Wikia

Psychology Wiki

Changes: Transsexualism

Edit

Back to page

m (fixing dead links)
 
(2 intermediate revisions by 2 users not shown)
Line 1: Line 1:
 
{{ClinPsy}}
 
{{ClinPsy}}
'''Definition'''
+
{{PsyPerspective}}
'''Transsexualism''' or '''transsexuality''' is a condition in which a '''transsexual''' person [[gender identity|self-identifies]] as a member of the [[gender]] opposite to the one assigned to them at birth. Transsexual people are stereotypically described as "women trapped in male bodies" or ''vice versa'', although some members of the transsexual community, as well as some outside the community, reject this model. [http://ftmichael.tashari.org/trans101.html]
+
[[File:TransgenreatParis2005.JPG|thumb|200px|A [[trans woman]] with the letters "[[XY sex-determination system|XY]]" written on her palm]]
  +
{{Transgender sidebar}}
   
Most transsexual [[transman|men]] and [[transwoman|women]] desire to establish a permanent [[gender role|social role]] as a member of the [[gender]] with which they identify. Many transsexual people also desire various types of medical alterations ([[sex reassignment therapy]]) to their bodies. These physical alterations are collectively referred to as [[sex reassignment therapy]] and often include [[Hormone replacement therapy (trans)|hormones]] and [[sex reassignment surgery]]. The entire process of switching from one physical and social gender presentation to the other is often referred to as [[Transitioning|transition]], and usually takes several years.
+
'''Transsexualism''' describes the condition in which an individual [[gender identity|identifies]] with a [[gender]] inconsistent or not culturally associated with their [[Sex assignment|assigned sex]], i.e. in which a person's assigned sex at birth conflicts with their brain sex. A medical diagnosis can be made if a person experiences discomfort as a result of a desire to be a member of the opposite gender,<ref name="icd-10">{{cite web
  +
|url=http://www.who.int/classifications/apps/icd/icd10online/gF60.htm#F640
  +
|title=ICD-10
  +
|accessdate=2008-09-28
  +
}}</ref> or if a person experiences impaired functioning or distress as a result of that gender identification.<ref name=DSM-IV-TR>{{Cite book
  +
|title=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Text Revision)
  +
|last=American Psychiatric Association
  +
|year=2000
  +
|publisher=American Psychiatric Publishing
  +
|isbn=0-89042-025-4}}</ref>
   
To obtain sex reassignment therapy, transsexual people are usually required to receive [[psychotherapy|psychological therapy]] and a diagnosis of [[gender identity disorder]]. They must also live as members of their target sex for a period of time, known as the ''Real-life test'', prior to surgery, and meet other requirements specified by protocols known as ''[[Standards of care for gender identity disorders|Standards of Care]]''. These requirements are intended to prevent individuals from transitioning and later regretting doing so; however, their effectiveness is questionable.
+
Transsexualism is [[stigmatized]] in many parts of the world but has become more widely known in Western culture in the mid to late 20th century, concurrently with the [[sexual revolution]] and the development of [[sex reassignment surgery]] (SRS). Discrimination or negative attitudes towards transsexualism often accompany certain religious beliefs or cultural values.
   
Currently, the causes of transsexualism are unknown, and estimates of prevalence vary substantially.
+
There are cultures that have no difficulty integrating people who change gender roles, often holding them with high regard, such as the traditional role for "[[Two-Spirit]]" people found among certain [[Native Americans in the United States|Native American]] tribes.<ref>''Two-Spirit People: Native American Gender Identity, Sexuality, and Spirituality'' 1997 U. Illinois, p.100 Sabine Lang et al.</ref>
   
==Definitions==
+
==Diagnosis==
Transsexualism is a complex condition that is defined differently by different people. Many terms have been proposed through the years to describe transsexual people and the processes they go through. Some of these terms are controversial, among the transsexual community as well as society at large.
+
Transsexualism appears in the two major diagnostic manuals used by mental health professionals worldwide, the [[American Psychiatric Association]]'s [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM, currently in its fourth edition) and the [[International Statistical Classification of Diseases and Related Health Problems]] (ICD, currently in its [[ICD-10|tenth edition]]). The ICD-10 incorporates ''transsexualism'', ''dual role transvestism'' and ''gender identity disorder of childhood'' into its [[gender identity disorder]] category, and defines 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."<ref name="ICD10TS">{{cite web| url = http://www.nhsdirect.nhs.uk/articles/article.aspx?articleid=435 | title = Gender dysphoria | accessdate=2008-09-13 }} {{Dead link|date=October 2010|bot=H3llBot}}</ref> The DSM does not distinguish between gender identity disorder and transsexualism, and defines [[transvestic fetishism]] as a separate phenomenon which may co-occur with transsexualism. The DSM diagnosis requires four components:<ref name="DSM-IV-TRans">{{cite web| url = http://72.3.233.244/images/asset_upload_file155_30369.pdf | format = PDF | title = Diagnostic criteria for Gender Identity Disorder | accessdate = 2008-12-21}} {{Dead link|date=October 2010|bot=H3llBot}}</ref>
  +
* A desire or insistence that one is of the opposite biological sex (that is not due to a perceived advantage of being the other sex)
  +
* Evidence of persistent discomfort with, and perceived inappropriateness of the individual's biological sex
  +
* The individual is not [[Intersexuality|intersex]] (although a diagnosis of GID ''Not Otherwise Specified'' is available, which enables intersex people who reject their sex-assignment to access transsexual treatments)
  +
* Evidence of clinically significant distress or impairment in work or social life.
   
===Defining transsexualism===
+
===Process===
The definition of "transsexual" is debated. Many within the trans community feel that a person is transsexual if they personally identify as such. However, some, especially [[health care]] providers and some transsexual people, believe there is a certain set of procedures that must always be completed for a person to be called "transsexual". The general public often defines "a transsexual" as someone who has had or plans to have "[[sex change]]" surgery, although this term is considered inaccurate by many people who believe that sex cannot really be ''changed''. The term currently in widest use for modification of [[primary sex characteristics]] is [[sex reassignment surgery]] (SRS), a term which reflects the belief that transsexual people do not consider themselves to be changing their sex, but to be correcting their bodies. However, some feel that the term "sex change" is appropriate and that it stresses that transsexual people are not castrated members of their original sex. [http://www.symposion.com/ijt/pfaefflin/1000.htm]
+
{{Refimprove section|date=July 2009}}
  +
The current [[diagnosis]] for transsexual people who present themselves for psychological treatment is "[[gender identity disorder]]" (leaving out those who have sexual identity disorders without gender concerns). The DSM changed its terminology in 1994 away from the diagnosis of "transsexualism". According to the Standards Of Care formulated by the World Professional Association for Transgender Health (WPATH),<ref name="WPATH web">{{cite web|url=http://wpath.org |title=World Professional Association for Transgender Health |publisher=WPATH |date=2011-09-25 |accessdate=2012-02-23}}</ref><ref name="WPATHSOCs">{{cite web
  +
|url=http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf
  +
|format=PDF|title=Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th Version
  +
|accessdate=2012-02-23
  +
|archiveurl=http://web.archive.org/web/20110930044557/http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf|archivedate=2011-09-30}}</ref> formerly the Harry Benjamin International Gender Dysphoria Association, this diagnostic label is often necessary to obtain sex reassignment therapy with health insurance coverage, and states that the designation of gender identity disorders as mental disorders is not a license for stigmatization, or for the deprivation of gender patients' civil rights. However, some people diagnosed with gender identity disorder have no desire for sex reassignment therapy at all, particularly not genital reassignment surgery, and/or are not appropriate candidates for such treatment. While some feel that formal diagnosis helps to destigmatize transsexualism, others feel that it only adds stigma, essentially feeling that such a diagnosis is equivalent to saying something really is wrong with transsexual people. The diagnosis of "gender identity disorder" is seen as insulting and irrelevant to some transsexual people, and may be considered a causal factor in instances of harm occurring to, or death of, transsexual people as the result of prejudice and discrimination when deprived of their civil rights. (Brown 105)
   
  +
Many transsexual people have asked the [[American Psychiatric Association]] to remove Gender Identity Disorder from the DSM, and [[World Health Organization]] from ICD-10 as it had been listed for some time. Many of these people feel that at least some mental health professionals are being insensitive by labeling transsexualism as "a disease", rather than as an inborn trait.<ref>{{cite book |author=Green, Jamison |title=Becoming a Visible Man |publisher=Vanderbilt University Press |date=May 2004 |page=79 |isbn=0-8265-1457-X }}</ref> The Principles 18 of [[The Yogyakarta Principles]], documents on [[international human rights law]]<ref>[http://web.archive.org/web/20101122035344/http://www.yogyakartaprinciples.org/yogyakarta-principles-jurisprudential-annotations.pdf Jurisprudential Annotations to the Yogyakarta Principles, p. 43]</ref> opposes such diagnosis as [[mental illness]] as medical abuse, as well as "[[Yogyakarta Principles in Action|Activist's Guide to the Yogyakarta Principles]]".<ref>[http://www.ypinaction.org/files/02/85/Activists_Guide_English_nov_14_2010.pdf Activist's Guide to the Yogyakarta Principles, p.100]</ref>
   
  +
==Relation to gender roles==
  +
{{Unreferenced section|date=January 2011}}
  +
Transsexual people may refer to themselves as [[trans man|trans men]] or [[trans woman|trans women]]. Transsexual people often desire to establish a permanent [[gender role]] as a member of the [[gender]] with which they identify. Some transsexual people pursue medical interventions as part of the process of expressing their gender.
   
  +
These medically based, physical alterations are collectively referred to as [[sex reassignment therapy]], and may include [[Hormone replacement therapy (female-to-male)|female-to-male]] or [[Hormone replacement therapy (male-to-female)|male-to-female]] hormone replacement therapy, or various surgeries. Surgeries may include genital surgery such as [[orchiectomy]] or [[sex reassignment surgery]]; chest surgery such as [[Breast augmentation surgery|top surgery]] or [[breast augmentation]]; or, in the case of trans women, facial surgery such as [[trachea shave]] or [[facial feminization surgery]]. The entire process of switching from one physical sex and social gender presentation to another is often referred to as [[Transitioning (transgender)|transition]], and usually takes several years.
   
'''Description'''
+
Not all transsexual people undergo a physical transition. Some find reasons not to, for example, the expense of surgery, the risk of medical complications, 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 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 and 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 which does not result in a fully erectile, sexually sensate penis.
It is accepted in the [[Diagnostic and Statistical Manual of Mental Disorders]] that expression of ''desire'' to be of the opposite sex, or assertion that one is of the sex opposite to the one with which they were identified at birth, constitutes being transsexual. [http://www.behavenet.com/capsules/disorders/genderiddis.htm] The [[ICD|ICD-10]] also states that transsexualism is defined by "the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment." In contrast, some [[transgender]] people often do not identify as being of or desiring to be ''the opposite sex'', but as being of or wanting to be ''another gender''.
 
   
Transsexualism (also known as '''transsexuality''') 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 role]]s. However, some in the transsexual community do not identify as transgender, or see transsexualism not as a sub-division of transgender. Often, those people complain that non-transsexual transgender people are somehow "degrading" transsexual people by first describing them as "just tranvestites" (this refers to the [[Gender identity disorder#ICD-10|assumption]], that gender variant people can neatly be divided into "transsexuals" and "[[Transvestitism|transvestites]]") or "perverts" or similar, and then claiming that this is not what transsexual people are. This is usually accompanied by demanding that medical treatment and legal change of name and legal gender should be reserved only for transsexual people. Some also see the term 'transgender' as subsuming and erasing their identity, rejecting it for themselves because to them it implies a breaking down of [[gender role]]s, when in fact they see themselves as fitting a gender role -- just not the one they were assigned at birth. Those contesting this view point out that the idea of a more inclusive "Gender identity disorder" has long replaced the idea of dividing gender variant people into "transsexuals" and "transvestites", that classifying transsexualism as a sub-division of transgender does not automatically erase any transsexual identity, that not all transgender people wish to break down gender barriers, and that any marginalized group trying to gain acceptance of those opposed to them by trying to oppress another group has not only never been successful, it is also ethically questionable according to certian individuals and faiths.
+
Some transsexual people live heterosexual lifestyles and gender roles, while some identify as gay, lesbian,<ref name="ekins2006">{{cite book|last=Ekins|first=Richard|title=The Transgender Phenomenon|year=2006|publisher=SAGE|location=London|isbn=0-7619-7164-5|coauthors=King, Dave}}</ref> or bisexual. Many trans people find that a shift occurs in their sexual orientation as they undergo transition. Many transsexual people choose the language of how they refer to their sexual orientation based on their gender identity, not their [[morphology (biology)|morphological]] sex,<ref name="ekins2006"/> though some transsexual people still find identification with their community: many trans men, for instance, are involved with lesbian communities, and identify as lesbian despite their male identity. Some lesbians are willing to become sexually or romantically involved with trans men; some gay men are willing to do the same with trans women; where both groups typically would not date members of the opposite sex.
   
Transsexualism should not be confused with [[Cross-dressing|cross dressing]] or with the behaviour of [[drag queen]]s, which can be described as transgender, but usually not transsexual. Also, [[transvestic fetishism]] usually has little, if anything, to do with transsexualism.
+
==Origins==
  +
<!-- Deleted image removed: [[File:Tipton portrait.jpg|thumb|[[Billy Tipton]] was born in 1914. He began living as a man full-time by 1940 at age 26, had a career as a jazz and swing pianist and entertainer, a common law marriage (unregistered but publicly accepted), and three sons by adoption. He was discovered to have been female-bodied after he died in 1989 due to a hemorrhaging ulcer (that he refused to have treated). Like many Female-to-Male transsexual people of his day, he did not have genital surgery.]] -->
  +
[[Gender]] was originally a linguistic term. In many languages, words can be considered masculine, feminine, or neutral, completely independently from the attributes of the things to which the word applies. Different languages manifest gender in various ways, recognizing two genders (female, male), three genders (female, male, neuter), or in some cases none at all. In some (e.g. the [[Romance languages]]), variation by gender is indicated by relatively simple changes in nouns and adjectives, while others require more complex grammatical changes. In English, a transsexual person's first step in [[Transitioning|transition]] often includes the request to be referred to using pronouns for their target gender (''she'' rather than ''he'', ''her'' rather than ''him'', and ''hers'' rather than ''his'', or vice versa). Some English speakers {{Who|date=May 2012}} who feel that they are best described as something in between or other than masculine or feminine prefer to use "they" and "them", as well as “ze” and “hir” (examples of [[gender-neutral pronoun]]s in English) or other invented neutral pronouns.<ref>{{cite web|title=Sie Hir, Now: Terms for Gender Variant People|url=http://www.webcitation.org/67dRXQoUR|accessdate=2012-05-13}}</ref>
   
===Gender terminology for transsexual people===
+
[[Norman Haire]] reported that in 1921,<ref>{{cite journal |author=Norman Haire |authorlink=Norman Haire|title=Encyclopaedia of Sexual Knowledge |year=1934 |url=http://www.transgenderzone.com/features/sex_change.htm}}</ref> that Dora-R of [[Germany]] under the care of [[Magnus Hirschfeld]], began surgical transition from 1921, ending in 1930 with a successful genital reassignment surgery.
Transsexual people are usually referred to by the gender pronouns and terms associated with their target gender. For example, a transsexual man is a person who was identified as female at birth on the basis of his [[Sex organ|genitals]], but who identifies as a man and is transitioning or has transitioned to a male gender role and has or will have a masculine body. Transsexual people are sometimes referred to with "assigned-to-target" gender terms such as "female-to-male" for a transsexual man or "male-to-female" for a transsexual woman. These terms may be abbreviated as "M2F", "F2M", "MTF", "F to M", etc. These terms help to prevent confusion, as some people are oblivious as to whether a "transsexual woman" is a female transitioning to become a male or a male transitioning to become a female. Transsexual men and women are also sometimes referred to as [[transman|transmen]] and [[transwoman|transwomen]].
+
In 1930, Magnus Hirschfeld supervised the second genital reassignment surgery to be reported in detail in a peer-reviewed journal on [[Lili Elbe]] of [[Denmark]]. The German term “Transsexualismus” was introduced by Hirschfeld in 1923.<ref>Hirschfeld, Magnus; “Die intersexuelle Konstitution” in ''Jarhbuch fuer sexuelle Zwischenstufen'' 1923.</ref> The neo-Latin term “psychopathia transexualis” and English “transexual” were introduced by [[D. O. Cauldwell]] in 1949,<ref>{{cite journal |author=Cauldwell, David Oliver |authorlink=D. O. Cauldwell |title=Psychopathia Transexualis |journal=Sexology: Sex Science Magazine |volume=16 |year=1949 |url=http://www.wpath.org/journal/www.iiav.nl/ezines/web/IJT/97-03/numbers/symposion/cauldwell_02.htm}}</ref> who subsequently also used the term “trans-sexual” in 1950.<ref>Cauldwell, David Oliver.''[http://www.wpath.org/journal/www.iiav.nl/ezines/web/IJT/97-03/numbers/symposion/cauldwell_04.htm ''Questions and Answers on the Sex Life and Sexual Problems of Trans-Sexuals: Trans-Sexuals Are Individuals of One Sex and Apparently Psychologically of the Opposite Sex. Trans-Sexuals Include Heterosexuals, Homosexuals, Bisexuals and Others. A Large Element of Transvestites Have Trans-Sexual Leanings.]'' (1950) Haldeman-Julius Big Blue Book B-856.</ref> Cauldwell appears to be the first to use the term in direct reference to those who desired a change of physiological sex.<ref name="meyerowitz">Meyerowitz, Joanne Jay; ''How Sex Changed: A History of Transsexuality in the United States''.</ref> (In 1969, Benjamin claimed to have been the first to use the term “transsexual” in a public lecture, which he gave in December 1953.<ref>{{cite book |author=Benjamin, H. |chapter=Introduction |editor=Green, R.; Money, J. |title=Transsexualism and Sex Reassignment |publisher=Johns Hopkins |location=Baltimore |year=1969 }}</ref>) This term continues to be used by the public and medical profession alike.<ref name="Pauly">{{Cite journal|last=Pauly MD |first=Ira B. |title=Terminology and Classification of Gender Identity Disorders |journal=Journal of Psychology & Human Sexuality |volume=5 |issue=4 |pages=1–12 |date=28 May 1993 |url=http://www.haworthpress.com/store/ArticleAbstract.asp?sid=DPRJKLWKVGB58LR50W0AD29WXCGU5XC7&ID=77620|accessdate=2007-02-26 |doi=10.1300/J056v05n04_01|issn=0890-7064}}</ref> It 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''.
   
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 terms. It should be noted that transsexualism is not associated with or dependent on [[sexual orientation]]. Transsexual men and women exhibit a range of sexual orientations just as non-transsexual ([[Cisgender|cissexual]]) people 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 [[Heterosexuality|heterosexual]], not [[gay]]; likewise, someone who was assigned female sex at birth, identifies as a man, and prefers male partners will identify as gay, not heterosexual. Transsexual people, like other people, can be [[bisexuality|bisexual]] or [[asexual]] as well.
+
[[Christine Jorgensen]] created an international sensation when in 1952 she was the first widely known person to have [[sex reassignment surgery]]—in this case, [[Transwoman|male to female]].
   
Older medical texts often referred to transpeople as members of their original sex; in other words referring to a male-to-female transsexual as a "male transsexual". They also described sexual orientation in relation to the person's assigned sex, not their gender of identity; in other words, referring to a male-to-female transsexual who is attracted to men as a "[[homosexual]] male transsexual." This dwindling usage is considered by many to be scientifically inaccurate and clinically insensitive today, and such a person would now be called and most likely identify herself as a [[heterosexual]] transwoman. Some medical textbooks still refer to transsexual people as members of their assigned sex, but many now use "assigned-to-target" terms.
+
The word ''transsexual'' was used by [[Harry Benjamin]] in his seminal 1966 book ''[[The Transsexual Phenomenon]]'' to describe transsexual people on a scale (later called the "[[Benjamin scale]]") that recognizes three levels of intensity of transsexualism: "Transsexual (nonsurgical)", "Transsexual (moderate intensity)", and "Transsexual (high intensity)".<ref name="benjaminscale">{{harvnb|Benjamin|1966|p=23}}</ref><ref>The non-surgical true Transsexual: a theoretical rationale. Paper presented at the1983 Harry Benjamin International Gender Dysphoria Association VIII International Symposium, Bordeaux, France.</ref><ref name="Ts-Si_Gaughan">{{cite web| last = Gaughan| first = Sharon | title = What About Non-op Transsexuals? A No-op Notion | publisher = TS-SI| date = 2006-08-19 | url = http://ts-si.org/content/view/1409/995/ | accessdate = September 30, 2008}}</ref> in ''The Transsexual Phenomenon'', Benjamin described "true" transsexualism in this way: "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."<ref>{{cite web| url = http://www.symposion.com/ijt/benjamin/chap_02.htm | title =Henry Benjamin Symposium&nbsp;– Chapter 2}}</ref> Benjamin suggested that moderate intensity male to female transsexual people may benefit from estrogen medication as a "substitute for or preliminary to operation."<ref name="benjaminscale"/> Some people have had SRS but do not meet the common definition of a transsexual (e.g., Gregory Hemingway).<ref name="Hemingway1">{{cite web| last = Conway| first = Lynn
  +
| title = The Strange Saga of Gregory Hemingway | year = 2003
  +
| url = http://ai.eecs.umich.edu/people/conway/TS/GregoryHemingway.html }}</ref><ref name="Hemingway2">{{Cite news| last = Schoenberg| first = Nara | title = The Son Also Falls From elephant hunter to bejeweled exhibitionist, the tortured life of Gregory Hemingway | newspaper = Chicago Tribune | date = November 19, 2001| url =http://www.newsday.com/features/printedition/ny-p2cover2470306nov19.story?coll=ny-features-print |archiveurl = http://web.archive.org/web/20011120185300/http://www.newsday.com/features/printedition/ny-p2cover2470306nov19.story?coll=ny-features-print |archivedate = November 20, 2001}}</ref> Other people do not desire SRS although they do meet Dr. Benjamin's definition of a "true transsexual".<ref name="Nonopexample1">{{cite video | people = [[Miriam (entertainer)|Miriam Rivera]]| title = Excerpt of "There's Something About Miriam"| medium = Television | publisher = Edemol & Brighter picture via various Newscorp properties.| location = Filmed in Ibiza, Spain Produced in England.|date = 2004 | url = http://www.youtube.com/watch?v=Zq-OrJQFbO4 }}</ref> Beyond Benjamin's work, which focused on male-to-female transsexual people, there is the case of the female to male transsexual for whom genital surgery may not be practical. Benjamin gives his MTF transsexual patients papers that will help with most legal problems. The certificates state 'Their anatomical sex, that is to say, the body, is male. Their psychological sex, that is to say, the mind, is female'. However, beyond 1967 Benjamin and his terminology of sexual identity are found to be mostly obsolete.<ref name="ekins2006"/>
   
A number of people outside the transsexual community still refer to transsexual people with terms associated with their birth sex (for example calling a male-to-female transsexual "him"). This usage, generally considered insensitive, has been (though not exclusively) based on biological arguments such as the unchanged [[karyotype]], which is usually consistent with the sex assigned to the person at birth, or the absence of reproductive capability after transition and sex reassignment surgery. Arguments for this usage have also been based on religious [[dogma]]. Conservative groups such as the [[Traditional Values Coalition]] are among those to refer to transsexual people as members of their original sex.
+
==Relation to transgenderism==
  +
{{Refimprove section|needs sources to confirm this, and omits other usage (i.e. specific not umbrella)|date=August 2009}}
  +
  +
Transsexualism is often included within the broader category of ''[[transgender]]ism'', which is generally used as an umbrella term for people who do not conform to typical accepted [[gender role]]s, for example [[cross-dresser]]s, [[transvestite]]s, and people who identify as [[genderqueer]]. Transsexualism refers to a specific condition in the transgender realm. Thus, even though a crossdresser and transsexual are both transgender people, their conditions differ radically.<ref name="VitaleNotes">{{cite web
  +
|url=http://www.avitale.com/FAQ.htm#category%203
  +
|title= Notes on Gender Role Transition - Crossdressing vs Transsexualism
  +
|author=Vitale, A.
  +
|date=2011-08-14
  +
|accessdate=2011-12-24
  +
}}</ref><ref>Sullivan, L. (1990). Information for the female to male cross dresser and transsexual. (3 ed.). Seattle, WA: Ingersoll Gender Center.</ref> Though some people use transgenderism and transsexualism interchangeably, they are not synonymous terms.<ref>Iyall Smith, K. E., & Leavy, P. (2008). Hybrid identities: theoretical and empirical examinations. Leiden, The Netherlands: IDC Publishers.</ref>
  +
  +
Some transsexual people object to being included in the transgender spectrum; anthropologist David Valentine contextualizes the objection to including transsexual people in his book "Transgender, an Ethnography of a Category."<ref>Valentine, David. Imagining Transgender: An Ethnography of a Category. Duke University, 2007.</ref> He writes that transgender is a term coined and used by activists to include many people who do not necessarily identify with the term. He observes that many current health clinics and services set up to serve gender variant communities employ the term, but that most of the service-seekers do not identify with the term. The rejection of this political category, first coined by self-identified activist Leslie Feinberg, illustrates the difference between a self-identifier and categories imposed by observers to understand other people.<ref>[[Susan Stryker|Stryker, Susan]]. Introduction. In Stryker and S. Whittle (Eds.), The Transgender Studies Reader. New York: Routledge, 2006. 1–17.</ref>
  +
  +
Historically the reason that transsexual people rejected associations with the transgender or broader LGBT community is largely that the medical community in the 1950s through the late 1980s encouraged this rejection of such a grouping in order to qualify as a 'true transsexual' who would thus be allowed to access medical and surgical care. The animosity that is present today is no longer fed by this same kind of pressure from the medical community.{{citation needed|date=June 2012}}
  +
  +
Though the beliefs of some modern day transsexual people that they are not "transgender" reflects this historical division (Denny 176), other transsexual people state that those who do not seek SRS are very different from those who need to be of "the other sex", and that these groups have different issues and concerns and are not doing the same things.<ref name="Ts-Si_Gaughan"/> The latter view is rather contested, with opponents pointing out that merely having or not having some medical procedures hardly can have such far-reaching consequences as to put those who have them and those who have not into such distinctive categories. Notably Harry Benjamin's original definition of transsexualism does not require that they need to have had SRS.<ref name="benjaminscale"/>
  +
  +
==Terminology==
  +
The word "transsexual" is most often used as an adjective rather than a noun&nbsp;– a "transsexual person" rather than simply "a transsexual". Transsexual people prefer to be referred to by the gender pronouns and terms associated with their target gender. For example, a transsexual man is a person who was assigned the female sex at birth on the basis of his [[Sex organ|genitals]], but despite that assignment identifies as a man and is transitioning or has transitioned to a male gender role and has or will have a masculine body. Transsexual people are sometimes referred to with "assigned-to-target" sex terms such as "female-to-male" for a transsexual man or "male-to-female" for a transsexual woman. These terms may be abbreviated as "M2F", "F2M", "MTF", "F to M", etc.
   
 
===Alternative terminology===
 
===Alternative terminology===
Among the transsexual community, the short form trans is sometimes used, e.g. ''trans guy'', ''trans dyke'', ''trans folk''. Some use the controversial terms ''tranny'' and/or ''trans'', though others consider these terms to be offensive. Those who use these terms claim that they are diminishing the power of the term as an insult. Others feel that the terms are insulting or inaccurate regardless of the context.
+
The term "gender dysphoria" and "gender identity disorder" were not used until the 1970s<ref name="Pauly" /> when Laub and Fisk published several works on transsexualism using these terms.<ref name="Laub">{{Cite journal|last=Laub |first=D. R. |coauthors=N. Fisk |title=A rehabilitation program for gender dysphoria syndrome by surgical sex change |journal=Plast Reconstr Surg. |volume=53 |issue=4 |pages=388–403 |month=April | year=1974 | pmid = 4592953 |doi=10.1097/00006534-197404000-00003 }}</ref><ref name="Fisk">{{Cite journal|last=Fisk |first=N. |title=Gender Dysphoria Syndrome |editor=Laub, D.; Gandy P. |journal=Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome |pages=7–14 |year=1974 }}</ref> "Transsexualism" was replaced in the DSM-IV by "gender identity disorder in adolescents and adults".
  +
  +
==Prevalence==
  +
The DSM-IV (1994) quotes a prevalence of roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek [[sex reassignment surgery]] in the USA. The most frequently quoted estimate of prevalence is from the Amsterdam Gender Dysphoria Clinic<ref>{{Cite journal|last=van Kesteren |first=Paul J. M |coauthors=Henk Asscheman, Jos A. J Megens, Louis J. G Gooren |title=Mortality and morbidity in transsexual subjects treated with cross-sex hormones |journal=J. Clin. Endocrinol. |volume=47 |issue=3 |pages=337–343 |publisher=Blackwell, Oxford, UK |year=1997 |url=http://www.blackwell-synergy.com/doi/abs/10.1046/j.1365-2265.1997.2601068.x |doi=10.1046/j.1365-2265.1997.2601068.x | pmid = 9373456 }}</ref> The data, spanning more than four decades in which the clinic has treated roughly 95% of Dutch transsexual clients, gives figures of 1:10,000 assigned males and 1:30,000 assigned females. Though no direct studies on the prevalence of 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.<ref>Transgender Mental Health, "The Prevalence of Transgenderism" http://tgmentalhealth.com/2010/03/31/the-prevalence-of-transgenderism/</ref>
  +
  +
Olyslager and [[Lynn Conway|Conway]] presented a paper<ref>{{Cite journal|last=Olyslager |first=Femke |coauthors=Lynn Conway |title=On the Calculation of the Prevalence of Transsexualism |year=2007 |url=http://ai.eecs.umich.edu/people/conway/TS/Prevalence/Reports/Prevalence%20of%20Transsexualism.pdf |format=PDF}}</ref> 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 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 U.S. and a "common sense" estimate of the number of undiagnosed transsexual people.
  +
  +
Olyslager and Conway also argued that the U.S. population of assigned males having already undergone reassignment surgery by the top three U.S. SRS surgeons alone is enough to account for the entire transsexual population implied by the 1:10,000 prevalence number. This excludes all other U.S. 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 prevalance of 1:10,000 is too low.
  +
  +
A study in 2008 examined the number of New Zealand passport holders who changed the sex on their passport and estimated that 1:3,639 birth-assigned males and 1:22,714 birth-assigned females were transsexual.<ref name="veale2008">{{Cite journal|author=Veale, Jaimie F.|year=2008|month=October|title=Prevalence of transsexualism among New Zealand passport holders|journal=Australian and New Zealand Journal of Psychiatry|pmid=18777233|volume=42|issue=10|pages=887–889|doi=10.1080/00048670802345490|url=http://www.jaimieveale.com/publications/prevalence.pdf}}</ref>
  +
  +
A presentation at the LGBT Health Summit in Bristol, UK,<ref>{{cite conference |last=Reed| first=Bernard|coauthors=Stephenne Rhodes |title=Presentation on prevalence of transsexual people in the UK|year=2008|url=http://www.gires.org.uk/prevalence.php }}</ref> based upon figures from a number of reputable European and UK sources, shows that this population is increasing rapidly (14% per year) and that the mean age of [[Transitioning (transgender)|transition]] is actually rising.
  +
  +
==Causes==
  +
{{Main|Causes of transsexualism}}
  +
  +
Psychological and biological causes for transsexualism have been proposed, i.a. by professor [[Dick Swaab]], with evidence leaning toward prenatal and genetic causes.<ref name="hawaii.edu">{{cite journal |author=Swaab, D.F. |title=Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation |journal=Gynecological Endocrinology |volume=19 |pages=301–312 |year=2004 |pmid=15724806 |doi=10.1080/09513590400018231 |url=http://www.hawaii.edu/hivandaids/Sexual_Differentiation_of_the_Human_Brain__Relevance_for_Gender_Identity,_Transsexualism_and_Sexual_Orientation.pdf |issue=6}}</ref><ref name=Kruijver00>{{harvnb|Kruijver|2000}}</ref><ref name="brain.oxfordjournals.org">{{cite journal |author=Garcia-Falgueras A, Swaab DF |title=A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity |journal=Brain |volume=131 |issue=Pt 12 |pages=3132–46 |year=2008 |month=December |pmid=18980961 |doi=10.1093/brain/awn276 |url=http://brain.oxfordjournals.org/content/131/12/3132.full}}</ref> One such proposed cause is related to the [[stria terminalis#Bed nucleus of the stria terminalis|bed nucleus of a stria terminalis]], or BSTc, a constituent of the basal ganglia of the brain which is affected by prenatal androgens.<ref>Psychology The Science Of Behaviour, pg 418, Pearson Education, Neil R.Carlson</ref> In one study, the BSTc of male-to-female transsexual women was similar to those of [[cisgender]] women whose psychological gender identity and assigned sex are the same. However, those of both heterosexual and homosexual men were similar to each other but different from those of women (both cis- and transsexual).<ref name=Kruijver00/> Another study suggests that transsexuality may have a genetic component.<ref>[http://news.bbc.co.uk/1/hi/health/7689007.stm Male transsexual gene link found] ''[[BBC News]]'' 26 October 2008 (accessed 26 October 2008)</ref> There is considerable evidence that prenatal exposure to endocrine-disrupting anti-miscarriage drugs such as [[diethylstilbestrol]] (DES) may also be positively associated with transsexualism, though research in this area has yet to establish a firm causal link.<ref name="pmid16203228">{{cite journal | author = Hood E | title = Are EDCs blurring issues of gender? | journal = Environmental Health Perspectives | volume = 113 | issue = 10 | pages = A670–7 | year = 2005 | pmid = 16203228 | pmc = 1281309 | doi =10.1289/ehp.113-a670 }}</ref><ref name = "Blackless_2006">{{cite journal | author = Blackless M, Besser M, Carr S, Cohen-Kettenis PT, Connolly P, De Sutter P, Diamond M, Di Ceglie D, Higashi Y, Jones L, Kruijver FPM, Martin J, Playdon Z-J, Ralph D, Reed T, Reid R, Reiner WG, Swaab D, Terry T, Wilson P, Wylie K | title = Atypical Gender Development – A Review | journal = International Journal of Transgenderism | volume = 9 | issue = 1 | pages = 29–44 | year = 2006 | doi = 10.1300/J485v09n01_04 }}</ref><ref name="pmid11580991">{{cite journal | author = Michel A, Mormont C, Legros JJ | title = A psycho-endocrinological overview of transsexualism | journal = Eur. J. Endocrinol. | volume = 145 | issue = 4 | pages = 365–76 | year = 2001 | pmid = 11580991 | doi = 10.1530/eje.0.1450365}}</ref><ref name="pmid16267416">{{cite journal | author = Selvaggi G, Ceulemans P, De Cuypere G, VanLanduyt K, Blondeel P, Hamdi M, Bowman C, Monstrey S | title = Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals | journal = Plast. Reconstr. Surg. | volume = 116 | issue = 6 | pages = 135e–145e | year = 2005 | pmid = 16267416 | doi = 10.1097/01.prs.0000185999.71439.06| url = http://www.shb-info.org/sitebuildercontent/sitebuilderfiles/vaginoplasty2005doc.pdf }}</ref>
  +
  +
Some people consider research into the "causes" of transsexualism to be based on the assumption that it is a pathology, an assumption that is rejected by many transsexual people.{{Citation needed|date=April 2012}} Others think of the condition as a form of [[intersexuality]], and support research into possible causes, believing that it will verify the theory of a biological origin and thereby reduce social stigma by demonstrating that it is not a delusion, a political statement, or a [[paraphilia]]. Note that social stigma has a role to play in the development of and adherence to both viewpoints. See the [[transfeminism]] article's section on GID for further discussion.
  +
  +
[[Harry Benjamin]] wrote, "Summarizing my impression, I would like to repeat here what I said in my first lecture on the subject more than 10 years ago: Our genetic and endocrine equipment constitutes either an unresponsive, sterile, or a more or less responsive, that is to say, fertile soil on which the wrong conditioning and a psychic trauma can grow and develop into such a basic conflict that subsequently a deviation like transsexualism can result."<ref>{{cite book |last=Benjamin |first=H. |title=The transsexual phenomenon |publisher=Julian Press |location=New York |year=1966 |page=85 |ref=harv |isbn=0-446-82426-7}}</ref>
  +
  +
==Sex reassignment therapy==
  +
{{Main|Sex reassignment therapy}}
  +
  +
Sex reassignment therapy (SRT) is an umbrella term for all medical treatments related to sex reassignment of both [[transgender]] and [[intersexual]] people. Though SRT is sometimes called "gender reassignment", those who use the word "sex" to describe an individual's biology and "gender" to describe their personal identity and social role consider this usage to be misleading. The process of changing from one gender presentation to another is often called [[transitioning|transition]].
  +
  +
Individuals make different choices regarding sex reassignment therapy, which can include [[hormone replacement therapy (trans)|hormone replacement therapy]] (HRT) to modify [[secondary sex characteristic]]s, [[sex reassignment surgery]] to alter [[primary sex characteristics]], [[facial feminization surgery]] and [[epilation|permanent hair removal]] for [[trans women]]. Transsexual people who transition usually change their social [[gender role]]s, [[legal name]]s and legal sex designation.
  +
  +
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.<ref name="WPATH web" /> 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.
  +
  +
===Psychological treatment===
  +
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<ref name="WPATHSOCs" /> note that sometimes the only reasonable and effective course of treatment for transsexual people is to go through sex reassignment therapy.<ref name="WPATHSOCs"/><ref>[http://jcem.endojournals.org/cgi/content/full/88/8/3467 Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects], Eva Moore, Amy Wisniewski and Adrian Dobs</ref>
  +
  +
The need for treatment is emphasized by the high rate of [[mental health]] problems, including [[clinical depression|depression]], [[anxiety]], and various [[Substance dependence|addictions]], as well as a higher [[suicide]] rate among untreated transsexual people than in the general population.<ref>[http://www.metrokc.gov/health/glbt/transgender.htm Seattle and King County Health&nbsp;– Transgender Health] {{dead link|date=December 2012}}</ref> These problems may be alleviated by a change of gender role and/or physical characteristics.<ref>[http://web.archive.org/20061021230001/the-sisterhood.tripod.com/id28.html The International Transsexual Sisterhood&nbsp;– Study On Transsexuality] {{dead link|date=December 2012}}</ref>
  +
  +
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<ref name="WPATHSOCs"/> because they don’t consider their gender identity to be a psychological problem.
  +
  +
Brown and Rounsley<ref>Brown, Mildred L.; Chloe Ann Rounsley (1996). True Selves: Understanding Transsexualism&nbsp;– For Families, Friends, Co-workers, and Helping Professionals. Jossey-Bass. ISBN 978-0-7879-6702-4.</ref> 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 and/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).
  +
  +
===Medical aspects===
  +
After an initial psychological evaluation, [[trans man|men]] and [[trans woman|women]] may begin medical treatment starting with [[Hormone replacement therapy (trans)|hormone replacement therapy]]<ref name="WPATHSOCs"/><ref name="Gooren">{{cite journal | last1 = Gooren | first1 = LJ | last2 = Giltay | first2 = EJ | last3 = Bunck | first3 = MC. | author-separator =, | last4 = Eliasson | year = 2008 | first4 = B. | last5 = Malloy | first5 = J. L. | last6 = Shaginian | first6 = R. M. | last7 = Deng | first7 = W. | last8 = Kendall | first8 = D. M. | last9 = Taskinen | first9 = M.-R. | title = Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience | journal = J Clin Endocrinol Metab | volume = 32 | issue = 5| pages = 19–25 | pmid = 19196887 | pmc = 2671094 | doi=10.2337/dc08-1797}}</ref> or hormone blockers. People who change sex are usually required to live as members of their target sex for at least one year prior to genital surgery, so-called [[Real life experience|Real-Life Experience (RLE)]] or Real-Life Test (RLT).<ref name="WPATHSOCs"/> 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)
  +
  +
===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%.<ref>{{Cite journal|last=Landén |first=M |coauthors=Wålinder, J, Hambert, G, Lundström, B. |title=Factors predictive of regret in sex reassignment |journal=Acta Psychiatr Scand. |volume=97 |issue=4 |month=April | year=1998 |pmid=9570489|pages=284–9}}</ref> A review of Medline literature suggests the total rate of patients expressing feelings of doubt or regret is estimated to be as high as 8%.<ref>{{Cite journal|last=Baranyi |first=A |coauthors=Piber, D, Rothenhäusler, HB. |title=Male-to-female transsexualism. Sex reassignment surgery from a biopsychosocial perspective |journal=Wien Med Wochenschr. |volume=159 |issue=21–22 | year=2009 |pmid=19997841|pages=548–57|doi=10.1007/s10354-009-0693-5}}</ref> 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.<ref name="Lawrence">{{Cite journal|last=Lawrence MD |first=A. A. |title=Factors associated with satisfaction or regret following male-to-female sex reassignment surgery |journal=Archives of Sexual Behavior |volume=32 |issue=4 |pages=299–315 |date=Aug 2003 |doi=10.1023/A:1024086814364|pmid=12856892 }}</ref>
  +
  +
==Legal and social aspects==
  +
{{See also|Legal aspects of transsexualism}}
  +
[[File:Anna Grodzka.jpg|thumb|200px|[[Poland]]'s [[Anna Grodzka]]<ref>[http://sejm.gov.pl/sejm7.nsf/posel.xsp?id=119 "Anna Grodzka"]. Sejm Rzeczypospolitej Polskiej. Retrieved December 2, 2011.</ref> is the first transsexual MP in the history of Europe to have had [[sex reassignment surgery]].<ref>Świerzowski, Bogusław. [http://www.infokrakow24.pl/2011/10/10/wybory-2011-andrzej-duda-pis-zdeklasowal-konkurentow-w-krakowie/ "Wybory 2011: Andrzej Duda (PIS) zdeklasował konkurentów w Krakowie"]. Info Kraków 24. October 10, 2011.</ref>]]
  +
Laws regarding changes to the legal status of transsexual people are different from country to country. Some jurisdictions allow an individual to [[name change|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.<ref name="transgenderlaw.org">{{cite web|url=http://transgenderlaw.org/ |title=The Transgender Law and Policy Institute: Home Page |publisher=Transgenderlaw.org |date= |accessdate=2011-07-06}}</ref> Some states seal earlier records against all but court orders in order to protect the transsexual'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 (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.<ref>[http://www.rememberingourdead.org Remembering Our Dead]&nbsp;– a memorial to transgender people who have been murdered</ref> In the United States, November 20 has been set aside as the "Day of Remembrance" for all murdered transgender people.<ref>[http://www.campkc.com/campkc-content.php?Page_ID=760 '' Don't Forget Transgender Day of Rememberance (sic)<!-- PLEASE NOTE that "Rememberance" is deliberately spelled incorrectly here, reflecting the mistake on the external page. -->''] by Jamie Tyroler, January 18, 2008, Kansas City Camp</ref>
  +
  +
Some people who have switched their gender role enter into traditional social institutions such as [[marriage]] and [[parenting]]. They sometimes [[adoption|adopt]] or provide [[foster care]] for children, as complete sex reassignment therapy inevitably results in [[infertility]]. Some transsexual people have children from before transition. Some of these children continue living with their transitioning/transitioned parent, or retain close contact with them.
  +
  +
The style guides of many media outlets prescribe that a journalist who writes about a transsexual person should use the name and pronouns used by that person. Family members and friends, who are often confused about pronoun usage or the definitions of [[sex]], are frequently 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 proper pronouns consistently. Deliberate mis-gendering is perceived to be a form of [[transphobia]].
  +
  +
Both "transsexualism" and "gender identity disorders not resulting from physical impairments" are specifically excluded from coverage under the [[Americans with Disabilities Act]] Section 12211.<ref>{{cite web|url=http://finduslaw.com/americans_with_disabilities_act_of_1990_ada_42_u_s_code_chapter_126#3 |title=Americans with Disabilities Act of 1990 - ADA - 42 U.S. Code Chapter 126 |publisher=find US law |date= |accessdate=2011-07-06}}</ref>
  +
Gender Dysphoria is not excluded.<ref>{{cite web|url=http://www.access-board.gov/about/laws/ada.htm#TITLE%20V%20-%20MISCELLANEOUS%20PROVISIONS |title=Americans with Disabilities Act of 1990 §512. DEFINITIONS. |publisher=United States Access Board, a Federal Agency |date=2009-01-01 |accessdate=2013-06-05}}</ref>
  +
  +
==Coming out==
  +
  +
===Employment issues===
  +
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 [[outing|outed]] at work.<ref>[http://www.tsroadmap.com/reality/jobtrans.html Work transition for transsexual women]&nbsp;– TS Road Map</ref> Transsexual people must decide whether to transition on-the-job,<ref>[http://www.jessicamckinnon.com/web/Resources/SampleTransitionDocuments/tabid/56/Default.aspx Making a successful transition at work]&nbsp;– helpful guide by [[Jessica McKinnon]] and sample transition-related documents</ref> 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.<ref>{{harvnb|Pepper|2008}}</ref> 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.<ref>{{Cite journal|last=Weiss |first=Jillian Todd |title=The Gender Caste System: Identity, Privacy and Heteronormativity |publisher=Tulane Law School |year=2001 |url=http://phobos.ramapo.edu/~jweiss/tulane.pdf |format=PDF|accessdate=2007-02-25 }}</ref> Because the Harry Benjamin Standards of Care require a one-year RLE 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.<ref name="transgenderlaw.org"/><ref>[http://www.hrc.org/Template.cfm?Section=transgender_issues&template=/TaggedPage/Taggedpagedisplay.cfm&TPLID=26&ContentID=31022 Workplace Discrimination: Gender Identity or Expression]&nbsp;– Human Rights Campaign Foundation</ref> Often these laws and policies do not cover all situations and are not strictly enforced. [[California]]'s [[anti-discrimination law]]s 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''.<ref>[http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:61994J0013:EN:HTML Judgment of the Court of 30 April 1996.&nbsp;– P v S and Cornwall County Council.&nbsp;– Reference for a preliminary ruling: Industrial Tribunal, Truro&nbsp;– United Kingdom.&nbsp;– Equal treatment for men and women&nbsp;– Dismissal of a transsexual.&nbsp;– Case C-13/94]&nbsp;– European Court reports 1996 Page I-02143</ref>
  +
  +
In the National Transgender Transgender Discrimination Survey, 44% of respondents reported not getting a job they applied for because of being transgender.<ref name="endtransdiscrimination.org">{{cite web|url=http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf}}</ref>
  +
36% of trans women reported losing a job due to discrimination compared to 19% of trans men.<ref name="endtransdiscrimination.org"/>
  +
54% of trans women and 50% of trans men report having been harassed in the workplace.<ref name="endtransdiscrimination.org"/> Transgender people who have been fired due to bias are more than 34 times likely than members of the general population to attempt suicide.<ref name="endtransdiscrimination.org"/>
  +
  +
===Stealth===
  +
Some transsexual men and women choose to live completely as members of their target gender without being public about their past. This approach is sometimes called ''stealth.'' Some people feel that they have an obligation to be open about their past in order to further the cause of civil rights for LGBT people.
  +
  +
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.<ref name="TyraTGR">{{Cite book|url=http://books.google.com/?id=HBRR1isU-VAC|title=The Transgender Studies Reader|publisher=CRC Press|year=2006|isbn=0-415-94709-X, 9780415947091|accessdate=2009-11-24|last=Stryker |first=Susan |authorlink=Susan Stryker |last2=Whittle |first2=Stephen |author2-link=Stephen Whittle}}</ref> For example, [[Leslie Feinberg]] was once turned away from a hospital [[emergency room]] where he had sought treatment for [[endocarditis]].<ref>{{Cite book|author=Leslie Feinberg|url=http://books.google.com/?id=j1HtppmYfBEC&pg=PA2&dq=%22Leslie+Feinberg%22+%22emergency+room%22#PPA4,M1|title=Trans Liberation: Beyond Pink Or Blue|pages=2–4|publisher=Beacon Press|year=1998|isbn=0-8070-7951-0}}</ref> {{Verify credibility|date=June 2010}} Feinberg was presenting as a man but had female genital anatomy. He nearly died after being denied treatment. Feinberg's case demonstrates one of the many dangers of having one's trans status discovered. [[Tyra Hunter]] died after being denied care by [[paramedics]] and emergency room physicians after she was injured in an automobile accident.<ref name="TyraTGR"/>
  +
  +
==In the media==
  +
{{See also|List of transgender characters in film and television}}
  +
[[File:Nina Poon threefour Shankbone 2010 NYC.jpg|thumb|Nina Poon, a transsexual model who has appeared in [[Kenneth Cole Productions|Kenneth Cole]] ads, at the 2010 [[Tribeca Film Festival]].]] Transsexualism was discussed in the mass media as long ago as the 1930s. The American magazine ''[[Time magazine|Time]]'' in 1936 devoted an article to what it called "[[Hermaphrodites#Other uses of the term|hermaphrodites]]", treating the subject with sensitivity and not sensationalism.<ref>{{cite news|url=http://www.time.com/time/magazine/article/0,9171,756527-1,00.html|title=Medicine: Change of Sex|date=24 Aug 1936|work=[[Time (magazine)|Time]]|accessdate=23 December 2010}}</ref> 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.
  +
  +
Before transsexual people were depicted in popular movies and television shows, [http://www.aleshiabrevard.com/default.htm Aleshia Brevard]&nbsp;— an actual transsexual whose surgery took place in 1962&nbsp;— was actively working as an [http://www.aleshiabrevard.com/Gallery_FilmTV.htm actress] and [http://www.aleshiabrevard.com/Gallery_Fashion.htm model] 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.<ref>{{IMDb name|0108087|Aleshia Brevard}}</ref><ref>{{cite book |author=Aleshia Brevard |title=The Woman I Was Not Born to Be: A Transsexual Journey |publisher=Temple University Press |location=Philadelphia |year=2001 |isbn=1-56639-840-1 }}</ref>
  +
  +
[[Thomas Harris]]'s ''[[The Silence of the Lambs (novel)|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.<ref>{{IMDb title|0102926|title=Silence of the Lambs}}</ref>
  +
  +
===In film===
  +
Films depicting transgender issues include: ''[[Come Back to the Five and Dime, Jimmy Dean, Jimmy Dean (film)|Come Back to the Five and Dime, Jimmy Dean, Jimmy Dean]]'', ''[[The World According to Garp]]'', ''[[The Adventures of Priscilla, Queen of the Desert]]'', 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 variance|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!"
   
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]]. [http://itre.cis.upenn.edu/~myl/languagelog/archives/000311.html] Some consider this usage to be silly and/or incorrect.
+
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. Within the film has a few scenes showing how Judy loses her parents who are unable to accept her, and buy her off with a bye forever present in purchasing a home for her.
   
Some prefer the term ''transsexed'' over ''transsexual'', as they believe the term ''sexual'' found in ''transsexual'' is misleading and implies that transsexualism is a sexual orientation. 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, 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.
+
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 (film)|Boys Don't Cry]]'' (about [[Brandon Teena]]'s murder). Calpernia Addams has appeared in numerous movies and television shows, including the 2005 movie ''[[Transamerica (film)|Transamerica]]'', in which [[Felicity Huffman]] portrays a transsexual woman.<ref>{{IMDb title|0407265|Transamerica}}</ref>
   
It is often assumed, particularly by transsexual people, that transsexualism is simply a subset of intersex. "Intersex" previously referred only to those who are genitally intersexed, i.e., with genitals that don't look classically male or female (in spite of the fact that human genitals show an extremely wide variation in general). However, since sex in humans is composed of many different attributes, such as [[genes]], [[chromosomes]], regulatory [[protein]]s, [[hormones]], [[hormone receptor]]s, body morphology, brain sex, and [[gender identity]], any variation among any of those attributes falls under the rubric of "intersex." Transsexualism, in this view, simply becomes [[neurology|neurological]] intersexuality. (See below for research of physiological causes of transsexualism).
+
In fall 2005, the [[Sundance Channel (United States)|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.<ref>{{IMDb title|0461110|TransGeneration}}</ref> In February 2006, [[Logo (TV channel)|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.<ref>[http://www.logoonline.com/shows/dyn/beautiful_daughters/series.jhtml Beautiful Daughters]&nbsp;– [[LOGO (TV channel)]] Documentary</ref> Also in 2006, [[Lifetime (TV channel)|Lifetime]] aired a movie biography on [[Murder of Gwen Araujo|the murder of "Eddie"/"Gwen" Araujo]] called ''[[A Girl Like Me: The Gwen Araujo Story]]''.
   
Some people feel that both 'trans' and 'sexual', are misleading. A large variety of other terms exist, though almost all of them are somewhat controversial.
+
===In television===
  +
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 (TV series)|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.
   
Some people also refer to transsexualism as ''Harry Benjamin's Syndrome'', or simply ''[[Benjamin's Syndrome]]'', named for [[Harry Benjamin]], a pioneer in the field of sex reassignment. They feel that this term is more medically accurate than transsexualism or [[gender identity disorder]], to describe what they believe to be an intersex condition. [http://sindromebenjamin.tk]
+
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]].<ref>{{IMDb name|1679529|Calpernia Addams}}</ref> The trans woman victim, Wendy, was played by [[Sarah Buxton (actress)|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]]''.
   
  +
''[[Hit & Miss]]'' is a Drama about Mia, played by ''[[Chloë Sevigny]]'', a preop transsexual woman who works as a contract killer and discovers she fathered a son.
   
''' : History of the disorder'''
+
===In pageantry===
*historical sources
+
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]].
*famous clinicans
 
   
  +
==Customs and traditions==
   
  +
===Transgender Day of Remembrance===
  +
{{Main|Transgender Day of Remembrance}}
  +
The [[Transgender Day of Remembrance]] is held every year on November 20. This event is held in honor of Rita Hester (killed Nov. 28, 1998), a victim of an anti-transgender hate crime. TDOR serves a number of purposes:
  +
* memorializes all of those who have been victims of hate crimes and prejudice
  +
* raises awareness about hate crimes towards the transgender community
  +
* honor the lost ones and their relatives by expressing respect for each other<ref>{{cite web|url=http://www.transgenderdor.org/?page_id=4 |title=About TDOR at Transgender Day of Remembrance |publisher=Transgenderdor.org |date=1998-11-28 |accessdate=2011-07-06}}</ref>
   
''' Transsexualism: Epidemiology'''
+
===Trans March===
*[[ Transsexualism: Incidence]]
+
The [[Trans March]] is one of three protests held in [[San Francisco, California]] during "Pride Weekend" during the last weekend of June. Every year people from the transexual community gather in San Francisco, CA to protest social justice and equality for them. In addition, through the march they strive to inspire everyone from the transexual community to come out to an environment where power is shared and where one can feel safe and cared for.
*[[ Transsexualism: Prevalence]]
+
The event also hosts comedians, music, and dancing at the park. After parties are often followed after the event.<ref>{{cite web|url=http://www.transmarch.org/ |title=San Francisco Trans March &#124; SF's premiere transgender Pride event, Friday, June 22, 2012 |publisher=Transmarch.org |date= |accessdate=2011-07-06}}</ref>
*[[ Transsexualism: Morbidity]]
 
*[[ Transsexualism: Mortality]]
 
*[[ Transsexualism: Racial distribution]]
 
*[[ Transsexualism: Age distribution]]
 
*[[ Transsexualism: Sex distribution]]
 
   
''' Transsexualism: Risk factors'''
+
==Thailand==
*[[ Transsexualism: Known evidence of risk factors]]
+
Transgender researcher and activist Prempreeda Pramoj Na Ayutthaya claims that there is notable discrimination against transexual people in relation to education and job opportunities in Thailand.<ref>http://www.bangkokpost.com/news/local/303850/sex-drugs-stigma-put-thai-transsexuals-at-hiv-risk</ref> An article in [[Bangkok Post]] in 2013, claims that there is [[societal]] discrimination against transsexuals in Thailand.<ref>[http://bangkokpost.com/news/investigation/334017/ladyboys-lost-in-legal-system http://bangkokpost.com/news/investigation/334017/ladyboys-lost-in-legal-system]</ref> An editorial in Bangkok Post in 2013, said "Yet it is also true that we don't find transgenders as high-ranking officials, doctors, lawyers, scientists, or teachers in state-run schools and colleges. Nor as executives in the corporate world. In short, the doors of government agencies and large corporations are still closed to transgender women. It is why they must be [[self-employed]] or work as [[freelancer]]s."<ref>[http://www.bangkokpost.com/opinion/opinion/355011/katoey-face-closed-doors Katoey face closed doors]</ref> Thai law does not give "[[post-operation]]" [[male-to-female]] transexual people—who are government employees—the right to wear female uniforms at work.<ref>http://www.bangkokpost.com/news/local/301113/transgender-official-right-to-wear-dress</ref>
*[[ Transsexualism: Theories of possible risk factors]]
 
   
''' Transsexualism: Etiology'''
+
==In history==
*[[ Transsexualism: Known evidence of causes]]
+
{{Main|List of transgender people}}
*[[ Transsexualism: Theories of possible causes]]
+
An apparent transsexual named [[Elagabalus]] was the [[Roman Emperor]] from 218 to 222.<ref>[http://www.roman-emperors.org/elagabal.htm Roman Emperors DIR Elagabalus Meckler, M. L. (August 26, 1997):]</ref>
   
''' Transsexualism: Diagnosis & evaluation'''
+
==See also==
*[[ Transsexualism: Psychological tests]]
+
{{Portal|Transgender}}
*[[ Transsexualism: Assessment isssues]]
+
* [[List of transgender-related topics]]
*[[ Transsexualism: Evaluation protocols]]
+
* [[List of transgender-rights organizations]]
  +
* [[List of LGBT-related organizations]]
  +
* [[List of transgender people]]
  +
* [[Transhumanism]]
   
''' : Treatment'''
+
==References==
*[[ Transsexualism: Outcome studies| outcome studies]]
+
{{Reflist|2}}
*[[ Transsexualism: Treatment protocols]]
 
*[[ Transsexualism: Treatment considerations]]
 
*[[ Transsexualism: Evidenced based treatment]]
 
*[[ Transsexualism: Theory based treatment]]
 
*[[ Transsexualism: Team working considerations]]
 
*[[ Transsexualism: Followup]]
 
   
''' : For people with this difficulty'''
+
==Bibliography==
*[[ Transsexualism: Service user: How to get help]]
+
{{Refbegin}}
*[[ Transsexualism: Service user: Self help materials]]
+
* [http://web.archive.org/web/20070621130835/http://www.pfc.org.uk/files/Why_Phrasebook_Diversity_is_Not_Enough.pdf Burns, Christine: Why Phrasebook Diversity is not Enough] (Press for Change)
*[[ Transsexualism: Service user: Useful reading]]
+
* {{Cite book|last=Brown |first=Mildred L. |coauthors=Chloe Ann Rounsley |title=True Selves: Understanding Transsexualism&nbsp;– For Families, Friends, Coworkers, and Helping Professionals |publisher=Jossey-Bass |year=1996 |isbn=978-0-7879-6702-4 }}
*[[ Transsexualism: Service user: Useful websites]]
+
* {{Cite book|last=Feinberg |first=Leslie |title=Trans Liberation : Beyond Pink or Blue |publisher=Beacon Press |year=1999 |isbn=978-0-8070-7951-5 }}
*[[ Transsexualism: Service user: User feedback on treatment of this condition]]
+
* [http://web.archive.org/web/20070221224621/http://www.wpath.org/Documents2/socv6.pdf Standards of Care for Gender Identity Disorders, Sixth Version.]&nbsp;– [[World Professional Association for Transgender Health]] (2001)
  +
* {{Cite journal|doi=10.1210/jc.85.5.2034|last=Kruijver |first=Frank P. M. |coauthors=Jiang-Ning Zhou, Chris W. Pool, Michel A. Hofman, Louis J. G. Gooren and Dick F. Swaab |title=Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus |journal=Journal of Clinical Endocrinology & Metabolism |volume=85 |issue=5 |pages=2034–41 |year=2000 |url=http://jcem.endojournals.org/cgi/content/full/85/5/2034 | pmid = 10843193 |ref=harv}}
  +
* {{Cite journal|last=Schneider |first=Harald J. |coauthors=Johanna Pickel, Günter K. Stalla |title=Typical female 2nd–4th finger length (2D:4D) ratios in male-to-female transsexuals-possible implications for prenatal androgen exposure |journal=International Society of Psychoneuroendocrinology |volume=31 |issue=2 |pages=265–9 |year=2006 |url=http://www.sciencedirect.com/science/article/B6TBX-4H16P9S-1/2/ae91dff18b1b99385054e3bf971d47f9 |pmid=16140461 |doi=10.1016/j.psyneuen.2005.07.005}}
  +
* Xavier, J., Simmons, R. (2000)&nbsp;– [http://www.gender.org/resources/dge/gea01011.pdf The Washington transgender needs assessment survey, Washington, DC: The Administration for HIV and AIDS of the District of Columbia Government]
  +
* {{Cite book|last=Rathus |first=Spencer A. |coauthors=Jeffery S. Nevid, Lois Fichner-Rathus |title=Human Sexuality in a World of Diversity |publisher=Allyn & Bacon |year=2002 |isbn=978-0-205-40615-9 }}
  +
* Denny, Dallas, (2006); Transgender Communities in ''Transgender Rights''.
  +
{{Refend}}
  +
* {{Cite journal|last=Pepper |first=Shanti M. |coauthors=Peggy Lorah |title=Career Issues and Workplace Considerations for the Transsexual Community: Bridging a Gap of Knowledge for Career Counselors and Mental Heath Care Providers |journal=The Career Development Quarterly |volume=56 |issue=4 |pages=330–343 |year=2008 |url=http://proquest.umi.com/pqdweb?did=1502846951&sid=1&Fmt=3&clientId=19912&RQT=309&VName=PQD |ref=harv|doi=10.1002/j.2161-0045.2008.tb00098.x}}
   
''' Transsexualism: For their carers'''
+
==External links==
*[[ Transsexualism: Carer: How to get help]]
+
{{Wiktionary}}
*[[ Transsexualism: Carer: Useful reading]]
+
<!----Please be conservative and discriminate about adding new links to this list; it is already a bit overwhelming and Wikipedia is not meant to be a repository of links. I know you have good intentions, but linking from here to every transgender blog on the web seems highly excessive. To contribute constructively to this article, I suggest adding inline citations, as this article needs more of those.---->
*[[ Transsexualism: Carer: Useful websites]]
+
* [http://www.thenobsts.com Full service information and interactive dialogue for transsexual people]
  +
* [http://www.transexualia.org Asociación Española de Transexuales. AET Transexualia]
  +
* [http://ai.eecs.umich.edu/people/conway/TS/TS.html Basic TG/TS/IS Information]&nbsp;– including ''Successful Transwomen'' and ''Successful Transmen''
  +
* [http://www.ftmi.org FTM International]&nbsp;– Female To Male International: practical and medical information
  +
* [http://www.mtra.org.au/ FTM Australia]&nbsp;– Comprehensive information for all men identified ''female'' at birth in [[Australia]].
  +
* [http://www.ftmguide.org Hudson's FTM Resource Guide]&nbsp;– Comprehensive information for female to male trans men and allies&nbsp;– USA-based
  +
* [http://www.gender.org/about/mission_values.html Gender.org]&nbsp;– The home of Gender Education & Advocacy, a nonprofit corporation using the web to provide education and advocacy for transsexual and transgender issues.
  +
* [http://www.gires.org.uk/Web_Page_Assets/Etiology_definition_signed.htm Definition and Synopsis of the Etiology of Adult Gender Identity Disorder and Transsexualism]&nbsp;– prepared by 24 internationally recognized experts, published by the Gender Identity Research and Education Society (GIRES)(See: http://www.gires.org.uk)
  +
* [http://www.wpath.org/publications_ijt.cfm The International Journal of Transgenderism]&nbsp;– The Official Journal of the [[World Professional Association for Transgender Health]] (formerly HBIGDA). [http://web.archive.org/web/20010709083555/http://www.symposion.com/ijt/ An archive of IJT Volumes I through V] is available, as are [http://web.archive.org/web/20010804031026/http://www.symposion.com/ijt/books/index.htm several books on transsexualism], including [[Harry Benjamin]]'s "The Transsexual Phenomenon"
  +
* [http://www.transparentcy.org/ TransParentcy]&nbsp;– supports transgender parents and their advocates (lawyers, mental health professionals, friends, family) by providing information and resources.
  +
* [http://www.tsroadmap.com Transsexual Road Map]&nbsp;– consumer information and advice for transsexual women.
  +
* [http://www.eecs.umich/people/conway/conway.html Lynn Conway's transsexual resources pages]
  +
* [http://www.annelawrence.com/ "Dr. Anne Lawrence On Transsexualism and Sexuality"] - detailed information on medical aspects of transition
  +
* [http://www.gires.org.uk The Gender Identity Research and Education Society]
  +
{{Sexual identities}}
  +
{{Transgender footer}}
  +
{{LGBT|state=collapsed|main=expanded}}
   
[[Instructions_for_archiving_academic_and_professional_materials]]
+
[[Category:Gender]]
''' Transsexualism: Academic support materials'''
+
[[Category:Transgender]]
*[[ Transsexualism: Academic: Lecture slides]]
 
*[[ Transsexualism: Academic: Lecture notes]]
 
*[[ Transsexualism: Academic: Lecture handouts]]
 
*[[ Transsexualism: Academic: Multimedia materials]]
 
*[[ Transsexualism: Academic: Other academic support materials]]
 
*[[ Transsexualism: Academic: Anonymous fictional case studies for training]]
 
   
''' Transsexualism: For the practitioner'''
+
<!--
*[[ Transsexualism: Practitioner: Further reading]]
+
[[ko:성전환]]
*[[ Transsexualism: Practitioner: Useful websites]]
+
[[uk:Транссексуалізм]]
  +
-->
   
[[ Transsexualism: Anonymous fictional case studies for training]]
+
{{enWP|Transsexualism}}}

Latest revision as of 22:09, August 25, 2014

Assessment | Biopsychology | Comparative | Cognitive | Developmental | Language | Individual differences | Personality | Philosophy | Social |
Methods | Statistics | Clinical | Educational | Industrial | Professional items | World psychology |

Clinical: Approaches · Group therapy · Techniques · Types of problem · Areas of specialism · Taxonomies · Therapeutic issues · Modes of delivery · Model translation project · Personal experiences ·


This article needs rewriting to enhance its relevance to psychologists..
Please help to improve this page yourself if you can..
File:TransgenreatParis2005.JPG


Transsexualism describes the condition in which an individual identifies with a gender inconsistent or not culturally associated with their assigned sex, i.e. in which a person's assigned sex at birth conflicts with their brain sex. A medical diagnosis can be made if a person experiences discomfort as a result of a desire to be a member of the opposite gender,[1] or if a person experiences impaired functioning or distress as a result of that gender identification.[2]

Transsexualism is stigmatized in many parts of the world but has become more widely known in Western culture in the mid to late 20th century, concurrently with the sexual revolution and the development of sex reassignment surgery (SRS). Discrimination or negative attitudes towards transsexualism often accompany certain religious beliefs or cultural values.

There are cultures that have no difficulty integrating people who change gender roles, often holding them with high regard, such as the traditional role for "Two-Spirit" people found among certain Native American tribes.[3]

DiagnosisEdit

Transsexualism appears in the two major diagnostic manuals used by mental health professionals worldwide, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM, currently in its fourth edition) and the International Statistical Classification of Diseases and Related Health Problems (ICD, currently in its tenth edition). The ICD-10 incorporates transsexualism, dual role transvestism and gender identity disorder of childhood into its gender identity disorder category, and defines 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."[4] The DSM does not distinguish between gender identity disorder and transsexualism, and defines transvestic fetishism as a separate phenomenon which may co-occur with transsexualism. The DSM diagnosis requires four components:[5]

  • A desire or insistence that one is of the opposite biological sex (that is not due to a perceived advantage of being the other sex)
  • Evidence of persistent discomfort with, and perceived inappropriateness of the individual's biological sex
  • The individual is not intersex (although a diagnosis of GID Not Otherwise Specified is available, which enables intersex people who reject their sex-assignment to access transsexual treatments)
  • Evidence of clinically significant distress or impairment in work or social life.

ProcessEdit

Template:Refimprove section The current diagnosis for transsexual people who present themselves for psychological treatment is "gender identity disorder" (leaving out those who have sexual identity disorders without gender concerns). The DSM changed its terminology in 1994 away from the diagnosis of "transsexualism". According to the Standards Of Care formulated by the World Professional Association for Transgender Health (WPATH),[6][7] formerly the Harry Benjamin International Gender Dysphoria Association, this diagnostic label is often necessary to obtain sex reassignment therapy with health insurance coverage, and states that the designation of gender identity disorders as mental disorders is not a license for stigmatization, or for the deprivation of gender patients' civil rights. However, some people diagnosed with gender identity disorder have no desire for sex reassignment therapy at all, particularly not genital reassignment surgery, and/or are not appropriate candidates for such treatment. While some feel that formal diagnosis helps to destigmatize transsexualism, others feel that it only adds stigma, essentially feeling that such a diagnosis is equivalent to saying something really is wrong with transsexual people. The diagnosis of "gender identity disorder" is seen as insulting and irrelevant to some transsexual people, and may be considered a causal factor in instances of harm occurring to, or death of, transsexual people as the result of prejudice and discrimination when deprived of their civil rights. (Brown 105)

Many transsexual people have asked the American Psychiatric Association to remove Gender Identity Disorder from the DSM, and World Health Organization from ICD-10 as it had been listed for some time. Many of these people feel that at least some mental health professionals are being insensitive by labeling transsexualism as "a disease", rather than as an inborn trait.[8] The Principles 18 of The Yogyakarta Principles, documents on international human rights law[9] opposes such diagnosis as mental illness as medical abuse, as well as "Activist's Guide to the Yogyakarta Principles".[10]

Relation to gender rolesEdit

Transsexual people may refer to themselves as trans men or trans women. Transsexual people often desire to establish a permanent gender role as a member of the gender with which they identify. Some transsexual people pursue medical interventions as part of the process of expressing their gender.

These medically based, physical alterations are collectively referred to as sex reassignment therapy, and may include female-to-male or male-to-female hormone replacement therapy, or various surgeries. Surgeries may include genital surgery such as orchiectomy or sex reassignment surgery; chest surgery such as top surgery or breast augmentation; or, in the case of trans women, facial surgery such as trachea shave or facial feminization surgery. The entire process of switching from one physical sex and social gender presentation to another is often referred to as transition, and usually takes several years.

Not all transsexual people undergo a physical transition. Some find reasons not to, for example, the expense of surgery, the risk of medical complications, 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 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 and 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 which does not result in a fully erectile, sexually sensate penis.

Some transsexual people live heterosexual lifestyles and gender roles, while some identify as gay, lesbian,[11] or bisexual. Many trans people find that a shift occurs in their sexual orientation as they undergo transition. Many transsexual people choose the language of how they refer to their sexual orientation based on their gender identity, not their morphological sex,[11] though some transsexual people still find identification with their community: many trans men, for instance, are involved with lesbian communities, and identify as lesbian despite their male identity. Some lesbians are willing to become sexually or romantically involved with trans men; some gay men are willing to do the same with trans women; where both groups typically would not date members of the opposite sex.

OriginsEdit

Gender was originally a linguistic term. In many languages, words can be considered masculine, feminine, or neutral, completely independently from the attributes of the things to which the word applies. Different languages manifest gender in various ways, recognizing two genders (female, male), three genders (female, male, neuter), or in some cases none at all. In some (e.g. the Romance languages), variation by gender is indicated by relatively simple changes in nouns and adjectives, while others require more complex grammatical changes. In English, a transsexual person's first step in transition often includes the request to be referred to using pronouns for their target gender (she rather than he, her rather than him, and hers rather than his, or vice versa). Some English speakers [attribution needed] who feel that they are best described as something in between or other than masculine or feminine prefer to use "they" and "them", as well as “ze” and “hir” (examples of gender-neutral pronouns in English) or other invented neutral pronouns.[12]

Norman Haire reported that in 1921,[13] that Dora-R of Germany under the care of Magnus Hirschfeld, began surgical transition from 1921, ending in 1930 with a successful genital reassignment surgery. In 1930, Magnus Hirschfeld supervised the second genital reassignment surgery to be reported in detail in a peer-reviewed journal on Lili Elbe of Denmark. The German term “Transsexualismus” was introduced by Hirschfeld in 1923.[14] The neo-Latin term “psychopathia transexualis” and English “transexual” were introduced by D. O. Cauldwell in 1949,[15] who subsequently also used the term “trans-sexual” in 1950.[16] Cauldwell appears to be the first to use the term in direct reference to those who desired a change of physiological sex.[17] (In 1969, Benjamin claimed to have been the first to use the term “transsexual” in a public lecture, which he gave in December 1953.[18]) This term continues to be used by the public and medical profession alike.[19] It 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.

Christine Jorgensen created an international sensation when in 1952 she was the first widely known person to have sex reassignment surgery—in this case, male to female.

The word transsexual was used by Harry Benjamin in his seminal 1966 book The Transsexual Phenomenon to describe transsexual people on a scale (later called the "Benjamin scale") that recognizes three levels of intensity of transsexualism: "Transsexual (nonsurgical)", "Transsexual (moderate intensity)", and "Transsexual (high intensity)".[20][21][22] in The Transsexual Phenomenon, Benjamin described "true" transsexualism in this way: "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."[23] Benjamin suggested that moderate intensity male to female transsexual people may benefit from estrogen medication as a "substitute for or preliminary to operation."[20] Some people have had SRS but do not meet the common definition of a transsexual (e.g., Gregory Hemingway).[24][25] Other people do not desire SRS although they do meet Dr. Benjamin's definition of a "true transsexual".[26] Beyond Benjamin's work, which focused on male-to-female transsexual people, there is the case of the female to male transsexual for whom genital surgery may not be practical. Benjamin gives his MTF transsexual patients papers that will help with most legal problems. The certificates state 'Their anatomical sex, that is to say, the body, is male. Their psychological sex, that is to say, the mind, is female'. However, beyond 1967 Benjamin and his terminology of sexual identity are found to be mostly obsolete.[11]

Relation to transgenderismEdit

Template:Refimprove section

Transsexualism is often included within the broader category of transgenderism, which is generally used as an umbrella term for people who do not conform to typical accepted gender roles, for example cross-dressers, transvestites, and people who identify as genderqueer. Transsexualism refers to a specific condition in the transgender realm. Thus, even though a crossdresser and transsexual are both transgender people, their conditions differ radically.[27][28] Though some people use transgenderism and transsexualism interchangeably, they are not synonymous terms.[29]

Some transsexual people object to being included in the transgender spectrum; anthropologist David Valentine contextualizes the objection to including transsexual people in his book "Transgender, an Ethnography of a Category."[30] He writes that transgender is a term coined and used by activists to include many people who do not necessarily identify with the term. He observes that many current health clinics and services set up to serve gender variant communities employ the term, but that most of the service-seekers do not identify with the term. The rejection of this political category, first coined by self-identified activist Leslie Feinberg, illustrates the difference between a self-identifier and categories imposed by observers to understand other people.[31]

Historically the reason that transsexual people rejected associations with the transgender or broader LGBT community is largely that the medical community in the 1950s through the late 1980s encouraged this rejection of such a grouping in order to qualify as a 'true transsexual' who would thus be allowed to access medical and surgical care. The animosity that is present today is no longer fed by this same kind of pressure from the medical community.[citation needed]

Though the beliefs of some modern day transsexual people that they are not "transgender" reflects this historical division (Denny 176), other transsexual people state that those who do not seek SRS are very different from those who need to be of "the other sex", and that these groups have different issues and concerns and are not doing the same things.[22] The latter view is rather contested, with opponents pointing out that merely having or not having some medical procedures hardly can have such far-reaching consequences as to put those who have them and those who have not into such distinctive categories. Notably Harry Benjamin's original definition of transsexualism does not require that they need to have had SRS.[20]

TerminologyEdit

The word "transsexual" is most often used as an adjective rather than a noun – a "transsexual person" rather than simply "a transsexual". Transsexual people prefer to be referred to by the gender pronouns and terms associated with their target gender. For example, a transsexual 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 and has or will have a masculine body. Transsexual people are sometimes referred to with "assigned-to-target" sex terms such as "female-to-male" for a transsexual man or "male-to-female" for a transsexual woman. These terms may be abbreviated as "M2F", "F2M", "MTF", "F to M", etc.

Alternative terminologyEdit

The term "gender dysphoria" and "gender identity disorder" were not used until the 1970s[19] when Laub and Fisk published several works on transsexualism using these terms.[32][33] "Transsexualism" was replaced in the DSM-IV by "gender identity disorder in adolescents and adults".

PrevalenceEdit

The DSM-IV (1994) quotes a prevalence of roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek sex reassignment surgery in the USA. The most frequently quoted estimate of prevalence is from the Amsterdam Gender Dysphoria Clinic[34] The data, spanning more than four decades in which the clinic has treated roughly 95% of Dutch transsexual clients, gives figures of 1:10,000 assigned males and 1:30,000 assigned females. Though no direct studies on the prevalence of 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.[35]

Olyslager and Conway presented a paper[36] 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 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 U.S. and a "common sense" estimate of the number of undiagnosed transsexual people.

Olyslager and Conway also argued that the U.S. population of assigned males having already undergone reassignment surgery by the top three U.S. SRS surgeons alone is enough to account for the entire transsexual population implied by the 1:10,000 prevalence number. This excludes all other U.S. 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 prevalance of 1:10,000 is too low.

A study in 2008 examined the number of New Zealand passport holders who changed the sex on their passport and estimated that 1:3,639 birth-assigned males and 1:22,714 birth-assigned females were transsexual.[37]

A presentation at the LGBT Health Summit in Bristol, UK,[38] based upon figures from a number of reputable European and UK sources, shows that this population is increasing rapidly (14% per year) and that the mean age of transition is actually rising.

CausesEdit

Main article: Causes of transsexualism

Psychological and biological causes for transsexualism have been proposed, i.a. by professor Dick Swaab, with evidence leaning toward prenatal and genetic causes.[39][40][41] One such proposed cause is related to the bed nucleus of a stria terminalis, or BSTc, a constituent of the basal ganglia of the brain which is affected by prenatal androgens.[42] In one study, the BSTc of male-to-female transsexual women was similar to those of cisgender women whose psychological gender identity and assigned sex are the same. However, those of both heterosexual and homosexual men were similar to each other but different from those of women (both cis- and transsexual).[40] Another study suggests that transsexuality may have a genetic component.[43] There is considerable evidence that prenatal exposure to endocrine-disrupting anti-miscarriage drugs such as diethylstilbestrol (DES) may also be positively associated with transsexualism, though research in this area has yet to establish a firm causal link.[44][45][46][47]

Some people consider research into the "causes" of transsexualism to be based on the assumption that it is a pathology, an assumption that is rejected by many transsexual people.[citation needed] Others think of the condition as a form of intersexuality, and support research into possible causes, believing that it will verify the theory of a biological origin and thereby reduce social stigma by demonstrating that it is not a delusion, a political statement, or a paraphilia. Note that social stigma has a role to play in the development of and adherence to both viewpoints. See the transfeminism article's section on GID for further discussion.

Harry Benjamin wrote, "Summarizing my impression, I would like to repeat here what I said in my first lecture on the subject more than 10 years ago: Our genetic and endocrine equipment constitutes either an unresponsive, sterile, or a more or less responsive, that is to say, fertile soil on which the wrong conditioning and a psychic trauma can grow and develop into such a basic conflict that subsequently a deviation like transsexualism can result."[48]

Sex reassignment therapyEdit

Main article: Sex reassignment therapy

Sex reassignment therapy (SRT) is an umbrella term for all medical treatments related to sex reassignment of both transgender and intersexual people. Though SRT is sometimes called "gender reassignment", those who use the word "sex" to describe an individual's biology and "gender" to describe their personal identity and social role consider this usage to be misleading. The process of changing from one gender presentation to another is often called transition.

Individuals make different choices regarding sex reassignment therapy, which can include hormone replacement therapy (HRT) to modify secondary sex characteristics, sex reassignment surgery to alter primary sex characteristics, facial feminization surgery and permanent hair removal for trans women. Transsexual people who transition usually change their social gender roles, legal names and legal sex designation.

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.[6] 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.

Psychological treatmentEdit

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[7] note that sometimes the only reasonable and effective course of treatment for transsexual people is to go through sex reassignment therapy.[7][49]

The need for treatment 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.[50] These problems may be alleviated by a change of gender role and/or physical characteristics.[51]

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[7] because they don’t consider their gender identity to be a psychological problem.

Brown and Rounsley[52] 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 and/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).

Medical aspectsEdit

After an initial psychological evaluation, men and women may begin medical treatment starting with hormone replacement therapy[7][53] or hormone blockers. People who change sex are usually required to live as members of their target sex for at least one year prior to genital surgery, so-called Real-Life Experience (RLE) or Real-Life Test (RLT).[7] 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)

Regrets and detransitionsEdit

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%.[54] A review of Medline literature suggests the total rate of patients expressing feelings of doubt or regret is estimated to be as high as 8%.[55] 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.[56]

Legal and social aspectsEdit

File:Anna Grodzka.jpg

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.[59] Some states seal earlier records against all but court orders in order to protect the transsexual'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.[60] In the United States, November 20 has been set aside as the "Day of Remembrance" for all murdered transgender people.[61]

Some people who have switched their gender role enter into traditional social institutions such as marriage and parenting. They sometimes adopt or provide foster care for children, as complete sex reassignment therapy inevitably results in infertility. Some transsexual people have children from before transition. Some of these children continue living with their transitioning/transitioned parent, or retain close contact with them.

The style guides of many media outlets prescribe that a journalist who writes about a transsexual person should use the name and pronouns used by that person. Family members and friends, who are often confused about pronoun usage or the definitions of sex, are frequently 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 proper pronouns consistently. Deliberate mis-gendering is perceived to be a form of transphobia.

Both "transsexualism" and "gender identity disorders not resulting from physical impairments" are specifically excluded from coverage under the Americans with Disabilities Act Section 12211.[62] Gender Dysphoria is not excluded.[63]

Coming outEdit

Employment issuesEdit

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.[64] Transsexual people must decide whether to transition on-the-job,[65] 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.[66] 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.[67] Because the Harry Benjamin Standards of Care require a one-year RLE 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.[59][68] 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.[69]

In the National Transgender Transgender Discrimination Survey, 44% of respondents reported not getting a job they applied for because of being transgender.[70] 36% of trans women reported losing a job due to discrimination compared to 19% of trans men.[70] 54% of trans women and 50% of trans men report having been harassed in the workplace.[70] Transgender people who have been fired due to bias are more than 34 times likely than members of the general population to attempt suicide.[70]

StealthEdit

Some transsexual men and women choose to live completely as members of their target gender without being public about their past. This approach is sometimes called stealth. Some people feel that they have an obligation to be open about their past in order to further the cause of civil rights for LGBT people.

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.[71] For example, Leslie Feinberg was once turned away from a hospital emergency room where he had sought treatment for endocarditis.[72] [unreliable source?]

Feinberg was presenting as a man but had female genital anatomy. He nearly died after being denied treatment. Feinberg's case demonstrates one of the many dangers of having one's trans status discovered. Tyra Hunter died after being denied care by paramedics and emergency room physicians after she was injured in an automobile accident.[71]

In the mediaEdit

File:Nina Poon threefour Shankbone 2010 NYC.jpg
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.[73] 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.

Before transsexual people were depicted in popular movies and television shows, Aleshia Brevard — an actual transsexual whose surgery took place in 1962 — was actively working as an actress and model 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.[74][75]

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.[76]

In filmEdit

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, 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. Within the film has a few scenes showing how Judy loses her parents who are unable to accept her, and buy her off with a bye forever present in purchasing a home for her.

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.[77]

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.[78] 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.[79] Also in 2006, Lifetime aired a movie biography on the murder of "Eddie"/"Gwen" Araujo called A Girl Like Me: The Gwen Araujo Story.

In televisionEdit

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.[80] 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.

Hit & Miss is a Drama about Mia, played by Chloë Sevigny, a preop transsexual woman who works as a contract killer and discovers she fathered a son.

In pageantryEdit

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.

Customs and traditionsEdit

Transgender Day of RemembranceEdit

Main article: Transgender Day of Remembrance

The Transgender Day of Remembrance is held every year on November 20. This event is held in honor of Rita Hester (killed Nov. 28, 1998), a victim of an anti-transgender hate crime. TDOR serves a number of purposes:

  • memorializes all of those who have been victims of hate crimes and prejudice
  • raises awareness about hate crimes towards the transgender community
  • honor the lost ones and their relatives by expressing respect for each other[81]

Trans MarchEdit

The Trans March is one of three protests held in San Francisco, California during "Pride Weekend" during the last weekend of June. Every year people from the transexual community gather in San Francisco, CA to protest social justice and equality for them. In addition, through the march they strive to inspire everyone from the transexual community to come out to an environment where power is shared and where one can feel safe and cared for. The event also hosts comedians, music, and dancing at the park. After parties are often followed after the event.[82]

ThailandEdit

Transgender researcher and activist Prempreeda Pramoj Na Ayutthaya claims that there is notable discrimination against transexual people in relation to education and job opportunities in Thailand.[83] An article in Bangkok Post in 2013, claims that there is societal discrimination against transsexuals in Thailand.[84] An editorial in Bangkok Post in 2013, said "Yet it is also true that we don't find transgenders as high-ranking officials, doctors, lawyers, scientists, or teachers in state-run schools and colleges. Nor as executives in the corporate world. In short, the doors of government agencies and large corporations are still closed to transgender women. It is why they must be self-employed or work as freelancers."[85] Thai law does not give "post-operation" male-to-female transexual people—who are government employees—the right to wear female uniforms at work.[86]

In historyEdit

Main article: List of transgender people

An apparent transsexual named Elagabalus was the Roman Emperor from 218 to 222.[87]

See alsoEdit

.

ReferencesEdit

  1. ICD-10. URL accessed on 2008-09-28.
  2. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Text Revision), American Psychiatric Publishing.
  3. Two-Spirit People: Native American Gender Identity, Sexuality, and Spirituality 1997 U. Illinois, p.100 Sabine Lang et al.
  4. Gender dysphoria. URL accessed on 2008-09-13. [dead link]
  5. Diagnostic criteria for Gender Identity Disorder. (PDF) URL accessed on 2008-12-21. [dead link]
  6. 6.0 6.1 World Professional Association for Transgender Health. WPATH. URL accessed on 2012-02-23.
  7. 7.0 7.1 7.2 7.3 7.4 7.5 Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th Version. (PDF) URL accessed on 2012-02-23.
  8. Green, Jamison (May 2004). Becoming a Visible Man, Vanderbilt University Press.
  9. Jurisprudential Annotations to the Yogyakarta Principles, p. 43
  10. Activist's Guide to the Yogyakarta Principles, p.100
  11. 11.0 11.1 11.2 Ekins, Richard; King, Dave (2006). The Transgender Phenomenon, London: SAGE.
  12. Sie Hir, Now: Terms for Gender Variant People. URL accessed on 2012-05-13.
  13. Norman Haire (1934). Encyclopaedia of Sexual Knowledge.
  14. Hirschfeld, Magnus; “Die intersexuelle Konstitution” in Jarhbuch fuer sexuelle Zwischenstufen 1923.
  15. Cauldwell, David Oliver (1949). Psychopathia Transexualis. Sexology: Sex Science Magazine 16.
  16. Cauldwell, David Oliver.Questions and Answers on the Sex Life and Sexual Problems of Trans-Sexuals: Trans-Sexuals Are Individuals of One Sex and Apparently Psychologically of the Opposite Sex. Trans-Sexuals Include Heterosexuals, Homosexuals, Bisexuals and Others. A Large Element of Transvestites Have Trans-Sexual Leanings. (1950) Haldeman-Julius Big Blue Book B-856.
  17. Meyerowitz, Joanne Jay; How Sex Changed: A History of Transsexuality in the United States.
  18. Benjamin, H. (1969). "Introduction" Green, R.; Money, J. Transsexualism and Sex Reassignment, Baltimore: Johns Hopkins.
  19. 19.0 19.1 Pauly MD, Ira B. (28 May 1993). Terminology and Classification of Gender Identity Disorders. Journal of Psychology & Human Sexuality 5 (4): 1–12.
  20. 20.0 20.1 20.2 Benjamin 1966, p. 23
  21. The non-surgical true Transsexual: a theoretical rationale. Paper presented at the1983 Harry Benjamin International Gender Dysphoria Association VIII International Symposium, Bordeaux, France.
  22. 22.0 22.1 Gaughan, Sharon What About Non-op Transsexuals? A No-op Notion. TS-SI. URL accessed on September 30, 2008.
  23. Henry Benjamin Symposium – Chapter 2.
  24. Conway, Lynn (2003). The Strange Saga of Gregory Hemingway.
  25. includeonly>Schoenberg, Nara. "The Son Also Falls From elephant hunter to bejeweled exhibitionist, the tortured life of Gregory Hemingway", November 19, 2001.
  26. Miriam Rivera. Excerpt of "There's Something About Miriam" [Television]. Filmed in Ibiza, Spain Produced in England.: Edemol & Brighter picture via various Newscorp properties..
  27. Vitale, A.. Notes on Gender Role Transition - Crossdressing vs Transsexualism. URL accessed on 2011-12-24.
  28. Sullivan, L. (1990). Information for the female to male cross dresser and transsexual. (3 ed.). Seattle, WA: Ingersoll Gender Center.
  29. Iyall Smith, K. E., & Leavy, P. (2008). Hybrid identities: theoretical and empirical examinations. Leiden, The Netherlands: IDC Publishers.
  30. Valentine, David. Imagining Transgender: An Ethnography of a Category. Duke University, 2007.
  31. Stryker, Susan. Introduction. In Stryker and S. Whittle (Eds.), The Transgender Studies Reader. New York: Routledge, 2006. 1–17.
  32. Laub, D. R., N. Fisk (April 1974). A rehabilitation program for gender dysphoria syndrome by surgical sex change. Plast Reconstr Surg. 53 (4): 388–403.
  33. Fisk, N. (1974). Gender Dysphoria Syndrome. Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome: 7–14.
  34. van Kesteren, Paul J. M, Henk Asscheman, Jos A. J Megens, Louis J. G Gooren (1997). Mortality and morbidity in transsexual subjects treated with cross-sex hormones. J. Clin. Endocrinol. 47 (3): 337–343.
  35. Transgender Mental Health, "The Prevalence of Transgenderism" http://tgmentalhealth.com/2010/03/31/the-prevalence-of-transgenderism/
  36. Olyslager, Femke, Lynn Conway (2007). On the Calculation of the Prevalence of Transsexualism.
  37. Veale, Jaimie F. (October 2008). Prevalence of transsexualism among New Zealand passport holders. Australian and New Zealand Journal of Psychiatry 42 (10): 887–889.
  38. Reed, Bernard; Stephenne Rhodes (2008). "Presentation on prevalence of transsexual people in the UK". {{{booktitle}}}. 
  39. Swaab, D.F. (2004). Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation. Gynecological Endocrinology 19 (6): 301–312.
  40. 40.0 40.1 Kruijver 2000
  41. Garcia-Falgueras A, Swaab DF (December 2008). A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. Brain 131 (Pt 12): 3132–46.
  42. Psychology The Science Of Behaviour, pg 418, Pearson Education, Neil R.Carlson
  43. Male transsexual gene link found BBC News 26 October 2008 (accessed 26 October 2008)
  44. Hood E (2005). Are EDCs blurring issues of gender?. Environmental Health Perspectives 113 (10): A670–7.
  45. Blackless M, Besser M, Carr S, Cohen-Kettenis PT, Connolly P, De Sutter P, Diamond M, Di Ceglie D, Higashi Y, Jones L, Kruijver FPM, Martin J, Playdon Z-J, Ralph D, Reed T, Reid R, Reiner WG, Swaab D, Terry T, Wilson P, Wylie K (2006). Atypical Gender Development – A Review. International Journal of Transgenderism 9 (1): 29–44.
  46. Michel A, Mormont C, Legros JJ (2001). A psycho-endocrinological overview of transsexualism. Eur. J. Endocrinol. 145 (4): 365–76.
  47. Selvaggi G, Ceulemans P, De Cuypere G, VanLanduyt K, Blondeel P, Hamdi M, Bowman C, Monstrey S (2005). Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals. Plast. Reconstr. Surg. 116 (6): 135e–145e.
  48. Benjamin, H. (1966). The transsexual phenomenon, New York: Julian Press.
  49. Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects, Eva Moore, Amy Wisniewski and Adrian Dobs
  50. Seattle and King County Health – Transgender Health [dead link]
  51. The International Transsexual Sisterhood – Study On Transsexuality [dead link]
  52. Brown, Mildred L.; Chloe Ann Rounsley (1996). True Selves: Understanding Transsexualism – For Families, Friends, Co-workers, and Helping Professionals. Jossey-Bass. ISBN 978-0-7879-6702-4.
  53. (2008). Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab 32 (5): 19–25.
  54. Landén, M, Wålinder, J, Hambert, G, Lundström, B. (April 1998). Factors predictive of regret in sex reassignment. Acta Psychiatr Scand. 97 (4): 284–9.
  55. Baranyi, A, Piber, D, Rothenhäusler, HB. (2009). Male-to-female transsexualism. Sex reassignment surgery from a biopsychosocial perspective. Wien Med Wochenschr. 159 (21–22): 548–57.
  56. Lawrence MD, A. A. (Aug 2003). Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Archives of Sexual Behavior 32 (4): 299–315.
  57. "Anna Grodzka". Sejm Rzeczypospolitej Polskiej. Retrieved December 2, 2011.
  58. Świerzowski, Bogusław. "Wybory 2011: Andrzej Duda (PIS) zdeklasował konkurentów w Krakowie". Info Kraków 24. October 10, 2011.
  59. 59.0 59.1 The Transgender Law and Policy Institute: Home Page. Transgenderlaw.org. URL accessed on 2011-07-06.
  60. Remembering Our Dead – a memorial to transgender people who have been murdered
  61. Don't Forget Transgender Day of Rememberance (sic) by Jamie Tyroler, January 18, 2008, Kansas City Camp
  62. Americans with Disabilities Act of 1990 - ADA - 42 U.S. Code Chapter 126. find US law. URL accessed on 2011-07-06.
  63. Americans with Disabilities Act of 1990 §512. DEFINITIONS.. United States Access Board, a Federal Agency. URL accessed on 2013-06-05.
  64. Work transition for transsexual women – TS Road Map
  65. Making a successful transition at work – helpful guide by Jessica McKinnon and sample transition-related documents
  66. Pepper 2008
  67. Weiss, Jillian Todd (2001). The Gender Caste System: Identity, Privacy and Heteronormativity.
  68. Workplace Discrimination: Gender Identity or Expression – Human Rights Campaign Foundation
  69. Judgment of the Court of 30 April 1996. – P v S and Cornwall County Council. – Reference for a preliminary ruling: Industrial Tribunal, Truro – United Kingdom. – Equal treatment for men and women – Dismissal of a transsexual. – Case C-13/94 – European Court reports 1996 Page I-02143
  70. 70.0 70.1 70.2 70.3 Error on call to template:cite web: Parameters url and title must be specified
  71. 71.0 71.1 Stryker, Susan (2006). The Transgender Studies Reader, CRC Press. URL accessed 2009-11-24.
  72. Leslie Feinberg (1998). Trans Liberation: Beyond Pink Or Blue, 2–4, Beacon Press.
  73. includeonly>"Medicine: Change of Sex", Time, 24 Aug 1936. Retrieved on 23 December 2010.
  74. Template:IMDb name
  75. Aleshia Brevard (2001). The Woman I Was Not Born to Be: A Transsexual Journey, Philadelphia: Temple University Press.
  76. Template:IMDb title
  77. Template:IMDb title
  78. Template:IMDb title
  79. Beautiful Daughters – LOGO (TV channel) Documentary
  80. Template:IMDb name
  81. About TDOR at Transgender Day of Remembrance. Transgenderdor.org. URL accessed on 2011-07-06.
  82. San Francisco Trans March | SF's premiere transgender Pride event, Friday, June 22, 2012. Transmarch.org. URL accessed on 2011-07-06.
  83. http://www.bangkokpost.com/news/local/303850/sex-drugs-stigma-put-thai-transsexuals-at-hiv-risk
  84. http://bangkokpost.com/news/investigation/334017/ladyboys-lost-in-legal-system
  85. Katoey face closed doors
  86. http://www.bangkokpost.com/news/local/301113/transgender-official-right-to-wear-dress
  87. Roman Emperors – DIR Elagabalus Meckler, M. L. (August 26, 1997):

BibliographyEdit

External linksEdit

Look up this page on
Wiktionary: Transsexualism

Transgender Pride flag
Transgender series
Transgender · Androgyny · Bigender · Cross-dressing · Drag king · Drag queen · Genderqueer · Third gender · Transsexualism · Transvestism · Transsexual sexuality
Attitudes LGBT history · Transphobia · Homosexuality and transgender · Gynephilia and androphilia · Transgender in film and television
Legal issues Legal aspects of transsexualism · Access to amenities
Lists Transgender-related topics · LGBT films · Transgender people
Categories Category:Transgender
LGBT Portal


This page uses Creative Commons Licensed content from Wikipedia (view authors).
}

Around Wikia's network

Random Wiki