, in 1999, the procedure for metoidioplasty was developed for female-to-male surgical transition by the doctors Lebovic and Laub. Considered a variant of phalloplasty, metoidioplasty works to create a penis out of the patient's present clitoris. This allows the patient to have a sensation-perceiving penis head. Metoidioplasty may be used in conjunction with phalloplasty to produce a larger, more "cis-appearing" penis in multiple stages.

21st century

On 12 June 2003, the European Court of Human Rights ruled in favor of Carola van Kück, a German trans woman whose insurance company denied her reimbursement for sex reassignment surgery as well as hormone replacement therapy. The legal arguments related to the Article 6 of the European Convention on Human Rights as well as the Article 8. This affair is referred to as van Kück vs Germany.

In 2011, Christiane Völling won the first successful case brought by an intersex person against a surgeon for non-consensual surgical intervention described by the International Commission of Jurists as "an example of an individual who was subjected to sex reassignment surgery without full knowledge or consent".

As of 2017, some European countries require forced sterilization for the legal recognition of sex reassignment. As of 2020, Japan also requires an individual to undergo sterilization to change their legal sex.

The early history of sex reassignment surgery in transgender people has been reviewed by various authors.

Prevalence

The prevalence of transgender-related surgeries is difficult to measure and likely underestimated. In 2015, the largest survey of transgender people in the United States reported that 25% of respondents reported having undergone such a surgery.

Prior to surgery

Medical considerations

Some transgender persons present with health conditions including diabetes, asthma, and HIV, which can lead to complications with future therapy and pharmacological management. Typical SRS procedures involve complex medication regimens, including sex hormone therapy, throughout and after surgery. Typically, a patient's treatment involves a healthcare team consisting of a variety of providers including endocrinologists, whom the surgeon may consult when determining if the patient is physically fit for surgery. Health providers including pharmacists can play a role in maintaining safe and cost-effective regimens, providing patient education, and addressing other health issues including smoking cessation and weight loss.

People with HIV or hepatitis C may have difficulty finding a surgeon able to perform successful surgery. Many surgeons operate in small private clinics that cannot treat potential complications in these populations. Some surgeons charge higher fees for HIV and hepatitis C-positive patients; other medical professionals assert that it is unethical to deny surgical or hormonal treatments to transgender people solely on the basis of their HIV or hepatitis status.

Fertility is also a factor considered in SRS, as patients are typically informed that if an orchiectomy or oöphoro-hysterectomy is performed, it will make them irreversibly infertile.

Gender dysphoric children

Sex reassignment surgery is generally not performed on children under 18, though in rare cases may be performed on adolescents if health care providers agree there is an unusual benefit to doing so or risk to not performing it. Preferred treatments for children include puberty blockers, which are thought to have some reversible physical changes, and sex hormones, which reduce the need for future surgery. Medical protocols typically require long-term mental health counseling to verify persistent and genuine gender dysphoria before any intervention, and consent of a parent or guardian or court order is legally required in most jurisdictions.

Intersex children and cases of trauma

Main article: Sex assignment § Assignment in cases of infants with intersex traits, or cases of trauma

Infants born with intersex conditions might undergo interventions at or close to birth. This is controversial because of the human rights implications.

There can be negative outcomes (including PTSD and suicide) that occur when the surgically assigned gender does not match the individual's gender identity, which will only be realized by the individual later in life. Milton Diamond at the John A. Burns School of Medicine, University of Hawaii recommended that physicians do not perform surgery on children until they are old enough to give informed consent and to assign such infants in the gender to which they will probably best adjust. Diamond believed introducing children to others with differences of sex development could help remove shame and stigma. Diamond considered the intersex condition as a difference of sex development, not as a disorder.

Standards of care

See also: Transgender rights

Sex reassignment surgery can be difficult to obtain due to financial barriers, insurance coverage, and lack of providers. An increasing number of surgeons are now training to perform such surgeries. In many regions, an individual's pursuit of SRS is often governed, or at least guided, by documents called Standards of Care for the Health of Transgender and Gender Diverse People (SOC). The most widespread SOC in this field is published and frequently revised by the World Professional Association for Transgender Health (WPATH, formerly the Harry Benjamin International Gender Dysphoria Association or HBIGDA). Many jurisdictions and medical boards in the United States and other countries recognize the WPATH Standards of Care for the treatment of transgender individuals. Some treatment may require a minimum duration of psychological evaluation and living as a member of the target gender full-time, sometimes called the real life experience (RLE) (sometimes mistakenly referred to as the real life test (RLT)) before sex reassignment surgeries are covered by insurance.

Standards of Care usually give certain very specific "minimum" requirements as guidelines for progressing with treatment, causing them to be highly controversial and often maligned documents among transgender patients seeking surgery. Alternative local standards of care exist, such as in the Netherlands, Germany, and Italy. Much of the criticism surrounding the WPATH/HBIGDA-SOC applies to these as well, and some of these SOCs (mostly European SOC) are actually based on much older versions of the WPATH SOC. Other SOCs are entirely independent of the WPATH. The criteria of many of those SOCs are stricter than the latest revision of the WPATH-SOC. Many qualified surgeons in North America and many in Europe adhere almost unswervingly to the WPATH SOC or other SOCs. However, in the United States many experienced surgeons are able to apply the WPATH SOC in ways which respond to an individual's medical circumstances, as is consistent with the SOC.

Many surgeons require two letters of recommendation for sex reassignment surgery. At least one of these letters must be from a mental health professional experienced in diagnosing gender identity disorder (now recognized as gender dysphoria), who has known the patient for over a year. Letters must state that sex reassignment surgery is the correct course of treatment for the patient.

Many medical professionals and numerous professional associations have stated that surgical interventions should not be required for transsexual individuals to change sex designation on identity documents. However, depending on the legal requirements of many jurisdictions, transsexual and transgender people are often unable to change the listing of their sex in public records unless they can furnish a physician's letter attesting that sex reassignment surgery has been performed. In some jurisdictions legal gender change is prohibited in any circumstances, even after genital or other surgery or treatment.

Insurance

A growing number of public and commercial health insurance plans in the United States now contain defined benefits covering sex reassignment-related procedures, usually including genital reconstruction surgery (MTF and FTM), chest reconstruction (FTM), breast augmentation (MTF), and hysterectomy (FTM). For patients to qualify for insurance coverage, certain insurance plans may require proof of the following:

• a written initial assessment by a qualified licensed mental health professional
• persistent, well-documented gender dysphoria
• months of prior physician-supervised hormone therapy

In June 2008, the American Medical Association (AMA) House of Delegates stated that the denial to patients with gender dysphoria or otherwise covered benefits represents discrimination, and that the AMA supports "public and private health insurance coverage for treatment for gender dysphoria as recommended by the patient's physician." Other organizations have issued similar statements, including WPATH, the American Psychological Association, and the National Association of Social Workers.

In 2017, the United States Defense Health Agency for the first time approved payment for sex reassignment surgery for an active-duty U.S. military service member. The patient, an infantry soldier who is a transgender woman, had already begun a course of treatment for gender reassignment. The procedure, which the treating doctor deemed medically necessary, was performed on 14 November at a private hospital, since U.S. military hospitals lack the requisite surgical expertise.

Post-procedural considerations

Quality of life and physical health

Several studies have measured quality of life and self-perceived physical health using different scales. Castellano et al. (2015) found similar quality of life compared to a control group for 60 SRS patients two years after surgery. Kuhn et al. (2008), assessing 52 trans women and 3 trans men 15 years after surgery, found quality of life lower than control in domains of health and limitations. De Cuypere et al. (2005), assessing 32 trans women and 23 trans men after surgery, concluded that patients' emotional and social needs were met, but less so their physical and sexual needs. Ainsworth and Spiegel (2010), in a study of 247 trans women, find improvements in mental health after genital reassignment surgery or face feminization surgery.

In 2021, a review published in Plastic And Reconstructive Surgery found that less than 1% of people who undergo gender-affirming surgery regret the decision.

Psychological and social consequences

A 2009 review in the International Journal of Transgenderism found that from 1998 onward, studies have shown that "the whole process of gender reassignment is effective in relieving gender dysphoria and that its positive results greatly outweighed any negative consequences", but noted methodological issues in many studies, particularly older ones. A 2010 meta-analysis in Clinical Endocrinology noted the lack of randomization and control groups and reliance of self-reporting in the studies it reviewed, reaching the conclusion "Very low quality evidence suggests that hormonal therapies given to individuals with GID as a part of sex reassignment are likely to improve gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life."

Smith et al. (2001) found that among 20 patients, anxiety, depression and hostility levels were lower after sex reassignment surgery. Wierckx et al. (2011), in a study of 49 trans men, found them in good self-perceived physical and mental health. Dhejne et al. (2011), in a study following 324 transgender people who received sex reassignment surgery from 1973 to 2003, found that they "have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population", concluding that "sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism". Lawrence (2003), in a study of 232 trans women who underwent surgery between 1994 and 2000, found "None reported outright regret and only a few expressed even occasional regret."

Risk categories for post-operative regret include being older, having characterised personality disorders with personal and social instability, lacking family support, lacking sexual activity, and expressing dissatisfaction with the results of surgery. During the process of sex reassignment surgery, transsexuals may become victims of different social obstacles such as discrimination, prejudice and stigmatising behaviours. The rejection faced by transgender people is much more severe than what is experienced by lesbian, gay, and bisexual individuals. The hostile environment may trigger or worsen internalized transphobia, depression, anxiety and post-traumatic stress.

Many patients perceive the outcome of the surgery as not only medically but also psychologically important. Social support can help them to relate to their minority identity, ascertain their trans identity and reduce minority stress.

Sexuality

Looking specifically at transsexual people's genital sensitivities, both trans men and trans women are capable of maintaining their genital sensitivities after SRS. However, these are counted upon the procedures and surgical tricks which are used to preserve the sensitivity. Considering the importance of genital sensitivity in helping transsexual individuals to avoid unnecessary harm or injuries to the genitals, allowing trans men to obtain an erection by inserting a penile implant after phalloplasty, the ability for transsexual people to experience erogenous and tactile sensitivity in their reconstructed genitals is one of the essential objectives surgeons want to achieve in SRS. Moreover, studies have also found that the critical procedure for genital sensitivity maintenance and achieving orgasms after phalloplasty is to preserve both the clitoris hood and the clitoris underneath the reconstructed phallus.

Erogenous sensitivity is measured by the capabilities to reach orgasms in genital sexual activities, like masturbation and intercourse. Many studies reviewed that both trans men and trans women have reported an increase of orgasms in both sexual activities, implying the possibilities to maintain or even enhance genital sensitivity after SRS.

The majority of the transsexual individuals have reported enjoying better sex lives and improved sexual satisfaction after sex reassignment surgery. The enhancement of sexual satisfaction was positively related to the satisfaction of new primary sex characteristics. Before undergoing SRS, transsexual patients possessed unwanted sex organs which they were eager to remove. Hence, they were not enthusiastic about engaging in sexual activity. Transsexual individuals who have undergone SRS are more satisfied with their bodies and experienced less stress when participating in sexual activity.

Most of the individuals have reported that they have experienced sexual excitement during sexual activity, including masturbation. The ability to obtain orgasms is positively associated with sexual satisfaction. Frequency and intensity of orgasms are substantially different among trans men and trans women. Almost all female-to-male individuals have revealed an increase in sexual excitement and are capable of achieving orgasms through sexual activity with a partner or via masturbation, whereas only 85% of the male-to-female individuals are able to achieve orgasms after SRS. A study found that both trans men and trans women reported qualitative change in their experience of orgasm. The female-to-male transgender individuals reported that they had been experiencing intensified and stronger excitements and orgasm while male-to-female individuals have been encountering longer and more gentle feelings.

The rates of masturbation have also changed after sex reassignment surgery for both trans women and trans men. A study reported an overall increase of masturbation frequencies exhibited in most transsexual individuals and 78% of them were able to reach orgasm by masturbation after SRS. A study showed that there were differences in masturbation frequencies between trans men and trans women, in which female-to-male individuals masturbated more often than male to female The possible reasons for the differences in masturbation frequency could be associated with the surge of libido, which was caused by the testosterone therapies, or the withdrawal of gender dysphoria.

Concerning trans people's expectations for different aspects of their life, the sexual aspects have the lowest level of satisfaction among all other elements (physical, emotional and social levels). When comparing transgender with cisgender individuals of the same gender, trans women had a similar sexual satisfaction to cis women, but trans men had a lower level of sexual satisfaction to cis men. Moreover, trans men also had a lower sexual satisfaction with their sexual life than trans women.