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Transsexual people experience a gender identity that is inconsistent with, or not culturally associated with, their assigned sex, and desire to permanently transition to the gender with which they identify, usually seeking medical assistance (including hormone replacement therapy and other sex reassignment therapies) to help them align their body with their identified sex or gender.
Transsexual is generally considered a subset of transgender, but some transsexual people reject the label of transgender. A medical diagnosis of gender dysphoria can be made if a person expresses a desire to live and be accepted as a member of their identified sex and if a person experiences impaired functioning or distress as a result of their gender identity.
Origin and use
Norman Haire reported that in 1921, Dora R of Germany began a surgical transition, under the care of Magnus Hirschfeld, which ended in 1930 with a successful genital reassignment surgery. In 1930, Hirschfeld supervised the second genital reassignment surgery to be reported in detail in a peer-reviewed journal, that of Lili Elbe of Denmark. In 1923, Hirschfeld introduced the (German) term "Transsexualismus", after which David Oliver Cauldwell introduced "transsexualism" and "transsexual" to English in 1949 and 1950.
Cauldwell appears to be the first to use the term to refer to those who desired a change of physiological sex. In 1969, Harry Benjamin claimed to have been the first to use the term "transsexual" in a public lecture, which he gave in December 1953. Benjamin went on to popularize the term in his 1966 book, The Transsexual Phenomenon, in which he described transsexual people on a scale (later called the "Benjamin scale") of three levels of intensity: "Transsexual (nonsurgical)", "Transsexual (moderate intensity)", and "Transsexual (high intensity)". In his book, Benjamin described "true" transsexualism as the following:
True transsexuals feel that they belong to the other sex, they want to be and function as members of the opposite sex, not only to appear as such. For them, their sex organs, the primary (testes) as well as the secondary (penis and others) are disgusting deformities that must be changed by the surgeon's knife.
Benjamin suggested that moderate intensity male to female transsexual people may benefit from estrogen medication as a "substitute for or preliminary to operation." Some people have had sex reassignment surgery (SRS) but do not meet the above definition of transsexual (e.g. Gregory Hemingway). Other people do not desire SRS although they meet the other elements of Benjamin's definition of a "true transsexual". Transsexuality was included for the first time in the DSM-III in 1980 and again in the DSM-III-R in 1987, where it was located under Disorders Usually First Evident in Infancy, Childhood or Adolescence.
Beyond Benjamin's work, which focused on male-to-female transsexual people, there are cases of the female to male transsexual, for whom genital surgery may not be practical. Benjamin gave certifying letters to his MTF transsexual patients that stated "Their anatomical sex, that is to say, the body, is male. Their psychological sex, that is to say, the mind, is female." After 1967 Benjamin abandoned his early terminology and adopted that of "gender identity."
Relationship of transsexual to transgender
Around the same time as Benjamin's book, in 1965, the term transgender was coined by John Oliven. By the 1990s, transsexual had come to be considered a subset of the umbrella term transgender. The term transgender is now more common, and many transgender people prefer the designation transgender and reject transsexual. The term transsexual, however, continues to be used, and some people who pursue medical assistance (for example, sex reassignment surgery) to change their sexual characteristics to match their gender identity prefer the designation transsexual and reject transgender. One perspective offered by transsexual people who reject a transgender label for that of transsexed is that, for people who have gone through sexual reassignment surgery, their anatomical sex has been altered, whilst their gender remains constant.
Historically, one reason some people preferred transsexual to transgender is that the medical community in the 1950s through the 1980s encouraged a distinction between the terms that would only allow the former access to medical treatment. Other self-identified transsexual people state that those who do not seek sex reassignment surgery (SRS) are fundamentally different from those who do, and that the two have different concerns, but this view is controversial, and others argue that merely having some medical procedures does not have such far-reaching consequences as to put those who have them and those who have not (e.g. because they cannot afford them) into such distinctive categories. Another reason for objecting to the term transsexual is the concern that it implies something to do with sexuality, when it is actually about gender identity. For example, Christine Jorgensen, the first person widely known to have sex reassignment surgery (in this case, male-to-female), rejected transsexual and instead identified herself in newsprint as trans-gender, on this basis.
The word transsexual is most often used as an adjective rather than a noun – a "transsexual person" rather than simply "a transsexual". Like other trans people, transsexual people prefer to be referred to by the gender pronouns and terms associated with their gender identity. For example, a trans man is a person who was assigned the female sex at birth on the basis of his genitals, but despite that assignment, identifies as a man and is transitioning or has transitioned to a male gender role; in the case of a transsexual man, he furthermore has or will have a masculine body. Transsexual people are sometimes referred to with directional terms, such as "female-to-male" for a transsexual man, abbreviated to "F2M", "FTM", and "F to M", or "male-to-female" for a transsexual woman, abbreviated "M2F", "MTF" and "M to F".
Individuals who have undergone and completed sex reassignment surgery are sometimes referred to as transsexed individuals; however, the term transsexed is not to be confused with the term transsexual, which can also refer to individuals who have not yet undergone SRS, and whose anatomical sex (still) does not match their psychological sense of personal gender identity.
The terms gender dysphoria and gender identity disorder were not used until the 1970s, when Laub and Fisk published several works on transsexualism using these terms. "Transsexualism" was replaced in the DSM-IV by "gender identity disorder in adolescents and adults".
Male-to-female transsexualism has sometimes been called "Harry Benjamin's syndrome" after the endocrinologist who pioneered the study of dysphoria. As the present-day medical study of gender variance is much broader than Benjamin's early description, there is greater understanding of its aspects, and use of the term Harry Benjamin's syndrome has been criticized for delegitimizing gender-variant people with different experiences.
Androphilia and gynephilia
The use of homosexual transsexual and related terms have been applied to transgender people since the middle of the 20th century, though concerns about the terms have been voiced since then. Harry Benjamin said in 1966:
...it seems evident that the question "Is the transsexual homosexual?" must be answered "yes" and " no." "Yes," if his anatomy is considered; "no" if his psyche is given preference.
What would be the situation after corrective surgery has been performed and the sex anatomy now resembles that of a woman? Is the "new woman" still a homosexual man? "Yes," if pedantry and technicalities prevail. "No" if reason and common sense are applied and if the respective patient is treated as an individual and not as a rubber stamp.
Many sources, including some supporters of the typology, criticize this choice of wording as confusing and degrading. Biologist Bruce Bagemihl writes "..the point of reference for "heterosexual" or "homosexual" orientation in this nomenclature is solely the individual's genetic sex prior to reassignment (see for example, Blanchard et al. 1987, Coleman and Bockting, 1988, Blanchard, 1989). These labels thereby ignore the individual’s personal sense of gender identity taking precedence over biological sex, rather than the other way around." Bagemihl goes on to take issue with the way this terminology makes it easy to claim transsexuals are really homosexual males seeking to escape from stigma. Leavitt and Berger stated in 1990 that "The homosexual transsexual label is both confusing and controversial among males seeking sex reassignment. Critics argue that the term "homosexual transsexual" is "heterosexist", "archaic", and demeaning because it labels people by sex assigned at birth instead of their gender identity. Benjamin, Leavitt, and Berger have all used the term in their own work. Sexologist John Bancroft also recently expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women. He says that he now tries to choose his words more sensitively. Sexologist Charles Allen Moser is likewise critical of the terminology.
Use of androphilia and gynephilia was proposed and popularized by psychologist Ron Langevin in the 1980s. Psychologist Stephen T. Wegener writes, "Langevin makes several concrete suggestions regarding the language used to describe sexual anomalies. For example, he proposes the terms gynephilic and androphilic to indicate the type of partner preferred regardless of an individual's gender identity or dress. Those who are writing and researching in this area would do well to adopt his clear and concise vocabulary."
Psychiatrist Anil Aggrawal explains why the terms are useful in a glossary:
Androphilia – The romantic and/or sexual attraction to adult males. The term, along with gynephilia, is needed to overcome immense difficulties in characterizing the sexual orientation of transmen and transwomen. For instance, it is difficult to decide whether a transman erotically attracted to males is a heterosexual female or a homosexual male; or a transwoman erotically attracted to females is a heterosexual male or a lesbian female. Any attempt to classify them may not only cause confusion but arouse offense among the affected subjects. In such cases, while defining sexual attraction, it is best to focus on the object of their attraction rather than on the sex or gender of the subject.
Psychologist Rachel Ann Heath writes, "The terms homosexual and heterosexual are awkward, especially when the former is used with, or instead of, gay and lesbian. Alternatively, I use gynephilic and androphilic to refer to sexual preference for women and men, respectively. Gynephilic and androphilic derive from the Greek meaning love of a woman and love of a man respectively. So a gynephilic man is a man who likes women, that is, a heterosexual man, whereas an androphilic man is a man who likes men, that is, a gay man. For completeness, a lesbian is a gynephilic woman, a woman who likes other women. Gynephilic transsexed woman refers to a woman of transsexual background whose sexual preference is for women. Unless homosexual and heterosexual are more readily understood terms in a given context, this more precise terminology will be used throughout the book. Since homosexual, gay, and lesbian are often associated with bigotry and exclusion in many societies, the emphasis on sexual affiliation is both appropriate and socially just." Author Helen Boyd agrees, writing, "It would be much more accurate to define sexual orientation as either "androphilic" (loving men) and "gynephilic" (loving women) instead." Sociomedical scientist Rebecca Jordan-Young challenges researchers like Simon LeVay, J. Michael Bailey, and Martin Lalumiere, who she says "have completely failed to appreciate the implications of alternative ways of framing sexual orientation."
Several terms are in common use, especially within the community itself relating to the surgical or operative status of someone who is transsexual, depending on whether they have already had SRS, have not had SRS but still intend to, or do not intend to have SRS. They are, post-op, pre-op, and non-op, respectively.
Transsexualism no longer is classified as a mental disorder in the International Statistical Classification of Diseases and Related Health Problems (ICD). The World Professional Association for Transgender Health (WPATH), and many transsexual people, had recommended this removal, arguing that at least some mental health professionals are being insensitive by labelling transsexualism as a "disease" rather than as an inborn trait as many transsexuals believe it to be. Now, instead, it is classified as a sexual health condition; this classification continues to enable healthcare systems to provide healthcare needs related to gender. The eleventh edition was released in June 2018. The previous version, ICD-10, had incorporated transsexualism, dual role transvestism, and gender identity disorder of childhood into its gender identity disorder category. It defined transsexualism as "[a] desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex."
Historically, transsexualism has also been included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). With the DSM-5, transsexualism was removed as a diagnosis, and a diagnosis of gender dysphoria was created in its place. This change was made to reflect the consensus view by members of the APA that transsexuality is not in and of itself a disorder and that transsexual people should not be stigmatized unnecessarily. By including a diagnosis for gender dysphoria, transsexual people are still able to access medical care through the process of transition.
The current diagnosis for transsexual people who present themselves for medical treatment is gender dysphoria (leaving out those who have sexual identity disorders without gender concerns). According to the Standards of care formulated by the World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association, this diagnostic label is often necessary to obtain sex reassignment therapy with health insurance coverage, and the designation of gender identity disorders as mental disorders is not a license for stigmatization or for the deprivation of gender patients' civil rights.
Causes, studies, and theories
The causes of transsexualism have been studied for decades. The most studied factors are biological. Certain brain structures in trans women have been found to be similar to cisgender women's as opposed to cis men's, and trans men's have been found to be similar to cis men's, even controlling for hormone use, which can also cause trans people's brains to become closer to those of cis people of the same gender. However, these studies are limited as they include a small number of tested individuals. Brain structure differences have also been noted between gay and heterosexual men, as well as lesbian and heterosexual women as part of extensive research on biology and sexual orientation. Studies have also found that both androphilic and gynephilic trans women's brain function and responses are like cis women's and unlike cis men's, or are intermediate between the two. Likewise, studies such as Rametti's have found that trans men have male-like white matter patterns (even before using hormones), regardless of sexual orientation.
With regard to genetic factors, a study by Hare reported that trans women have a longer androgen receptor gene than cis men, which is less effective at binding testosterone, potentially preventing complete masculinization of the brain (prenatal androgen exposure or sensitivity, or lack thereof, is an often cited mechanism to explain observed brain-structure differences). A study by Bentz found that trans men have a CYP17 allele distribution like cis men and unlike cis women. A twin study published in the International Journal of Transgenderism found that 33% of identical twin pairs were both trans, compared to only 2.6% of non-identical twins who were raised in the same family at the same time, but were not genetically identical.
Environmental factors have also been proposed. The failure of an attempt to raise David Reimer from infancy through adolescence as a girl after his genitals were accidentally mutilated is cited as disproving the theory that gender identity is determined by upbringing. Ray Blanchard developed a taxonomy of male-to-female transsexualism that proposes two distinct etiologies for androphilic and gynephilic individuals that has become highly controversial, supported by J. Michael Bailey, Anne Lawrence, James Cantor, Richard F. Docter and others, but opposed by Charles Allen Moser, Larry Nuttbrock, Julia Serano, and the World Professional Association for Transgender Health.
Sex reassignment therapy
Sex reassignment therapy (SRT) is an umbrella term for all medical treatments related to sex reassignment of both transgender and intersex people. Individuals make different choices regarding sex reassignment therapy, which may include female-to-male or male-to-female hormone replacement therapy (HRT) to modify secondary sex characteristics, sex reassignment surgery (such as orchiectomy) to alter primary sex characteristics, chest surgery such as top surgery or breast augmentation, or, in the case of trans women, a trachea shave, facial feminization surgery or permanent hair removal.
To obtain sex reassignment therapy, transsexual people are generally required to undergo a psychological evaluation and receive a diagnosis of gender identity disorder in accordance with the Standards of Care (SOC) as published by the World Professional Association for Transgender Health. This assessment is usually accompanied by counseling on issues of adjustment to the desired gender role, effects and risks of medical treatments, and sometimes also by psychological therapy. The SOC are intended as guidelines, not inflexible rules, and are intended to ensure that clients are properly informed and in sound psychological health, and to discourage people from transitioning based on unrealistic expectations.
Gender roles and transitioning
After an initial psychological evaluation, trans men and trans women may begin medical treatment, starting with hormone replacement therapy or hormone blockers. In these cases, people who change their gender are usually required to live as members of their target gender for at least one year prior to genital surgery, gaining real-life experience, which is sometimes called the "real-life test" (RLT). Transsexual individuals may undergo some, all, or none of the medical procedures available, depending on personal feelings, health, income, and other considerations. Some people posit that transsexualism is a physical condition, not a psychological issue, and assert that sex reassignment therapy should be given on request. (Brown 103)
Like other trans people, transsexual people may refer to themselves as trans men or trans women. Transsexual people desire to establish a permanent gender role as a member of the gender with which they identify, and many transsexual people pursue medical interventions as part of the process of expressing their gender. The entire process of switching from one physical sex and social gender presentation to another is often referred to as transitioning, and usually takes several years. Transsexual people who transition usually change their social gender roles, legal names and legal sex designation.
Not all transsexual people undergo a physical transition. Some find reasons not to; for example, the expense of surgery, the risk of medical complications, or medical conditions which make the use of hormones or surgery dangerous. Some may not identify strongly with another binary gender role. Others may find balance at a mid-point during the process, regardless of whether or not they are binary-identified. Many transsexual people, including binary-identified transsexual people, do not undergo genital surgery, because they are comfortable with their own genitals, or because they are concerned about nerve damage and the potential loss of sexual pleasure, including orgasm. This is especially so in the case of trans men, many of whom are dissatisfied with the current state of phalloplasty, which is typically very expensive, not covered by health insurance, and commonly does not achieve desired results. For example, not only does phalloplasty not result in a completely natural erection, it may not allow for an erection at all, and its results commonly lack penile sexual sensitivity; in other cases, however, phalloplasty results are satisfying for trans men. By contrast, metoidioplasty, which is more popular, is significantly less expensive and has far better sexual results.
Some transsexual people live heterosexual lifestyles (see heteronormative), while some identify as gay, lesbian, or bisexual. Many transsexual people choose the language of how they refer to their sexual orientation based on their gender identity, not their birth assigned sex, though some transsexual people still find identification with a physical-sex-based community: many trans men, for instance, are involved with lesbian communities.
Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex are typically ineffective. The widely recognized Standards of Care note that sometimes the only reasonable and effective course of treatment for transsexual people is to go through sex reassignment therapy.
The need for treatment of transsexual people is emphasized by the high rate of mental health problems, including depression, anxiety, and various addictions, as well as a higher suicide rate among untreated transsexual people than in the general population. These problems are alleviated by a change of gender role and/or physical characteristics.
Many transgender and transsexual activists, and many caregivers, note that these problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-variant individuals. Some transsexual people reject the counseling that is recommended by the Standards of Care because they do not consider their gender identity to be a cause of psychological problems.
Brown and Rounsley noted that "[s]ome transsexual people acquiesce to legal and medical expectations in order to gain rights granted through the medical/psychological hierarchy." Legal needs, such as a change of sex on legal documents, and medical needs, such as sex reassignment surgery, are usually difficult to obtain without a doctor or therapist's approval. Because of this, some transsexual people feel coerced into affirming outdated concepts of gender to overcome simple legal and medical hurdles (Brown 107).
Regrets and detransitions
People who undergo sex reassignment surgery can develop regret for the procedure later in life, largely due to lack of support from family or peers, with data from the 1990s suggesting a rate of 3.8%. In a 2001 study of 232 MTF patients who underwent GRS with Dr. Toby Meltzer, none of the patients reported complete regret and only 6% reported partial or occasional regrets. A 2009 review of Medline literature suggests the total rate of patients expressing feelings of doubt or regret is estimated to be as high as 8%. An issue reported by some is the inability to find sexual partners.
A 2010 meta-study, based on 28 previous long-term studies of transsexual men and women, found that the overall psychological functioning of transsexual people after transition was similar to that of the general population and significantly better than that of untreated transsexual people.
Estimates of the prevalence of transsexual people are highly dependent on the specific case definitions used in the studies, with prevalence rates varying by orders of magnitude. In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V 2013) gives the following estimates: "For natal adult males [MTF], prevalence ranges from 0.005% to 0.014%, and for natal females [FTM], from 0.002% to 0.003%." It states, however, that these are likely underestimates since the figures are based on referrals to specialty clinics.
A 1996 study of Swedes estimated transsexualism in 0.17 per 100,000 inhabitants, and a sex ratio (male:female) of 1.4:1 for those trans men and trans women requesting sex reassignment surgery and a ratio of 1:1 for those who proceeded.
The Amsterdam Gender Dysphoria Clinic over four decades has treated roughly 95% of Dutch transsexual clients, and it suggests (1997) a prevalence of 1:10,000 among assigned males and 1:30,000 among assigned females.
Olyslager and Conway presented a paper at the WPATH 20th International Symposium (2007) arguing that the data from their own and other studies actually imply much higher prevalence, with minimum lower bounds of 1:4,500 male-to-female transsexual people and 1:8,000 female-to-male transsexual people for a number of countries worldwide. They estimate the number of post-op women in the US to be 32,000 and obtain a figure of 1:2500 male-to-female transsexual people. They further compare the annual incidences of sex reassignment surgery (SRS) and male birth in the U.S. to obtain a figure of 1:1000 MTF transsexual people and suggest a prevalence of 1:500 extrapolated from the rising rates of SRS in the US and a "common sense" estimate of the number of undiagnosed transsexual people. Olyslager and Conway also argue that the US population of assigned males having already undergone reassignment surgery by the top three US SRS surgeons alone is enough to account for the entire transsexual population implied by the 1:10,000 prevalence number, yet this excludes all other US SRS surgeons, surgeons in countries such as Thailand, Canada, and others, and the high proportion of transsexual people who have not yet sought treatment, suggesting that a prevalence of 1:10,000 is too low.
A 2008 presentation at the LGBT Health Summit in Bristol, UK, showed that the prevalence of transsexual people in the UK was increasing (14% per year) and that the mean age of transition was rising.
Though no direct studies on the prevalence of gender identity disorder (GID) have been done, a variety of clinical papers published in the past 20 years provide estimates ranging from 1:7,400 to 1:42,000 in assigned males and 1:30,040 to 1:104,000 in assigned females.
In 2015, the National Center for Transgender Equality conducted a National Transgender Discrimination Survey. Of the 27,715 transgender and genderqueer people who took the survey, 35% identified as "non-binary", 33% identified as transgender women, 29% identified as transgender men, and 3% said that "crossdresser" best described their gender identity.
A 2016 systematic review and meta-analysis of "how various definitions of transgender affect prevalence estimates" in 27 studies found a meta-prevalence (mP) estimates per 100,000 population of 9.2 (95% CI = 4.9–13.6), equal to 1:11,000 for surgical or hormonal gender affirmation therapy and 6.8 (95% CI = 4.6–9.1), equal to 1:15,000 for transgender-related medical condition diagnoses. Of studies assessing self-reported transgender identity, prevalence was 355 (95% CI = 144–566), equal to 1 in 282. However, a single outlier study would have influenced the result to 871 (95% CI = 519–1,224), equal to 1 in 115; this study was removed. "Significant heterogeneity was observed in most analyses."
|Country||Publication||Year||prevalence in males||prevalence in females|
|Sweden||Acta Psychiatrica Scandinavica||1996||1:588,235||1:588,235|
|Netherlands||The Journal of Clinical Endocrinology & Metabolism||1997||1:10,000||1:30,000|
|US||International Journal of Transgenderism||2007||1:4,500||1:8,000|
|New Zealand||Australian and New Zealand Journal of Psychiatry||2008||1:3,639||1:22,714|
|US||The Journal of Sexual Medicine||2016||1:11,000||1:15,000|
Society and culture
A number of Native American and First Nations cultures have traditional social and ceremonial roles for individuals who do not fit into the usual roles for males and females in that culture. These roles can vary widely between tribes, because gender roles, when they exist at all, also vary considerably among different Native cultures. However, a modern, pan-Indian status known as Two-Spirit has emerged among LGBT Natives in recent years.
Legal and social aspects
Laws regarding changes to the legal status of transsexual people are different from country to country. Some jurisdictions allow an individual to change their name, and sometimes, their legal gender, to reflect their gender identity. Within the US, some states allow amendments or complete replacement of the original birth certificates. Some states seal earlier records against all but court orders in order to protect the transsexual person's privacy.
In many places, it is not possible to change birth records or other legal designations of sex, although changes are occurring. Estelle Asmodelle’s book documented her struggle to change the Australian birth certificate and passport laws, although there are other individuals who have been instrumental in changing laws and thus attaining more acceptance for transsexual people in general.
Medical treatment for transsexual and transgender people is available in most Western countries. However, transsexual and transgender people challenge the "normative" gender roles of many cultures and often face considerable hatred and prejudice. The film Boys Don't Cry chronicles the case of Brandon Teena, a transsexual man who was raped and murdered after his status was discovered. The project Remembering Our Dead, founded by Gwendolyn Ann Smith, archives numerous cases of transsexual and transgender people being murdered. In the United States, November 20 has been set aside as the "Day of Remembrance" for all murdered transgender people.
Jurisdictions allowing changes to birth records generally allow trans people to marry members of the opposite sex to their gender identity and to adopt children. Jurisdictions which prohibit same sex marriage often require pre-transition marriages to be ended before they will issue an amended birth certificate.
Health-practitioner manuals, professional journalistic style guides, and LGBT advocacy groups advise the adoption by others of the name and pronouns identified by the person in question, including present references to the transgender or transsexual person's past. Family members and friends who may be confused about pronoun usage or the definitions of sex are commonly instructed in proper pronoun usage, either by the transsexual person or by professionals or other persons familiar with pronoun usage as it relates to transsexual people. Sometimes transsexual people have to correct their friends and family members many times before they begin to use the transsexual person's desired pronouns consistently. According to Julia Serano, deliberate mis-gendering of transsexual people is "an arrogant attempt to belittle and humiliate trans people"
Both "transsexualism" and "gender identity disorders not resulting from physical impairments" are specifically excluded from coverage under the Americans with Disabilities Act Section 12211. Gender dysphoria is not excluded.
Openly transsexual people can have difficulty maintaining employment. Most find it necessary to remain employed during transition in order to cover the costs of living and transition. However, employment discrimination against trans people is rampant and many of them are fired when they come out or are involuntarily outed at work. Transsexual people must decide whether to transition on-the-job, or to find a new job when they make their social transition. Other stresses that transsexual people face in the workplace are being fearful of coworkers negatively responding to their transition, and losing job experience under a previous name—even deciding which rest room to use can prove challenging. Finding employment can be especially challenging for those in mid-transition.
Laws regarding name and gender changes in many countries make it difficult for transsexual people to conceal their trans status from their employers. Because the Harry Benjamin Standards of Care requires one-year of real life experience prior to SRS, some feel this creates a Catch-22 situation which makes it difficult for trans people to remain employed or obtain SRS.
In many countries, laws provide protection from workplace discrimination based on gender identity or gender expression, including masculine women and feminine men. An increasing number of companies are including "gender identity and expression" in their non-discrimination policies. Often these laws and policies do not cover all situations and are not strictly enforced. California's anti-discrimination laws protect transsexual persons in the workplace and specifically prohibit employers from terminating or refusing to hire a person based on their transsexuality. The European Union provides employment protection as part of gender discrimination protections following the European Court of Justice decisions in P v S and Cornwall County Council.
In the United States National Transgender Discrimination Survey, 44% of respondents reported not getting a job they applied for because of being transgender. 36% of trans women reported losing a job due to discrimination compared to 19% of trans men. 54% of trans women and 50% of trans men report having been harassed in the workplace. Transgender people who have been fired due to bias are more than 34 times likely than members of the general population to attempt suicide.
Many transsexual men and women choose to live completely as members of their gender without disclosing details of their birth-assigned sex. This approach is sometimes called stealth. Stealth transsexuals choose not to disclose their past for numerous reasons, including fear of discrimination and fear of physical violence. There are examples of people having been denied medical treatment upon discovery of their trans status, whether it was revealed by the patient or inadvertently discovered by the doctors.
In the media
Transsexualism was discussed in the mass media as long ago as the 1930s. The American magazine Time in 1936 devoted an article to what it called "hermaphrodites", treating the subject with sensitivity and not sensationalism. It described the call by Avery Brundage, who led the American team to the 1936 Summer Olympics in Berlin, that a system be established to examine female athletes for "sex ambiguities"; two athletes changed sex after the Games.
Christine Jorgensen was a transgender woman who received considerable attention in American mass media in the 1950s. Jorgensen was a former G.I. that went to Denmark to receive sex reassignment surgery. Her story appeared in publications including Time and Newsweek. Other representations of transgender women appeared in mainstream media in the 1950s and 1960s, such as Delisa Newton, Charlotte McLeod, Tamara Rees, and Marta Olmos Ramiro, but Jorgensen received the most attention. Her story was sensationalized, but received positively. In comparison, news articles about Newton, McLeod, Rees, and Ramiro had negative implications.
Before transsexual people were depicted in popular movies and television shows, Aleshia Brevard—a transsexual whose surgery took place in 1962:3—was actively working as an actress:141 and model:200 in Hollywood and New York throughout the 1960s and '70s. Aleshia never portrayed a transsexual person, though she appeared in eight Hollywood-produced films, on most of the popular variety shows of the day, including The Dean Martin Show, and was a regular on The Red Skelton Show and One Life to Live before returning to university to teach drama and acting.
Thomas Harris's Silence of the Lambs included a serial killer who considered himself a transsexual. After being turned down for sex reassignment surgery due to not meeting necessary psychological evaluations, he then harvested female bodies to make a feminine suit. In the novel, it is noted that the character is not actually a transsexual; this distinction is made only briefly in the film.
Films depicting transgender issues include: Come Back to the Five and Dime, Jimmy Dean, Jimmy Dean; The World According to Garp; The Adventures of Priscilla, Queen of the Desert; All About My Mother and The Crying Game. The film Different for Girls is notable for its depiction of a transsexual woman who meets up with, and forms a romantic relationship with, her former best friend from her all-male boarding school. Ma Vie en Rose portrays a six-year-old child who is gender variant. The film Wild Zero features Kwancharu Shitichai, a transsexual Thai actor. When the main character is conflicted about falling in love with a "woman who is also a man", Guitar Wolf tells him "Love knows no race, nationality or gender!"
Although Better Than Chocolate is primarily about the romance of two lesbians, a subplot in the 1999 Canadian film has Judy (Peter Outerbridge), a trans woman with a crush on Frances (Ann-Marie MacDonald), the owner of a lesbian bookstore. The film has a few scenes showing how Judy loses her parents, who are unable to accept her and buy her off with a home as a goodbye forever present.
Southern Comfort is a 2001 documentary by filmmaker Katie Davis, which follows the final months of the life of Robert Eads, a female-to-male transsexual living in Georgia. Eads was diagnosed with ovarian cancer and rejected for treatment by over two dozen doctors due to his transsexuality. The documentary follows Eads and several of his closest friends, a support group of transsexual southerners known as "Southern Comfort". The documentary won several awards, including the Grand Jury Prize at the Sundance Film Festival, First Prize at the Seattle International Film Festival, and the Special Audience Award at the Berlin International Film Festival.
Two notable films depict transphobic violence based on true events: Soldier's Girl (about the relationship between Barry Winchell and Calpernia Addams, and Winchell's subsequent murder) and Boys Don't Cry (about Brandon Teena's murder). Calpernia Addams has appeared in numerous movies and television shows, including the 2005 movie Transamerica, in which Felicity Huffman portrays a transsexual woman.
In fall 2005, the Sundance Channel aired a documentary series known as TransGeneration. This series focused on four transsexual college students, including two trans women and two trans men, in various stages of transition. In February 2006, Logo aired Beautiful Daughters, a documentary film about the first all-trans cast of The Vagina Monologues, which included Addams, Lynn Conway, Andrea James, and Leslie Townsend. Also in 2006, Lifetime aired a movie biography on the murder of "Eddie"/"Gwen" Araujo called A Girl Like Me: The Gwen Araujo Story.
Transsexual people have also been depicted in popular television shows. In part of the first season of the 1970s t.v. comedy series, Soap, Billy Crystal plays Jodie Dallas, a gay man who is about to undergo a sex change in order to legally marry his male lover, who breaks off the relationship just before the surgery. In Just Shoot Me!, David Spade's character meets up with his childhood male friend, who has transitioned to living as a woman. After initially being frightened, he eventually forms sexual attraction to his friend, but is scorned, as he is 'not her type'. In an episode of Becker Dr. Becker gets an out-of-town visit from an old friend who turns out to have undergone SRS, it plays out very similar to the situations in Just Shoot Me!. In a 1980s episode of The Love Boat, McKenzie Phillips portrays a trans woman who is eventually accepted as a friend by her old high school classmate, series regular Fred Grandy. In the 1970s on The Jeffersons, George's Navy buddy Eddie shows up as Edie and is eventually accepted by George.
Dramas including Law & Order and Nip/Tuck have had episodes featuring transsexual characters and actresses. While in Nip/Tuck the role was played by a non-transsexual woman, in Law & Order some were played by professional cross-dressers. Without a Trace and CSI: Crime Scene Investigation have had episodes dealing with violence against transsexual characters. Many transsexual actresses and extras appeared on the CSI episode, "Ch-Ch-Changes," including Marci Bowers and Calpernia Addams. The trans woman victim, Wendy, was played by Sarah Buxton, a cisgender woman. Candis Cayne, a transsexual actress, appeared in CSI: NY as a transsexual character. From 2007 to 2008, she also portrayed a transsexual character (this time recurring) in the ABC series Dirty Sexy Money.
There's Something About Miriam was a 2003 reality television show. It featured six men wooing 21-year-old Mexican model Miriam without revealing that she was a pre-operative trans woman until the final episode.
"Coronation Street" once had a transsexual woman named Hayley, who was Harold in her childhood. She died on 20 January 2014.
Since 2004, with the goal of crowning the top transsexual of the world, a beauty pageant by the name of The World's Most Beautiful Transsexual Contest was held in Las Vegas, Nevada. The pageant accepted pre-operation and post-operation trans women, but required proof of their gender at birth. The winner of the 2004 pageant was a woman named Mimi Marks.
Jenna Talackova, the 23-year-old woman who forced Donald Trump and his Miss Universe Canada pageant to end its ban on transgender contestants, competed in the pageant on May 19, 2012 in Toronto.
On Saturday, January 12, 2013, Kylan Arianna Wenzel was the first transgender woman allowed to compete in a Miss Universe Organization pageant since Donald Trump changed the rules to allow women like Wenzel to enter officially. Miss Wenzel was the first transgender woman to compete in a Miss Universe Organization pageant since officials disqualified 23-year-old Miss Canada Jenna Talackova the previous year after learning she was transgender.
Events and organizations
Trans communities in various countries hold several events annually; in the United States, the most prominent are the Transgender Day of Remembrance held every year on November 20, and the Trans March, one of three protests held in San Francisco, California during "Pride Weekend", the last weekend of June.
All About Trans is an organization in the UK whose goal is to influence and improve media professionals' understanding and portrayal of transsexual people. They do this by connecting media outlets with members of the transsexual community throughout the UK in order to foster a greater sensitivity toward this group of people. Paris Lees works as a facilitator with this organization and was recognized on The Independent on Sunday's Pink List in 2013 for being the most influential figure in the LGBT community in the UK.
Transgender At Work (TAW) is an organization with a focus on addressing issues in the workplace for transsexual individuals. Its goal is to allow transsexual employees to work productively without feeling as if they must hide an essential part of themselves. This includes addressing such issues as transsexual individuals being excluded from employer health care on the basis of their transsexuality.
The National Transgender Advocacy Coalition is a lobbying organization in the United States dedicated to preserving the civil rights of transsexual individuals. It began in Virginia in 1999 and held its first lobbying event in 2001. It has no paid employees, but consists of a board of experienced lobbyists and activists.
The Renaissance Education Association is a non-profit organization founded in Pennsylvania that is dedicated to providing education and social support regarding transgender issues. This includes providing educational programs, support groups, and resources to community care providers. It also strives to provide personal and educational resources for individuals struggling with issues related to transsexuality and those close to them.
Survivor Project is a non-profit organization founded in 1997 that is devoted to assisting intersex and transsexual survivors of domestic and sexual violence. This is done through caring action and education. The Project provides presentations, workshops, and consultation materials to many communities and universities across the United States. It also works to find information regarding the specific issues faced by intersex and transsexual individuals who are victimized. Empowering survivors and allowing them to participate in anti-violence activism is one major philosophy of the organization.
The Transgender Law and Policy Institute (TLPI) was founded by Paisley Currah, Associate Professor of Political Science at Brooklyn College. It is dedicated to engaging in effective advocacy for transgender people in our society. The TLPI brings experts together to work on law and policy initiatives designed to advance transgender equality. Their website provides information and resources on legislation, case law, employer and college policies and other resources.They also work with the Gay & Lesbian Advocates & Defenders (GLAD) in New England.
Trans*topia is section of Youth Resource (a project of Advocates for Youth, a nonprofit organization located in Washington D.C.) designed for the needs of transsexual youth. Their website includes articles about being young and transgender, both personal accounts and scientific articles that are intended to help transgender youth become more informed and comfortable with their sexuality and gender.
- Transgender Rights (2006, ISBN 0816643121), edited by Paisley Currah, Richard M. Juang, Shannon Minter
- Thomas E. Bevan, The Psychobiology of Transsexualism and Transgenderism (2014, ISBN 1440831270), page 42: "The term transsexual was introduced by Cauldwell (1949) and popularized by Harry Benjamin (1966) [...]. The term transgender was coined by John Oliven (1965) and popularized by various transgender people who pioneered the concept and practice of transgenderism. It is sometimes said that Virginia Prince (1976) popularized the term, but history shows that many transgender people advocated the use of this term much more than Prince. The adjective transgendered should not be used [...]. Transsexuals constitute a subset of transgender people."
- A. C. Alegria, Transgender identity and health care: Implications for psychosocial and physical evaluation, in the Journal of the American Academy of Nurse Practitioners, volume 23, issue 4 (2011), pages 175–182: "Transgender, Umbrella term for persons who do not conform to gender norms in their identity and/or behavior (Meyerowitz, 2002). Transsexual, Subset of transgenderism; persons who feel discordance between natal sex and identity (Meyerowitz, 2002)."
- Valentine, David. Imagining Transgender: An Ethnography of a Category, Duke University, 2007
- Stryker, Susan. Introduction. In Stryker and S. Whittle (Eds.), The Transgender Studies Reader, New York: Routledge, 2006. 1–17
- Kelley Winters, "Gender Madness in American Psychiatry, essays from the struggle for dignity, 2008, p. 198. "Some Transsexual individuals also identify with the broader transgender community; others do not."
- "Transsexualism". Gender Centre. March 2014. Archived from the original on 2016-03-04. Retrieved 2016-07-05.
Transsexualism is often included within the broader term 'transgender', which is generally considered an umbrella term for people who do not conform to typically accepted gender roles for the sex they were assigned at birth. The term 'transgender' is a word employed by activists to encompass as many groups of gender diverse people as possible. However, many of these groups individually don't identify with the term. Many health clinics and services set up to serve gender variant communities employ the term, however most of the people using these services again don't identify with this term. The rejection of this political category by those that it is designed to cover clearly illustrates the difference between self-identification and categories that are imposed by observers to understand other people.
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- Benjamin 1966, p. 23
- The non-surgical true Transsexual: a theoretical rationale. Paper presented at the 1983 Harry Benjamin International Gender Dysphoria Association VIII International Symposium, Bordeaux, France.
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- R Polly, J Nicole, Understanding the transsexual patient: culturally sensitive care in emergency nursing practice, in the Advanced Emergency Nursing Journal (2011): "The use of terminology by transsexual individuals to self-identify varies. As aforementioned, many transsexual individuals prefer the term transgender, or simply trans, as it is more inclusive and carries fewer stigmas. There are some transsexual individuals[,] however, who reject the term transgender; these individuals view transsexualism as a treatable congenital condition. Following medical and/or surgical transition, they live within the binary as either a man or a woman and may not disclose their transition history."
- A Swenson, Medical Care of the Transgender Patient, in Family Medicine (2014): "While some transsexual people still prefer to use the term to describe themselves, many transgender people prefer the term transgender to transsexual."
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If you understand trans-genders," she says, (the word she prefers to transsexuals), "then you understand that gender doesn’t have to do with bed partners, it has to do with identity.
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she describes people who have had such operations’ "transgender" rather than transsexual. "Sexuality is who you sleep with, but gender is who you are," she explained
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- Kacala, Alexander (18 June 2018). "Being Trans Is (Finally) No Longer Classified as a Mental Disorder by the WHO". Hornet. Retrieved 19 June 2018.
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Historically, many transmen who have had phalloplasty have not been satisfied with the results. Doctors continue to make improvements to this surgery, but many surgeons in the United States choose not to perform it because of the high risk of complications (severe scarring or fistulas for example), the significant risk of never regaining sensation in the penis or donor sites, and the chance that the result will not be aesthetically pleasing. However, some transmen are satisfied with their results and would choose to do it again if given the choice.
- Susan Stryker, Stephen Whittle (2013). The Transgender Studies Reader. Routledge. p. 353. ISBN 1135398844. Retrieved August 20, 2015.
In addition, phalloplasty 'cannot produce an organ rich in the sexual feeling of the natural one.'
- Carroll, Janell (2015). Sexuality Now: Embracing Diversity. Routledge. p. 132. ISBN 1305446038. Retrieved August 20, 2015.
Penises made from phalloplasty cannot achieve a natural erection, so penile implants of some kind are usually used (we will discuss these implants in more detail in Chapter 14). Overall, metoidioplasty is a simpler procedure than phalloplasty, which explains its popularity. It also has fewer complications, takes less time, and is less expensive (e.g., a metoidioplasty takes about 1 to 2 hours and can cost around $15,000 to 20,000, whereas, a phalloplasty can take about 8 hours can cost more than $65,000).
- Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects, Eva Moore, Amy Wisniewski and Adrian Dobs
- Seattle and King County Health – Transgender Health
- De Cuypere, Greta (2006). "Long-term follow-up: psychosocial outcome of Belgian transsexuals after sex reassignment surgery". Sexologies. 15 (2): 126–133. doi:10.1016/j.sexol.2006.04.002.
...the suicide attempt rate dropped significantly from 29.3% to 5.1%
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- For examples see Jill Stark, 'I will never be able to have sex again. Ever', The Age, May 31, 2009.
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- Murad, Mohammad; Elamin, Mohomed; Garcia, Magaly; Mullan, Rebecca; Murad, Ayman; Erwin, Patricia; Montori, Victor (2010). "Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes". Clinical Endocrinology. 72 (2): 214–231. doi:10.1111/j.1365-2265.2009.03625.x. PMID 19473181.
- Collin, Lindsay, et al. "Prevalence of Transgender Depends on the “Case” Definition: A Systematic Review." The Journal of Sexual Medicine 13.4 (2016): 613-626
- Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, D.C.: American Psychiatric Association. 2013. p. 454. ISBN 089042554X.
- Landén, M., Wålinder, J., Lundstrom, B. (1996) "...Results: During the 20-year period of the study, 233 requests for sex reassignment were processed, and the incidence data were calculated on the basis of this group. This means that the average annual frequency was 11.6 cases. The number of inhabitants in Sweden over 15 years of age increased during the study period from 6.5 million to 7.1 million, i.e. there was a mean population of 6.8 million (12), which gives an annual incidence of request for sex reassignment of 0.17 per 100,000 inhabitants. The sex ratio (male:female) is 1.4 :1. To resolve the question of whether transsexualism increases or decreases, we divided the group into two 10-year periods. As can be seen from Table 1, not only do our results agree with the Swedish incidence data published in the 1970s, but also they remain remarkably stable over time. Separating from all applications the group with primary transsexualism yielded 188 cases, i.e. 9.4 cases annually. As is shown in Table 2, this corresponds to an incidence of primary transsexualism of 0.14 per 100,000 inhabitants over 15 years of age. It should also be noted that primary transsexualism is equally common in women and men..." in Incidence and sex ratio of transsexualism in Sweden from Acta Psychiatrica Scandanavica, Volume 93, pages 261-263. Retrieved on 2007-09-22.
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- The Age, Dec 28 2014, "When Albert met Ann: 'Ridiculous' marriage laws force transgender divorce", http://www.theage.com.au/victoria/when-albert-met-ann-ridiculous-marriage-laws-force-transgender-divorce-20141210-124b8q.html
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Use whatever name and gender pronoun the person prefers
- Sponsored by the American Medical Association and The Fenway Health with unrestricted support from Fenway Health and Pfizer. "Meeting the Health Care Needs of Lesbian, Gay, Bisexual, and Transgender (LGBT) People: The End to LGBT Invisibility" (PowerPoint Presentation). The Fenway Institute. p. 24. Retrieved 2013-09-17.
Use the pronoun that matches the person’s gender identity
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listen to your clients – what terms do they use to describe themselves
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- Work transition for transsexual women – TS Road Map
- Making a successful transition at work – helpful guide by Jessica McKinnon and sample transition-related documents
- Pepper 2008
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- Skidmore, Emily (2011). "Constructing the "Good Transsexual": Christine Jorgensen, Whiteness, and Heteronormativity in the Mid-Twentieth-Century Press". Feminist Studies. 37 (2): 270–296. JSTOR 23069901.
- Brevard, Aleshia (19 January 2011). Woman I Was Not Born To Be: A Transsexual Journey. Philadelphia: Temple University Press. ISBN 978-1-4399-0527-2. OCLC 884015871.
- Aleshia Brevard on IMDb
- Silence of the Lambs on IMDb
- LovelyShiksa (23 May 2002). "Southern Comfort (2001)". IMDb. Retrieved 29 August 2015.
- Transamerica on IMDb
- TransGeneration on IMDb
- Beautiful Daughters – LOGO (TV channel) Documentary
- Calpernia Addams on IMDb
- Paula Newton (May 21, 2012). "Transgender Miss Universe Canada contestant falls short of title". CNN.
- Bennettsmith, Meredith (2013-01-11). "Transgender Miss California Contestant Set To Make History". Huffington Post.
- "Transgender woman to compete in Miss California USA pageant". LGBT Weekly. Retrieved 2015-08-29.
- "Encouraging greater understanding between the media and transgender people in the UK". All About Trans. Retrieved 2015-08-29.
- "Paris Lees: From prison to transgender role model". BBC News. 2013-10-27.
- "Transgender at Work Home Page". Tgender.net. Retrieved 2015-08-29.
- "Apache2 UbuntuDefault Page: It works". ntac.org. Retrieved 29 August 2015.
- Katie Wannabe. "Renaissance Education Association | Ren.org | Non-Profit Organization". Ren.org. Retrieved 2015-08-29.
- "Safety * Empowerment * Justice". Survivor Project. Retrieved 2015-08-29.
- "Transgenderlaw.org". Transgenderlaw.org. Retrieved 2015-08-29.
- "Youthresource.Com". Youthresource.Com. Retrieved 2015-08-29.
- Brown, Mildred L.; Chloe Ann Rounsley (1996). True Selves: Understanding Transsexualism – For Families, Friends, Coworkers, and Helping Professionals. Jossey-Bass. ISBN 978-0-7879-6702-4.
- Feinberg, Leslie (1999). Trans Liberation : Beyond Pink or Blue. Beacon Press. ISBN 978-0-8070-7951-5.
- Standards of Care for Gender Identity Disorders, Seventh Version. – World Professional Association for Transgender Health (2012)
- Kruijver, Frank P. M.; Jiang-Ning Zhou, Chris W. Pool, Michel A. Hofman, Louis J. G. Gooren and Dick F. Swaab (2000). "Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus". Journal of Clinical Endocrinology & Metabolism. 85 (5): 2034–41. doi:10.1210/jcem.85.5.6564. PMID 10843193.
- Rathus, Spencer A.; Jeffery S. Nevid, Lois Fichner-Rathus (2002). Human Sexuality in a World of Diversity. Allyn & Bacon. ISBN 978-0-205-40615-9.
- Schreiber, Gerhard (2016). Transsexuality in Theology and Neuroscience. Findings, Controversies, and Perspectives. Walter de Gruyter. ISBN 978-3-11-044080-5.
- Pepper, Shanti M.; Peggy Lorah (2008). "Career Issues and Workplace Considerations for the Transsexual Community: Bridging a Gap of Knowledge for Career Counselors and Mental Health Care Providers". The Career Development Quarterly. 56 (4): 330–343. doi:10.1002/j.2161-0045.2008.tb00098.x.
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- Asociación Española de Transexuales. AET Transexualia
- Basic TG/TS/IS Information– including Successful Transwomen and Successful Transmen
- FTM International – Female To Male International: practical and medical information
- FTM Australia – Comprehensive information for all men identified female at birth in Australia.
- Hudson's FTM Resource Guide – Comprehensive information for female to male trans men and allies – US-based
- Gender.org– Gender Education & Advocacy, a nonprofit corporation providing online education and advocacy for transsexual and transgender issues
- The International Journal of Transgenderism – The Official Journal of the World Professional Association for Transgender Health (formerly HBIGDA). An archive of IJT Volumes I through V is available, as are several books on transsexualism, including Harry Benjamin's "The Transsexual Phenomenon"
- TransParentcy – supports transgender parents and their advocates (lawyers, mental health professionals, friends, family) by providing information and resources.
- Transsexual Road Map – consumer information and advice for transsexual women.
- "Dr. Anne Lawrence On Transsexualism and Sexuality" - detailed information on medical aspects of transition
- The Gender Identity Research and Education Society