Online Encyclopedia
Transsexual
A transsexual (sometimes transexual) person establishes a permanent identity with the opposite gender to their assigned (usually at birth) sex. Transsexual men and women make or desire to make a transition from their birth sex to that of the opposite sex, with some type of medical alteration (gender reassignment therapy) to their body. The stereotypical explanation is of a "woman trapped in a man's body" or vice versa, although many in the transsexual community reject this formulation. For the exact wording of formal medical definitions, see gender identity disorder.
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Definitions
The minimum requirements for a person to be considered transsexual are debated. Some feel hormonally induced changes, without surgical changes, are sufficient to qualify for the label transsexual. Others, especially health care providers, believe there is a certain set of procedures that must always be completed; also the general public's definition of "a transsexual" is often taken to be people who have "sex change" surgery -- the correct term is sex reassignment surgery (SRS), as transsexual people do not consider themselves to be changing their sex, but to be correcting their bodies. However, it is also often accepted (and is also evident in the Diagnostic and Statistical Manual) that to express desire to be of the opposite sex, or to assert that one is of the opposite sex to which they were born, constitutes being transsexual. In contrast, some transgendered people, on the other hand, often do not identify as being of or wanting to be the opposite sex, but as being of or wanting to be another gender.
Transsexuality (also known as transsexualism) is one of a number of behaviours or states collectively referred to as transgender, which is generally considered an umbrella term for people who do not conform to typical gender roles. However, many in the transsexual community do not identify as transgendered. Some see transgender as subsuming and erasing their identity, rejecting the term for themselves because to them it implies a breaking down of gender roles, when in fact they see themselves as fitting a gender role -- just not the one they were assigned at birth.
Transsexual people are often construed as belonging to the LGBT or the Queer community, and many identify with the community; others do not, or prefer not to use the term to describe it. It should be noted that transsexuality is not associated with or dependent on sexual orientation. Transsexual men and women exhibit a range of sexual orientations just as non-transsexuals (cissexuals) do. They almost always use terms for their sexual orientation that relate to their target gender; for example, someone assigned to the male gender at birth but who identifies as a woman, and who is attracted solely to men, will identify as heterosexual, not gay.
Transsexuality should not be confused with cross dressing or the behaviour of drag queens, who can be described as transgender, but usually not transsexual. Also, transvestic fetishism has usually little, if anything, to do with transsexuality.
Terminology
Gender terms used to describe transsexual people always relate to the target. For example, a transsexual man is a someone who has been born with a female body, but identifies as a man and who is transitioning, or has transitioned, to a male social gender role and a male body (an alternative term is female-to-male transsexual or transman; compare also transwoman).
Among the transsexual community, the short form trans is more commonly used, e.g. trans guy, trans dyke, trans folk. Some also use the somewhat more controversial term tranny, e.g. tranny boy. Both abbreviated forms are also used by non-transsexual transgendered people.
Some people prefer to spell transexual with one s, in an attempt to divorce the word from the realm of psychiatry and medicine and place it in the realm of identity, but this trend is most common in the United States and, for example, is almost never used in the United Kingdom.
Some people prefer the term transsexed over transsexual, as they believe the term sexual found in transsexual is misleading. Another justification made for this preference is that they feel it is more in line with the term intersex, as more transsexual groups are welcoming them because they feel both groups have much in common. It is by some definitions also possible to be both intersexed and transsexed. Other attempts to avoid the misleading -sexual have been the increasing acceptance of transgender or trans* and in some areas, transidentity.
Causes of transsexualism
There is no scientifically proven cause of transsexualism. However, many theories have been proposed which suggest that the cause of transsexualism has its roots in biology.
Scholars of gender theory, gender professionals and transsexual rights activists contest the very rationale of looking for a "cause" to transsexualism. The basic assumption behind this quest for "causes" is that gender dimorphism (the idea that there are only two discrete, well defined and dichotomous genders) is an established fact. The critics cite, among other things, historiographic and anthropological findings pointing to the fact that different cultures had diverse concepts of gender, some of them including three or more genders.
The main argument against the search for a "cause" to transsexualism is that it assumes a priori the legitimacy of normative gender identity, i.e. gender identity congruent with the external genitalia. This, affirm the critics, is an unproved contention. Historical research shows that the relation of genitals and gender identity changed across cultures. Assuming a priori that variant gender identity is anomalous (and therefore its "causes" should be investigated) distorts science's view of gender and contributes to the stigmatization of gender non-conformant people.
Proposed psychological causes
In the past, many reasons for transsexualism have been proposed. Those reasons have usually been psychological; including "overbearing mothers and absent fathers", "parents who wanted a child of the other sex", "repressed homosexuality", "sexual abuse" or a variety of sexual perversions.
None of these theories however was able to be applied successfully to a majority of transsexual people, let alone to even a significant minority of transsexuals. Many theories also were developed in order to describe transsexual women, and when applied to transmen, they usually worked even less. Many of these theories had also previously been applied to homosexuals, where they did not work out, either. This led theories to consider physical reasons for transsexualism.
Experience with individuals who were surgically reassigned at birth (in order to correct deformities such as those caused by accidental castration) suggests strongly that the mental gender identification is determined at birth - individuals born male but raised as female show the same symptoms of gender dysphoria as transsexuals.
Psychological treatments aimed at "curing" transsexuality are historically known to be unsucessful, and there is anecdotal evidence that this may increase the suicide rate among transsexuals. A number of treatments were frequently attempted in the past that are now considerd ineffective and in some cases barbaric, including aversion therapy, psychoactive medications, electroconvulsive therapy, hormone treatments consistant with the birth gender, and psychotherapy alone.
Physical causes
Many transsexual (and also many other transgendered) people have assumed that there is a physical cause of their transsexualism, because they claim to have had the feeling of being a girl or a boy for as long as they remember. However, until recently, no physical cause could, with any certainty, be proposed or established.
There has been preliminary evidence to suggest that the brains of transsexual people are gendered in alignment with their perceived gender identity, i.e. transsexual women have a female brain, and transsexual men have a male brain. This evidence concerns the central subdivision of the bed nucleus of the stria terminalis (BSTc). Males have a larger BSTc than females; in a study of six male-to-female transsexuals' brains, it was found that all had a female-sized BSTc. [1] [2] Likewise, it has been found that a female-to-male transsexual had a male-sized BSTc region. [3] The high accuracy and applicability of the male-to-female results (despite the small size of the study) is discussed (see [4]).
The general structure (e.g. size and hemispheric differences) of transsexual peoples' brains is not significantly different from that of other members of their birth sex. It should be noted, however, that brain size correlates to body size.
However, extending the study is difficult, because currently, the only way to establish the size of the BST is through an autopsy, which limits the number of available subjects.
Transsexual youth
An individual may begin to come to terms with his or her gender identity at many stages in their life. In most cases, it becomes apparent at some period in childhood, (some, very early in childhood), where the child may be expressing behaviour incongruent with and dissatisfaction related to their assigned gender.
Most of the time, though, these children try to hide being different as soon as they experience rejection because of it.
Coming out
Since transsexualism is still not widely accepted in many countries, transsexual youth may feel they need to remain in the closet until they feel that there is a time appropriate to reveal to their parents their gender identity -- understandably so, as parents have a great deal of influence in their children's lives, some parents can react negatively towards such news. Other parents can be very supportive, initially, or after such news has been broken to them.
Ensuring the child's security
Only in recent years have some transsexual or transgendered children received both appropriate counselling and in some rare cases also medical treatment, as well as the possibilitiy to change their social role.
Families with a young member who may identify already as trans or trans curious and who have chosen to transition between the sex roles through dress and behaviors may decide to relocate their child and home to another area in order to afford the young person the best opportunity to live in the desired gender role and among a new set of peers and a community to whom they have had no previous acquaintance.
Choosing to remain and live within an intolerant society where the local community has had previous experience of the child's assigned sex may raise many challenging issues. Gwen Araujo of Newark, California is such a young person who had attempted to cross-live in the gender opposite the sex to which she was assigned at birth (male). She became the victim of violent crimes that resulted in her death after she attended a party where her birth sex was revealed.
Ma Vie En Rose (1997), by Alain Berliner, depicts a similar scenario including a trans curious youth whose gender play brings about both family and community conflicts causing them to relocate to a new community.
Creature (1999), a documentary film directed by Parris Patton, tells the story of Stacey "Hollywood" Dean, a young transsexual woman who grew up in rural North Carolina. It follows her through four years and includes interviews with her conservative Christian parents.
The necessity to relocate, however, depends very much on the social environment. There are also several cases where this was not necessary, particularly in Western Europe.
Gender reassignment therapy
Most transsexual men and women suffer from great psychological and emotional pain due to the conflict between their gender identity and their original gender role and anatomy. They find their only recourse is to change their gender role and undergo gender reassignment therapy. This may include taking hormones and/or having sex reassignment surgery to modify their primary and secondary sexual characteristic s.
Mental health approaches, that is, attempts to change their gender identity to match their sex, have been shown to be ineffective. It is generally accepted, therefore, that the only effective course of treatment for transsexuals is gender reassignment therapy.
The need for treatment is emphasised by the high rate of mental health problems, including depression, various addictions, and a suicide rate among untreated transsexual people many times the rate of the general population (with estimates ranging between thirty and seventy percent).
Requirements for gender reassignment treatment
Main article: Standards of Care for Gender Identity Disorders
The requirements for hormone replacement therapy vary greatly. Often a minimum time period of psychological counseling is required, along with a time of living in the desired gender role in order to assure they can psychologically function in that life-role. (If that is possible; transmen especially often cannot "pass" without hormones. ) This period is usually called the Real Life Test (RLT).
Generally speaking, physicians who perform sex-reassignment surgery require the patient to live as the opposite gender in all possible ways for at least a year ("cross-live") prior to the start of surgery. The RLT is usually part of a battery of requirements. Other frequent requirements are regular psychological counseling and letters of recommendation for this surgery.
Hormone replacement therapy
Main article: Hormone replacement therapy (trans)
For both transsexual men and women hormone replacement therapy (HRT) causes the development of the secondary sexual characteristics of their desired gender. The already existing primary and secondary sexual characteristics are not undone by HRT; surgery is required to remove them or change their appearance; transwomen also require epilation to remove their unwanted facial and, if necessary, body hair.
Sex reassignment surgery
Main article: Sex reassignment surgery
Sex reassignment surgery consists of processes transsexual women and men take in order to match their anatomical sex to their gender identity; however, this surgery to correct genitalia (SRS) is also very expensive and not everywhere covered by public or private health insurance.
Prior to surgery, trans men and women are often referred to as pre-operative (pre-op); those who have already had the surgery may be referred to as post-operative (post-op) or simply identified by the sex and sexual status to which they have ascribed. Not all transsexual people are able to or choose to have sexual reassignment surgery (for several reasons, for example financial reasons, due to the high cost of such surgery, or medical reasons, or simply not wanting it for other reasons), although they live constantly in their target gender role; these are often called non-operative.
A more modern idea suggests the notion that the focus on surgery status is misplaced, and therefore more and more people are refusing to define themselves in terms of operative status.
Legal and social aspects
Main article: Legal aspects of transsexualism
Many Western societies today have some sort of procedure whereby an individual can change their name, sometimes also their legal gender, to reflect their gender identity. Medical procedures for transgender people are also available in most Western countries. However, because gender roles are an important part of many cultures, those engaged in strong challenges to the prevalence of these roles, such as many transgender people, often have to face considerable prejudice. One such case is chronicled in the movie Boys Don't Cry.
A few persons undergoing sexual reassignment surgery will adopt or provide foster care for children in the corresponding sex role which they have assumed. Societies are in some instances challenged to assimilate these men and women into their social institutions such as marriage and the role of parenting. Also, often children exist from the time before SRS. Many of these children stay with their transgender parent. A recent report shows that this does not harm the development of these children in any way.
Style guides used to publish more accurate information about the public and private lives of individuals pursuing or having changed gender and/or undergone sexual reassignment surgery to assist journalists or news reporting agencies to use the appropriate pronouns. Family members often confused about pronoun usage or the definitions of sex are frequently corrected by either the transsexual or the professionals who assist them as they approach that point at which they begin to "pass" as a member of the sex they wish to adopt.
Stealth
After this level of transition and development has been achieved, many transsexual men and women may wish to blend back in with other members of their new sex and will avoid revealing their past preferring the relative peace and security they find on the other side of a stressful and potentially dangerous transition.
This behaviour is known as stealth, and is somewhat a contentious issue. Some people, including some transsexual people, feel that they should be upfront about their past, and that stealth living is somehow dishonest; however, others claim that transsexual men and women should be able to live in their true gender role in a normal way and be in control of whom they reveal their past to.
The choice to live completely in stealth is known to present its own psychological difficulties - while its desireable for the transsexual male or female to assimilate fully into the new gender role, without someone in which to confide there are often tendancies torwards anxiety and depression. The term deep stealth is sometimes used for these individuals, referring to those that have completely isolated themselves from their past and from the support structures that may have helped them through transition, and who now are only known as transsexual to the medical professionals directly involved it their treatment process.
Retransitions
As with every transition, in children and in adults, "experts" often raise the spectre of transitions gone wrong, that is people transitioning back to their original sex. These cases do in fact exist, however, every recent study done on the number of these cases states that their number is below 1%, and that the reasons for retransitioning are very diverse. See this article in the International Journal of Transgenderism for examples.
These cases are often cited as reasons for the lengthly triadic process outlined in the Standards of Care, which specifies a treatment process combining supportive psychological, hormonal, and surgical care. While many have criticized this process as being too slow for some, its argued that without the safeguards within the standards of care, the incidence of unsuccessful surgical transitions would be much higher. This however is also questioned by many critics, especially with regard of particular demands or behaviour of some caretakers. The article above for example states clearly that in some of these cases, transitioning could have been prevented in the first place if some demands made by caretakers (or demands percieved as coming from the caretakers) had been less rigid; particularly, if the patients had not felt that talking about any problems or doubts would jeopardize their further treatment. (This assumption is very often correct.) Such a treatment would not be supportive, either.
Critics claim that when patients cannot talk about problems or doubts, but have to present themselves as having neither, the patients, anxious to get treatment they percieve at this point to be absolutely necessary, will face these problems or doubts after transitioning, when dealing with them is much more difficult, and this will often lead to social problems, depression, anxiety, or similar problems, and, in some rare cases, to a retransitioning. While there is no scientific study on the question, many trans*-organisations and groups claim from experience that the less pressure is felt by the patient to conform to any particular stereotype, the more satisfactory the outcome of the transition will be. This of course does not preclude any screening for mental problems which might lead to pseudo-transsexuality, nor a supportive psychological therapy if necessary.
External links
- The International Journal of Transgenderism - The Official Journal of the Harry Benjamin International Gender Dysphoria Association (HBIGDA)
- Basic TG/TS/IS Information - including Successful Transwomen and Successful Transmen
- How to Respect a Transsexual Person
- What transsexuality Is
- FTM International
- Press for Change - UK information about the trans rights campaign, and details about the legal, medical, political and social issues surrounding the people it represents.
- Mom, I Need to Be a Girl - a book by the mother of a transsexual child
- Changing Sex, Changing Islam