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'''Transsexualism''' 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 people outside the community, reject this model. [http://ftmichael.tashari.org/trans101.html] |
'''Transsexualism''' 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 people outside the community, reject this model. [http://ftmichael.tashari.org/trans101.html] |
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Transsexualism often manifests itself as a [[dysphoria]] toward one's biological birth sex, as well as conflict living in |
Transsexualism often manifests itself as a [[dysphoria]] toward one's biological birth sex, as well as conflict living in one's social role. If untreated, it can lead to mental and emotional problems, and sometimes, [[suicide]]. [[Netherlands|Dutch]] researcher Peggy Cohen-Kettenis estimates that 40% of untreated transsexual people are either [[institutionalization|institutionalized]] or die prematurely. However, with proper treatment, transsexual people often become fully functional members of society. [http://ai.eecs.umich.edu/people/conway/TSsuccesses/TSsuccesses.html] The suicide statistics of treated transsexual people (Cohen-Kettenis et al, 1988) do not differ remarkably from non-transsexual populations. |
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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 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. |
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 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. |
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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 |
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 at least one year prior to surgery, but this time may be longer if the psychotherapist has concerns about the transsexual person's readiness. This time is known as the ''Real-Life Test'' or ''Real-Life Experience'', and is one of a number of requirements that a transsexual person must meet, which are specified by protocols known as ''[[Standards of care for gender identity disorders|Standards of Care]]''. These requirements are intended to prevent those individuals, who are not genuinely transsexual persons, from transitioning and later regretting having done so. These standards are however often criticized as being either ineffective or too strict. The intentions of the standard are to prevent people from transitioning when such a transition would be inappropriate (as a dramatic example, a person seeking to transition in order to veil their identity from police), or ill-advised (as an example a strong crossdresser, who still identifies themselves as their assigned gender). Although the intentions of the standards may be good, they have been suggested as discouraging genuinely transsexual people from seeking treatment. Despite anyone's concerns about the protocols, by most estimates, less than 1% of people who transition ever regret doing so, whether they had followed the standards or not. [http://www.symposion.com/ijt/ijtc0502.htm] |
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Currently, the causes of transsexualism are unknown |
Currently, the causes of transsexualism are unknown and estimates of prevalence vary substantially. Perhaps the most prominent theory at this time among transsexual people suggests that transsexualism is a neurobiological condition which manifests itself as ''[[gender dysphoria]]'' and has as its fundamental cause a difference in a brain structure known as the Bed nucleus of Stria Terminalis (BSTc), which would make their brain functions more similar to the brain functions shown by the gender that they identify with most. |
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==Definitions== |
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⚫ | Transsexualism (also known as transsexuality) 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. |
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===Defining transsexualism=== |
===Defining transsexualism=== |
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⚫ | Transsexualism (also known as transsexuality) 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. As with any terms used by a group, or to refer to a particular group, some of these terms are controversial, or have become controversial, not only to society at large, but even among the transsexual community as well. |
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⚫ | The definition of " |
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⚫ | The definition of "transsexuality" is debated. Many within the transsexual 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 be completed before a person may be called "transsexual". While the general public often defines "a transsexual" as someone who has had, or plans to have, a "[[sex change]]" operation. Although this phrase is considered inaccurate by many people, who believe that sex cannot really be ''changed''. Opposing this view is that many transsexual people consider "sex change" rude and prefer "sex reassignment" or "gender reassignment" instead. |
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The term currently in widest use for modification of [[primary sex characteristics]] is [[sex reassignment surgery]] (SRS). This latter term in particular 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 no longer members of their original sex. [http://www.symposion.com/ijt/pfaefflin/1000.htm]. In the [[UK]], ''gender reassignment surgery'' (GRS) is a prevalent term, but many prefer ''gender affirmation surgery'', which emphasizes their personal perspective upon the surgery. |
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⚫ | Transsexualism has been described as a [[trait]], [[disease]], [[behavior]], [[desire]], [[mental illness]], [[perversion]], [[paraphilia]], [[politics|political identity]] |
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⚫ | The [[Diagnostic and Statistical Manual of Mental Disorders]] accepts the expression of ''desire'' to be of the opposite sex, or assertion that one is of the sex opposite from the one with which they were assigned at birth, as suffficient for being transsexual. [http://www.behavenet.com/capsules/disorders/genderiddis.htm] The [[ICD|ICD-10]] states in a similar way 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''. |
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⚫ | Transsexualism falls under the broader term ''[[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 |
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⚫ | Transsexualism has been described as a [[trait]], [[disease]], [[behavior]], [[desire]], [[mental illness]], [[perversion]], [[paraphilia]], [[politics|political identity]] and [[sin]], although this list is certainly not exaustive. Some of these labels are considered offensive by many people regardless of if they are transsexual or not. These people typically will define transexualism as a trait, desire, political identity, or as a medical condition, which avoids the loaded language implied in "disease" and "sin". No matter how one views transsexualism in many parts of the world it has been viewed as a [[taboo]] subject, and many people—even in relatively open and accepting cultures—had little knowledge of the subject prior to the late 20th century. |
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⚫ | |||
⚫ | Transsexualism typically falls under the broader term ''[[transgender]]'', which is generally considered an umbrella term for people who do not conform to typical accepted [[gender role]]s. However, some people in the transsexual community do not self-identify as transgender, or they disagree that transsexualism is a sub-division under transgenderism. "Transgendered" is found by some transsexual people to be insulting, because they may feel they should not be placed in a category that also contains [[transvestite]]s. 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 be neatly divided into "transsexuals" and "[[Transvestitism|transvestites]]") or "perverts" or even term with even more loaded meanings. They then assert that this is not what transsexual people are. This is usually accompanied by demanding that medical treatment, legal change of name and legal gender should be reserved only for transsexual people. |
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Some transsexual people also see the term 'transgender' as subsuming and erasing their identity, rejecting the identification for themselves, because to them it implies a breaking down of [[gender role]]s, while they see themselves as fitting just fine in a gender role -- just not the one they were assigned at birth. Those contesting this perspective express that the idea of a more inclusive "Gender identity disorder" has long replaced the idea of dividing gender variant people into "transsexuals" and "transvestites", and that classifying transsexualism as a sub-division of transgender does not automatically erase transsexual identity. They also express that not all transgender people wish to break down gender barriers, and that any marginalized group trying to gain acceptance by those opposing them by trying to oppress another group has not only never been successful, but it is also ethically questionable. |
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⚫ | Regardless of how you define transsexualism, it 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. The difference between this group can typically be expressed most easily i that while many transsexual people dress conservatively and modestly, most drag queens and crossdressers dress in a more flamboyant manner, usually exaggerating their ideals of what is feminine. |
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===Gender terminology for transsexual people=== |
===Gender terminology for transsexual people=== |
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Transsexual people |
Transsexual people almost universally 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 gender 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" 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 are particularly helpful in preventing confusion, because to some people the term "transsexual woman" is a female transitioning to become a male, and to others a male transitioning to become a female. When the terms [[transman|transmen]] and [[transwoman|transwomen]] are used though, it is typical for them to be used to refer to the gender that the person identifies with, regardless of their appearance or state of transition. |
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Transsexual people are often |
Transsexual people are often considered as part of the [[LGBT]] community, and although many do identify with this community, others do not, or prefer not to use the terms at all. Transsexual people typical feel it important that transexualism does not depend upon, nor related to [[sexual orientation]]. Transsexual men and women exhibit a range of sexual orientations just as non-transsexual (some times refered to as [[Cisgender|cissexual]]) people do, and they will almost always use terms for their sexual orientation that relate to the gender that they identify with. For example, someone assigned 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 the female gender 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. |
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Older medical texts often referred to |
Older medical texts often referred to transsexual people as members of their original sex by 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 usage is considered by many to be scientifically inaccurate and clinically insensitive today. As such someone who would have been refered to as a "homosexual male transsexual" would now be called and most likely identify herself as a [[heterosexual]] transsexual woman. Although this usage is dwindling, some medical textbooks still refer to transsexual people as members of their assigned sex, but now many use "assigned-to-target" terms. |
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There are still are and probably always will be people outside the transsexual community, who refer to transsexual people with terms associated with their assigned gender at birth, for example calling a male-to-female transsexual "him". This usage, generally considered insensitive or insulting (especially if intentional), has been (though not exclusively) based on biological arguments such as the unchanging [[karyotype]], which is usually consistent with the sex assigned to the person at birth. It may also be based on the absence of reproductive capability after transition and sex reassignment surgery. Arguments for this usage have also typically been based on religious [[dogma]]. Conservative groups such as the [[Traditional Values Coalition]] are among those who refer to transsexual people as members of their assigned sex at birth. |
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===Alternative terminology=== |
===Alternative terminology=== |
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The transsexual community typically use the short form "trans", or simply "T" as a substitution for the full word "transsexual", e.g. ''TS'', ''trans guy'', ''trans dyke'', ''T-folk'', ''trans folk''. Some may even use term that have become controversial to some, such as ''tranny'' and/or ''trans'', despite others considering these terms to be offensive. Those who do use these terms claim that they are diminishing the power of the term as an insult, just as some members of the gay and African-American communities have embraced slurs directed at them. Others feel that the terms are insulting or inaccurate regardless of the context. Some feel that such words are problematic because they do not differentiate between transsexual people, and people who are merely "playing" with gender. |
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Some people prefer to spell '' |
Some people may prefer to spell ''transsexual'' with only one ''s'', thus writing ''transexual''. They will typically assert that they are attempting to divorce the word from the realm of psychiatry and medicine and place it in the realm of identity. This trend is most common in the [[United States]], and 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. |
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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 |
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 more closely parallels with the term [[intersexed|intersex]], which is considered by them to be important 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''. |
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Some transsexual people also prefer ''transgendered'' over ''transsexual'', because the issue is about ''gender'' rather than ''sexuality''. They make a parallel with ''intergender'', whose issue is about being |
Some transsexual people may also prefer ''transgendered'' over ''transsexual'', because the issue is about ''gender'' rather than ''sexuality''. They make a parallel with ''intergender'', whose issue is about being between (inter) the genders rather than "intersexual". It is often assumed, particularly by transsexual people, that transsexualism is 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. (Despite the fact that human genitals show an extremely wide variation in general, intersexed people typically have quite obviously ambiguous genitalia that frustrate attempts to assign them within a binary sex system.) 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 could fall under the rubric of "intersex." Transsexualism, in this view, simply becomes a form of being [[neurology|neurological]] intersexed. (See below for research of physiological causes of transsexualism). |
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Some people prefer that transsexualism be referred to as [[Benjamin's syndrome]], as it follows the naming conventions of other intersex conditions. [http://sindromebenjamin.tk] This term is named for [[Harry Benjamin]], a pioneer in sex reassignment and research on transsexual people. Many transsexual people who prefer this term |
Some people prefer that transsexualism be referred to as [[Benjamin's syndrome]], as it follows the naming conventions of other intersex conditions. [http://sindromebenjamin.tk] This term is named for [[Harry Benjamin]], a pioneer in sex reassignment and research on transsexual people. Many transsexual people who prefer this term assert that scientific research has strongly suggested that their condition is biological rather than psychological in nature. They also feel that 'trans' is misleading, as they believe that their gender was fixed in their brains, and has never changed. Thus that nothing about their steps in correcting themselves is actually "trans" at all, but rather they are simply taking steps to assert what they feel that they are already. |
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While the above gives a fairly comprehensive view of terminology, it's imporant to note that some people may feel that both 'trans' and 'sexual', are misleading, and others may take objections to terminology that are unique to their perspective. While a large variety of other terms exist from those presented here, they have not been excluded with bias, although almost all of them are somewhat controversial. |
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Others object to being referred to as ''transgender'' because they feel this links to to other behaviors that they have no connection with. Also, they will point out that they are not changing their gender, which most transsexual people do not consider to be possible. Nor do they feel that they are ''transcending'' or ''transgressing'' gender but are simply expressing the gender they were born as. |
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Some people feel that both 'trans' and 'sexual', are misleading. Many feel that people will assume that transsexualism is related to [[sexual behavior]] because it contains 'sexual'. A large variety of other terms exist, though almost all of them are somewhat controversial. |
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==Prevalence== |
==Prevalence== |
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There are no reliable statistics on the prevalence of transsexualism. According to the DSM-IV, statistics from smaller European countries have suggested that roughly 1 in 30,000 |
There are no reliable statistics on the prevalence of transsexualism. According to the DSM-IV, statistics from smaller European countries have suggested that roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek [[sex reassignment surgery]]. [http://www.tsfaq.info]. However, it is commonly expressed that many transsexual people do not seek SRS and therefore are not reflected in such statistics. The DSM itself states that no recent epidemiological studies on transsexualism are available. It has also been suggested, in particular by [[Lynn Conway]], that transsexualism is much more prevalent. Her position stating that although 1 in 2500 physical males in the United States have undergone SRS since the 1960s, perhaps 1 in 500 individuals may experience gender dysphoria. [http://ai.eecs.umich.edu/people/conway/TS/TSprevalence.html]. Apart from this estimate, an estimate from Holland (Cohen-Kettenis et al, 1988) would suggest that the frequency is 1 in 12,000—and surprisingly for some—is equally common amongst physical males and females, although they estimate that females often seek treatment less than males. |
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==Causes of transsexualism== |
==Causes of transsexualism== |
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''Main article: [[Etiology of Transsexualism]]'' |
''Main article: [[Etiology of Transsexualism]]'' |
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There is no scientifically proven cause of transsexualism. For many years, many medical and psychological professionals, and the public, assumed that transsexualism was caused by [[psychology|psychological]] or emotional factors. However, most psychological models of transsexualism could not be successfully applied to significant numbers of transsexual people, and attempts to |
There is no scientifically proven cause of transsexualism. For many years, many medical and psychological professionals, and the public, assumed that transsexualism was caused by [[psychology|psychological]] or emotional factors. However, most psychological models of transsexualism could not be successfully applied to significant numbers of transsexual people, and despite attempts by some people to cure a person of the transsexual disease through psychological or [[psychiatry|psychiatric]] means, such "cures" are rarely effective, and many times considered by peers to be unethical. |
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In recent years, theories have been presented which suggest that the cause of transsexualism has its roots in biology. Building from this, much of the medical profession has slowly come to view transsexualism as a physiological issue, rather than a psychological one. However, at this time (2006), physiological causes of transsexualism have not yet been proven. |
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⚫ | Some transsexual people and professionals feel that research into causes of transsexualism assumes |
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⚫ | Some transsexual people and professionals feel that research into causes of transsexualism assumes at face value the legitimacy of a [[normative]] gender identity, and/or that transsexualism is contrary to normal development, and could be considered a [[disease]], or [[syndrome]], which a transsexual may feel is stigmatizing. They usually consider such research to be unnecessary, and wonder if such studies might possibly be causing more harm than good for transsexual people. |
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==Sex reassignment therapy== |
==Sex reassignment therapy== |
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Most transsexual men and women suffer from psychological and emotional |
Most transsexual men and women suffer from psychological and emotional distress due to the conflict between their gender identity and their assigned gender role and/or anatomy. They often find that their only recourse is to change their [[gender role]] and possibly undergo [[sex reassignment therapy]]. This may include [[Hormone replacement therapy (trans)|hormone therapy]] to modify their [[secondary sex characteristic]]s and/or [[sex reassignment surgery]] to alter their [[primary sex characteristics]]. |
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===Psychological treatment=== |
===Psychological treatment=== |
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Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex have been shown to be ineffective |
Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex have typically been shown to be ineffective. Therefore, it is generally accepted that the only reasonable and effective course of treatment for transsexual people would be sex reassignment therapy. |
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The need for |
The need for treatment is emphasized by the high rate of [[mental health]] problems, including [[clinical depression|depression]], [[anxiety]], and various [[addictions]], as well as a higher [[suicide]] rate among untreated transsexual people than in the general population. [http://www.metrokc.gov/health/glbt/transgender.htm] Many of these problems, in the majority of cases, disappear or decrease significantly after a change of gender role and/or physical characteristics. [http://the-sisterhood.tripod.com/id28.html] |
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Many transgender and transsexual activists, and many caregivers, point out that these problems usually are not related to the gender identity issues themselves, but to problems that arise from dealing with those issues and social problems related to them. Also, many feel that those problems are much more likely to be diagnosed in transsexual people than in the general population, because transsexual people are usually required to visit a mental health professional to obtain approval for hormones and sex reassignment surgery. |
Many transgender and transsexual activists, and many caregivers, point out that these problems usually are not related to the gender identity issues themselves, but to problems that arise from dealing with those issues and social problems related to them. Also, many feel that those problems are much more likely to be diagnosed in transsexual people than in the general population, because transsexual people are usually required to visit a mental health professional to obtain approval for hormones and sex reassignment surgery. Thus exposing the transsexual community to a higher level of evaluation for mental health issues than the general populace. |
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A growing number of transsexual people are resenting or even refusing psychological treatment which is mandated by the Harry Benjamin |
A growing number of transsexual people are resenting or even refusing psychological treatment which is mandated by the Harry Benjamin [[Standards of Care for Gender Identity Disorders|Standards of Care]], because they believe that gender dysphoria itself is untreatable by psychological means, and that they have no other problems that need treatment. Unfortunately, this can often cause them significant problems when they attempt to obtain physical treatment. As health professionals expect such therapy to be occuring concurrently with physical treatment. |
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Therapists' records reveal that many transsexual people do not believe they need psychological counseling, but acquiesce to legal and medical |
Therapists' records reveal that many transsexual people do not believe they need psychological counseling, but rather they will acquiesce to legal and medical expectations in order to gain rights which are thusly granted through the medical/psychological hierarchy. (Brown 103) Legal needs such as a change of sex on legal documents, and medical needs, such as [[sex reassignment surgery]], are usually impossible to obtain without a doctor and/or therapist's approval. Because of this, many transsexual people feel coerced into affirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference, in order to overcome simple legal and medical hurdles. (Brown 107) Transsexual people who do not submit to this medical hierarchy typically face the option of remaining invisible, with no legal rights and possibly with identification documents incongruent with gender presentation. |
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====Diagnosing transsexualism==== |
====Diagnosing transsexualism==== |
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The current [[diagnosis]] for transsexual people who present themselves for psychological treatment is "[[gender identity disorder]]". As the DSM has changed its terminology, the diagnosis of "transsexualism" has become unused in recent years. This diagnostic label is often necessary to obtain sex reassignment therapy. 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 them. (Brown 105) |
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⚫ | Some people who desire sex reassignment therapy do not have gender identity disorder, as the term is usually defined, and desire to transition for other reasons. This can include [[homosexual]] people who are unable to accept their homosexuality (or which were, up until the 1970s, ''encouraged'' by caretakers to change their gender role, including SRS), [[cross-dressing|cross-dressers]] who feel more comfortable dressed as members of the opposite gender and may become confused (although, it may be important to realize that many transsexual women do go through a period where they self-identify as cross-dressers), and people with certain psychiatric disorders, such as [[schizophrenia]], [[borderline personality disorder]], [[dissociative identity disorder]], and [[Munchausen syndrome]]. (Brown 106-107) Most professionals believe that sex reassignment therapy is not appropriate for such individuals. (Brown 107) If SRS is performed in such cases, the result is usually expected to be very negative for the individual, since it, unlike with patients with GID, typically does not alleviate issues for them, but rather leaves them with an intolerable body. [http://www.transsexual.org/whattodo.html]. |
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⚫ | However, some transsexual people may suffer from [[comorbidity|co-morbid]] psychiatric conditions unrelated to their gender dysphoria. The [[DSM-IV]] itself states that in rare instances, gender identity disorder may co-exist with schizophrenia, and that psychiatric disorders are generally not considered contraindications to sex reassignment therapy, that is unless they are the primary cause of the patient's gender dysphoria. (Brown 108) Despite this permissiveness, the process of psychological treatment is usually much more complicated for transsexual people with co-morbid psychiatric conditions. |
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⚫ | Some transsexual people have pressured the [[American Psychiatric Association]] to remove Gender Identity Disorder from the DSM. 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. [http://www.genderpsychology.org/psychology/mental_illness_model.html] Furthermore, many people express that some psychologists and psychiatrists in viewing transsexualism as "a disease" have sought to develop specific models of transsexualism, which they feel exclude many transsexual people, such as [[Ray Blanchard]]'s model. Some who feel that transsexualism is a physical rather than a mental condition have proposed the diagnosis of ''[[Benjamin's syndrome]]'' to replace GID. |
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⚫ | Some people who desire sex reassignment therapy do not have gender identity disorder, as the term is usually defined, and desire to transition for other reasons. This |
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[[Andrea James]] has proposed the terms ''interest in feminization'' and ''interest in masculinization'' to refer to a desire for sex reassignment therapy, regardless of whether the person with the desire is transsexual, [http://www.tsroadmap.com/info/gender_identity.html]although some people who feel that transsexualism is an inborn trait, believe that defining it as an "interest" would place emphasis on the hypothesis that transsexualism is a "lifestyle choice". |
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⚫ | However, some transsexual people suffer from [[comorbidity|co-morbid]] psychiatric conditions unrelated to their gender dysphoria. The [[DSM-IV]] itself states that in rare instances, gender identity disorder may co-exist with schizophrenia |
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Other people under the position that transsexual is a physical condition, and not a psychological issue assert that sex reassignment therapy should be given if requested, and may even allign with those who feel that all [[body modification]] should be offered on demand. (Brown 103) |
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⚫ | Some transsexual people have pressured the [[American Psychiatric Association]] to remove Gender Identity Disorder from the DSM. Many of these people feel that mental health professionals are being insensitive by labeling transsexualism as "a disease", rather than as |
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Additionally, the rules or requirements for diagnosis are almost always determined by non-transsexual medical gatekeepers, who have the power to allow or deny a transsexual person's |
Additionally, the rules or requirements for diagnosis are almost always determined by non-transsexual medical gatekeepers, who have the power to allow or deny a transsexual person's will to transition based on their own perceptions of how a transsexual person should act and/or appear, which are sometimes may be prejudiced or based largely on cultural stereotypes. For example, they may reject the hair of a transsexual man as being "too long", even though many non-transsexual men like to wear long hair. |
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===Requirements for sex reassignment therapy=== |
===Requirements for sex reassignment therapy=== |
Revision as of 01:33, 7 October 2006
Transsexualism is a condition in which a transsexual person 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 people outside the community, reject this model. [1]
Transsexualism often manifests itself as a dysphoria toward one's biological birth sex, as well as conflict living in one's social role. If untreated, it can lead to mental and emotional problems, and sometimes, suicide. Dutch researcher Peggy Cohen-Kettenis estimates that 40% of untreated transsexual people are either institutionalized or die prematurely. However, with proper treatment, transsexual people often become fully functional members of society. [2] The suicide statistics of treated transsexual people (Cohen-Kettenis et al, 1988) do not differ remarkably from non-transsexual populations.
Most transsexual men and women desire to establish a permanent social role as a member of the gender with which they identify. Many transsexual people also desire various types of medical alterations to their bodies. These physical alterations are collectively referred to as sex reassignment therapy and often include 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 transition, and usually takes several years.
To obtain sex reassignment therapy, transsexual people are usually required to receive psychological therapy and a diagnosis of gender identity disorder. They must also live as members of their target sex for at least one year prior to surgery, but this time may be longer if the psychotherapist has concerns about the transsexual person's readiness. This time is known as the Real-Life Test or Real-Life Experience, and is one of a number of requirements that a transsexual person must meet, which are specified by protocols known as Standards of Care. These requirements are intended to prevent those individuals, who are not genuinely transsexual persons, from transitioning and later regretting having done so. These standards are however often criticized as being either ineffective or too strict. The intentions of the standard are to prevent people from transitioning when such a transition would be inappropriate (as a dramatic example, a person seeking to transition in order to veil their identity from police), or ill-advised (as an example a strong crossdresser, who still identifies themselves as their assigned gender). Although the intentions of the standards may be good, they have been suggested as discouraging genuinely transsexual people from seeking treatment. Despite anyone's concerns about the protocols, by most estimates, less than 1% of people who transition ever regret doing so, whether they had followed the standards or not. [3]
Currently, the causes of transsexualism are unknown and estimates of prevalence vary substantially. Perhaps the most prominent theory at this time among transsexual people suggests that transsexualism is a neurobiological condition which manifests itself as gender dysphoria and has as its fundamental cause a difference in a brain structure known as the Bed nucleus of Stria Terminalis (BSTc), which would make their brain functions more similar to the brain functions shown by the gender that they identify with most.
Defining transsexualism
Transsexualism (also known as transsexuality) 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. As with any terms used by a group, or to refer to a particular group, some of these terms are controversial, or have become controversial, not only to society at large, but even among the transsexual community as well.
The definition of "transsexuality" is debated. Many within the transsexual 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 be completed before a person may be called "transsexual". While the general public often defines "a transsexual" as someone who has had, or plans to have, a "sex change" operation. Although this phrase is considered inaccurate by many people, who believe that sex cannot really be changed. Opposing this view is that many transsexual people consider "sex change" rude and prefer "sex reassignment" or "gender reassignment" instead.
The term currently in widest use for modification of primary sex characteristics is sex reassignment surgery (SRS). This latter term in particular 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 no longer members of their original sex. [4]. In the UK, gender reassignment surgery (GRS) is a prevalent term, but many prefer gender affirmation surgery, which emphasizes their personal perspective upon the surgery.
The Diagnostic and Statistical Manual of Mental Disorders accepts the expression of desire to be of the opposite sex, or assertion that one is of the sex opposite from the one with which they were assigned at birth, as suffficient for being transsexual. [5] The ICD-10 states in a similar way 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 has been described as a trait, disease, behavior, desire, mental illness, perversion, paraphilia, political identity and sin, although this list is certainly not exaustive. Some of these labels are considered offensive by many people regardless of if they are transsexual or not. These people typically will define transexualism as a trait, desire, political identity, or as a medical condition, which avoids the loaded language implied in "disease" and "sin". No matter how one views transsexualism in many parts of the world it has been viewed as a taboo subject, and many people—even in relatively open and accepting cultures—had little knowledge of the subject prior to the late 20th century.
Transsexualism typically falls under the broader term transgender, which is generally considered an umbrella term for people who do not conform to typical accepted gender roles. However, some people in the transsexual community do not self-identify as transgender, or they disagree that transsexualism is a sub-division under transgenderism. "Transgendered" is found by some transsexual people to be insulting, because they may feel they should not be placed in a category that also contains transvestites. 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 assumption that gender variant people can be neatly divided into "transsexuals" and "transvestites") or "perverts" or even term with even more loaded meanings. They then assert that this is not what transsexual people are. This is usually accompanied by demanding that medical treatment, legal change of name and legal gender should be reserved only for transsexual people.
Some transsexual people also see the term 'transgender' as subsuming and erasing their identity, rejecting the identification for themselves, because to them it implies a breaking down of gender roles, while they see themselves as fitting just fine in a gender role -- just not the one they were assigned at birth. Those contesting this perspective express that the idea of a more inclusive "Gender identity disorder" has long replaced the idea of dividing gender variant people into "transsexuals" and "transvestites", and that classifying transsexualism as a sub-division of transgender does not automatically erase transsexual identity. They also express that not all transgender people wish to break down gender barriers, and that any marginalized group trying to gain acceptance by those opposing them by trying to oppress another group has not only never been successful, but it is also ethically questionable.
Regardless of how you define transsexualism, it should not be confused with cross dressing or with the behaviour of drag queens, which can be described as transgender, but usually not transsexual. Also, transvestic fetishism usually has little, if anything, to do with transsexualism. The difference between this group can typically be expressed most easily i that while many transsexual people dress conservatively and modestly, most drag queens and crossdressers dress in a more flamboyant manner, usually exaggerating their ideals of what is feminine.
Gender terminology for transsexual people
Transsexual people almost universally 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 gender 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" 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 are particularly helpful in preventing confusion, because to some people the term "transsexual woman" is a female transitioning to become a male, and to others a male transitioning to become a female. When the terms transmen and transwomen are used though, it is typical for them to be used to refer to the gender that the person identifies with, regardless of their appearance or state of transition.
Transsexual people are often considered as part of the LGBT community, and although many do identify with this community, others do not, or prefer not to use the terms at all. Transsexual people typical feel it important that transexualism does not depend upon, nor related to sexual orientation. Transsexual men and women exhibit a range of sexual orientations just as non-transsexual (some times refered to as cissexual) people do, and they will almost always use terms for their sexual orientation that relate to the gender that they identify with. For example, someone assigned the male gender at birth but who identifies as a woman, and who is attracted solely to men, will identify as heterosexual, not gay. Likewise, someone who was assigned the female gender at birth, identifies as a man, and prefers male partners will identify as gay, not heterosexual. Transsexual people, like other people, can be bisexual or asexual as well.
Older medical texts often referred to transsexual people as members of their original sex by 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 usage is considered by many to be scientifically inaccurate and clinically insensitive today. As such someone who would have been refered to as a "homosexual male transsexual" would now be called and most likely identify herself as a heterosexual transsexual woman. Although this usage is dwindling, some medical textbooks still refer to transsexual people as members of their assigned sex, but now many use "assigned-to-target" terms.
There are still are and probably always will be people outside the transsexual community, who refer to transsexual people with terms associated with their assigned gender at birth, for example calling a male-to-female transsexual "him". This usage, generally considered insensitive or insulting (especially if intentional), has been (though not exclusively) based on biological arguments such as the unchanging karyotype, which is usually consistent with the sex assigned to the person at birth. It may also be based on the absence of reproductive capability after transition and sex reassignment surgery. Arguments for this usage have also typically been based on religious dogma. Conservative groups such as the Traditional Values Coalition are among those who refer to transsexual people as members of their assigned sex at birth.
Alternative terminology
The transsexual community typically use the short form "trans", or simply "T" as a substitution for the full word "transsexual", e.g. TS, trans guy, trans dyke, T-folk, trans folk. Some may even use term that have become controversial to some, such as tranny and/or trans, despite others considering these terms to be offensive. Those who do use these terms claim that they are diminishing the power of the term as an insult, just as some members of the gay and African-American communities have embraced slurs directed at them. Others feel that the terms are insulting or inaccurate regardless of the context. Some feel that such words are problematic because they do not differentiate between transsexual people, and people who are merely "playing" with gender.
Some people may prefer to spell transsexual with only one s, thus writing transexual. They will typically assert that they are attempting to divorce the word from the realm of psychiatry and medicine and place it in the realm of identity. This trend is most common in the United States, and is almost never used in the United Kingdom. [6] Some consider this usage to be silly and/or incorrect.
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 more closely parallels with the term intersex, which is considered by them to be important 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.
Some transsexual people may also prefer transgendered over transsexual, because the issue is about gender rather than sexuality. They make a parallel with intergender, whose issue is about being between (inter) the genders rather than "intersexual". It is often assumed, particularly by transsexual people, that transsexualism is 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. (Despite the fact that human genitals show an extremely wide variation in general, intersexed people typically have quite obviously ambiguous genitalia that frustrate attempts to assign them within a binary sex system.) However, since sex in humans is composed of many different attributes, such as genes, chromosomes, regulatory proteins, hormones, hormone receptors, body morphology, brain sex, and gender identity, any variation among any of those attributes could fall under the rubric of "intersex." Transsexualism, in this view, simply becomes a form of being neurological intersexed. (See below for research of physiological causes of transsexualism).
Some people prefer that transsexualism be referred to as Benjamin's syndrome, as it follows the naming conventions of other intersex conditions. [7] This term is named for Harry Benjamin, a pioneer in sex reassignment and research on transsexual people. Many transsexual people who prefer this term assert that scientific research has strongly suggested that their condition is biological rather than psychological in nature. They also feel that 'trans' is misleading, as they believe that their gender was fixed in their brains, and has never changed. Thus that nothing about their steps in correcting themselves is actually "trans" at all, but rather they are simply taking steps to assert what they feel that they are already.
While the above gives a fairly comprehensive view of terminology, it's imporant to note that some people may feel that both 'trans' and 'sexual', are misleading, and others may take objections to terminology that are unique to their perspective. While a large variety of other terms exist from those presented here, they have not been excluded with bias, although almost all of them are somewhat controversial.
Prevalence
There are no reliable statistics on the prevalence of transsexualism. According to the DSM-IV, statistics from smaller European countries have suggested that roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek sex reassignment surgery. [8]. However, it is commonly expressed that many transsexual people do not seek SRS and therefore are not reflected in such statistics. The DSM itself states that no recent epidemiological studies on transsexualism are available. It has also been suggested, in particular by Lynn Conway, that transsexualism is much more prevalent. Her position stating that although 1 in 2500 physical males in the United States have undergone SRS since the 1960s, perhaps 1 in 500 individuals may experience gender dysphoria. [9]. Apart from this estimate, an estimate from Holland (Cohen-Kettenis et al, 1988) would suggest that the frequency is 1 in 12,000—and surprisingly for some—is equally common amongst physical males and females, although they estimate that females often seek treatment less than males.
Causes of transsexualism
Main article: Etiology of Transsexualism
There is no scientifically proven cause of transsexualism. For many years, many medical and psychological professionals, and the public, assumed that transsexualism was caused by psychological or emotional factors. However, most psychological models of transsexualism could not be successfully applied to significant numbers of transsexual people, and despite attempts by some people to cure a person of the transsexual disease through psychological or psychiatric means, such "cures" are rarely effective, and many times considered by peers to be unethical.
In recent years, theories have been presented which suggest that the cause of transsexualism has its roots in biology. Building from this, much of the medical profession has slowly come to view transsexualism as a physiological issue, rather than a psychological one. However, at this time (2006), physiological causes of transsexualism have not yet been proven.
Some transsexual people and professionals feel that research into causes of transsexualism assumes at face value the legitimacy of a normative gender identity, and/or that transsexualism is contrary to normal development, and could be considered a disease, or syndrome, which a transsexual may feel is stigmatizing. They usually consider such research to be unnecessary, and wonder if such studies might possibly be causing more harm than good for transsexual people.
Sex reassignment therapy
Most transsexual men and women suffer from psychological and emotional distress due to the conflict between their gender identity and their assigned gender role and/or anatomy. They often find that their only recourse is to change their gender role and possibly undergo sex reassignment therapy. This may include hormone therapy to modify their secondary sex characteristics and/or sex reassignment surgery to alter their primary sex characteristics.
Psychological treatment
Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex have typically been shown to be ineffective. Therefore, it is generally accepted that the only reasonable and effective course of treatment for transsexual people would be sex reassignment therapy.
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. [10] Many of these problems, in the majority of cases, disappear or decrease significantly after a change of gender role and/or physical characteristics. [11]
Many transgender and transsexual activists, and many caregivers, point out that these problems usually are not related to the gender identity issues themselves, but to problems that arise from dealing with those issues and social problems related to them. Also, many feel that those problems are much more likely to be diagnosed in transsexual people than in the general population, because transsexual people are usually required to visit a mental health professional to obtain approval for hormones and sex reassignment surgery. Thus exposing the transsexual community to a higher level of evaluation for mental health issues than the general populace.
A growing number of transsexual people are resenting or even refusing psychological treatment which is mandated by the Harry Benjamin Standards of Care, because they believe that gender dysphoria itself is untreatable by psychological means, and that they have no other problems that need treatment. Unfortunately, this can often cause them significant problems when they attempt to obtain physical treatment. As health professionals expect such therapy to be occuring concurrently with physical treatment.
Therapists' records reveal that many transsexual people do not believe they need psychological counseling, but rather they will acquiesce to legal and medical expectations in order to gain rights which are thusly granted through the medical/psychological hierarchy. (Brown 103) Legal needs such as a change of sex on legal documents, and medical needs, such as sex reassignment surgery, are usually impossible to obtain without a doctor and/or therapist's approval. Because of this, many transsexual people feel coerced into affirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference, in order to overcome simple legal and medical hurdles. (Brown 107) Transsexual people who do not submit to this medical hierarchy typically face the option of remaining invisible, with no legal rights and possibly with identification documents incongruent with gender presentation.
Diagnosing transsexualism
The current diagnosis for transsexual people who present themselves for psychological treatment is "gender identity disorder". As the DSM has changed its terminology, the diagnosis of "transsexualism" has become unused in recent years. This diagnostic label is often necessary to obtain sex reassignment therapy. 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 them. (Brown 105)
Some people who desire sex reassignment therapy do not have gender identity disorder, as the term is usually defined, and desire to transition for other reasons. This can include homosexual people who are unable to accept their homosexuality (or which were, up until the 1970s, encouraged by caretakers to change their gender role, including SRS), cross-dressers who feel more comfortable dressed as members of the opposite gender and may become confused (although, it may be important to realize that many transsexual women do go through a period where they self-identify as cross-dressers), and people with certain psychiatric disorders, such as schizophrenia, borderline personality disorder, dissociative identity disorder, and Munchausen syndrome. (Brown 106-107) Most professionals believe that sex reassignment therapy is not appropriate for such individuals. (Brown 107) If SRS is performed in such cases, the result is usually expected to be very negative for the individual, since it, unlike with patients with GID, typically does not alleviate issues for them, but rather leaves them with an intolerable body. [12].
However, some transsexual people may suffer from co-morbid psychiatric conditions unrelated to their gender dysphoria. The DSM-IV itself states that in rare instances, gender identity disorder may co-exist with schizophrenia, and that psychiatric disorders are generally not considered contraindications to sex reassignment therapy, that is unless they are the primary cause of the patient's gender dysphoria. (Brown 108) Despite this permissiveness, the process of psychological treatment is usually much more complicated for transsexual people with co-morbid psychiatric conditions.
Some transsexual people have pressured the American Psychiatric Association to remove Gender Identity Disorder from the DSM. 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. [13] Furthermore, many people express that some psychologists and psychiatrists in viewing transsexualism as "a disease" have sought to develop specific models of transsexualism, which they feel exclude many transsexual people, such as Ray Blanchard's model. Some who feel that transsexualism is a physical rather than a mental condition have proposed the diagnosis of Benjamin's syndrome to replace GID.
Andrea James has proposed the terms interest in feminization and interest in masculinization to refer to a desire for sex reassignment therapy, regardless of whether the person with the desire is transsexual, [14]although some people who feel that transsexualism is an inborn trait, believe that defining it as an "interest" would place emphasis on the hypothesis that transsexualism is a "lifestyle choice".
Other people under the position that transsexual is a physical condition, and not a psychological issue assert that sex reassignment therapy should be given if requested, and may even allign with those who feel that all body modification should be offered on demand. (Brown 103)
Additionally, the rules or requirements for diagnosis are almost always determined by non-transsexual medical gatekeepers, who have the power to allow or deny a transsexual person's will to transition based on their own perceptions of how a transsexual person should act and/or appear, which are sometimes may be prejudiced or based largely on cultural stereotypes. For example, they may reject the hair of a transsexual man as being "too long", even though many non-transsexual men like to wear long hair.
Requirements for sex reassignment therapy
Main article: Standards of Care for Gender Identity Disorders
The requirements for hormone replacement therapy vary greatly. Often, a minimum time period of psychological counseling, or a time period spent living in the desired gender role is required. This time period of "cross-living" is usually known as the Real-Life-Test (RLT) or Real-Life-Experience (RLE). This is not always possible; transsexual men frequently cannot "pass" this period without hormones. Transsexual women may also require hormones to pass as women in society. Most transwomen also require facial hair removal, voice training or voice surgery, and sometimes, facial feminization surgery, to be passable as females; these treatments are usually provided upon request with no requirements for psychotherapy or "cross-living". The most recent revision of the HBIGDA Standards of Care recognizes this limitation for some transgender people. Therefore, the SOC state that patients may be approved for hormone treatment after either a period of successful cross-living or a period of diagnostic psychotherapy - generally at least three months. Some doctors are willing to prescribe hormones to any patient who requests them; however, most physicians are reluctant to do so, especially for transmen. In transmen, some hormonally-induced changes may become virtually irreversible within weeks, whereas transwomen usually have to take hormones for many months before any irreversible changes will result. Some transsexual men and women are able to avoid the medical community's requirements for hormone therapy altogether by either obtaining hormones from black market sources, such as internet pharmacies which ship from overseas, or more rarely, by synthesizing hormones themselves.
Some surgeons who perform sex reassignment surgeries may require their patients to live as members of their target gender in as many ways as possible for a specified period of time, prior to any surgery. However, some surgeons recognize that this so-called real-life test for transmen, without breast removal and/or chest reconstruction, may be difficult. Therefore, many surgeons are willing to perform some or all elements of sex reassignment surgery without a real-life test. This is especially common amongst surgeons who practice in Asia. However, almost all surgeons practicing in North America and Europe who perform genital reassignment surgery require letters of approval from two psychotherapists; most Standards of Care recommend and most therapists require a one-year real-life test prior to genital reassignement surgery, though some therapists are willing to waive this requirement for certain patients. A recent study done on transwomen has shown that a real-life test of less than one year, or no real-life test at all, does not increase the likelihood that a patient will regret genital reassignment surgery. [15] Many transsexual people opt for a real-life experience longer than is officially required, to remove any doubts they may have of whether they should undergo surgery.
Hormone replacement therapy
Main article: Hormone replacement therapy (trans)
For transsexual men and women, hormone replacement therapy (HRT) causes the development of many of the secondary sexual characteristics of their desired gender. However, many of the existing primary and secondary sexual characteristics cannot be reversed by HRT. For example, breasts will grow in transsexual women but they will not regress in transsexual men. Facial hair will grow in transsexual men, but will not regress in transsexual women. However, some characteristics, such distribution of body fat and muscle, as well as menstruation in transsexual men, may be reversed by hormonal treatment. Generally, those traits that are easily reversible will also revert on cessation of hormonal treatment, unless chemical or surgical castration has occurred. For many transsexual people, surgery is required to obtain satisfactory physical characteristics.
Several health risks are associated with hormone replacement therapy, especially when higher doses are taken, as is common for pre-operative transsexual patients. Therefore, it is generally inadvisable for transsexual people to take hormones without a physician's supervision.
Some transsexual women use herbal phytoestrogens as alternatives to pharmaceutical estrogens. However, little research has been done on the safety or effectiveness of such products, and anecdotal evidence suggests that their effects, if noticeable at all, are very subtle when compared to conventional hormone therapy.
Sex reassignment surgery
Main article: Sex reassignment surgery
Sex reassignment surgery consists of procedures which transsexual women and men undergo in order to match their anatomical sex to their gender identity. While genital reassignment surgery (GRS) refers only to surgeries that correct genital anatomy, sex reassignment surgery (SRS) may refer to all surgical procedures undergone by transsexual patients.
SRS tends to be expensive and is not always covered by public or private health insurance. In many countries with comprehensive nationalized health care, such as Canada and most European countries, SRS is covered under these plans. However, requirements for obtaining SRS and other transsexual services under these plans are sometimes more stringent than the requirements laid out in the Harry Benjamin Standards of Care, and in Europe, many local Standards of Care exist. In other countries, such as the United States, no national health plan exists and the majority of private insurance companies do not cover SRS. There are also significant medical risks associated with SRS that should be considered by those who are contemplating the surgery.
Prior to surgery, transsexual men and women are often referred to as pre-operative (pre-op); those who have already had the surgery may be referred to as post-operative (post-op) or simply identified as members of the sex to which they have transitioned. Not all transsexual people undergo sexual reassignment surgery (either because of the high cost of such surgery, medical reasons, or other reasons), although they live constantly in their preferred gender role; these people are often called non-operative (non-op).
A more modern idea suggests that the focus on surgery status is misplaced, and therefore, an increasing number of people are refusing to define themselves in terms of operative status, often defining themselves based on their social presentation instead. Many transsexual people believe that SRS is only a small part of a complete transition.
Legal and social aspects
Many Western societies have procedures whereby an individual can change their name, and sometimes, their legal gender, to reflect their gender identity (see Legal aspects of transsexualism).
Medical treatment for transsexual and transgender people is also 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. [16] In the United States, November 20 has been set aside as the "Day of Remembrance" for all murdered transgender people.
Some people who have switched their gender role enter into traditional social institutions such as marriage and the role of parenting. They sometimes adopt or provide foster care for children, as complete sex reassignment therapy inevitably results in infertility. Sometimes, they adopt children who are also transsexual or transgender and help them live according to their gender identity.[citation needed] 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. A recent study shows that this does not harm the development of these children in any way.[17]
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.
Coming out
Employment issues
Transsexual people have historically had difficulty maintaining employment. Most transsexual people 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. [18] Transsexual people must decide whether to transition on-the-job, or to find a new job when they make their social transition. The transsexual community usually regards this as a personal decision, though those who are fired during transition will have to find new jobs. Finding employment is often a challenge, especially for those in mid-transition.
Legal policies regarding name and gender changes in many countries make it difficult for pre-op transsexual people to conceal their trans status from their employers. [19] Because the Harry Benjamin Standards of Care require a one year RLT prior to SRS, some feel this creates a Catch 22 situation which makes it difficult for transpeople to remain employed or obtain SRS.
In many countries, laws are providing increasing protection to transpeople from workplace discrimination, and an increasing number of companies are including "gender identity" in their non-discrimination policies. [20] However, these laws and policies often have gaps, and they are not always fully implemented and enforced. California has strigent anti-discrimination laws to protect transsexual persons in the workplace and specifically prohibits employers from terminating or refusing to hire persons who are discovered to be transsexual. Member states of the European Union provide employment protection as part of gender discrimination protections following the European Court of Justice decisions in P v S and Cornwall County Council [21].
Stealth
After transsexual men and women are living full-time as members of their target gender, they may wish to blend in with other members of their new sex, and will avoid revealing their past. They do this believing that it will provide greater peace and security on the other side of a stressful and potentially dangerous transition, and/or because they wish to be seen only as members of their target sex, not as transsexuals.
This behaviour, known as stealth, is recognized by most people in the transsexual community as an individual decision that one must make. Some, however, within and outside the transsexual community, feel that one should be upfront about his or her past, and that stealth living is somehow dishonest. Some draw a parallel with a perceived need for lesbian and gay people to "come out", and may perceive a failure to do so as betrayal of a greater community, seeing hope for advancement of civil rights and public image in the visibility of greater numbers. However, most people within the community understand that revealing one's transsexual history is a deeply personal choice. Moreover, this is part of an individual's medical history, and as such should be his or hers alone to disclose.
The equation with "coming out", whereby a lesbian or gay person, or a transsexual person who has hidden their true gender identity while maintaining their originally assigned gender role, feels they reveal their true self, has been countered by the explanation that, in contrast, because of prejudice, sensationalism, and how it can trigger unconscious personal feelings and emotions, knowledge of someone's transsexual past can prevent the average person from being able see the transitioned person's true self.
The decision to live completely stealth is believed to present its own psychological difficulties. Many believe that post-transition transsexual people who have no one in which to confide may have tendencies towards anxiety and depression. The term deep stealth is sometimes used for those who have completely isolated themselves from their past, their birth families, the medical professionals directly involved in their treatment process, and from the support structures that may have helped them through transition. Several examples exist of people who have gone deep stealth whose status was only discovered at their death. For example, the jazz musician Billy Tipton was deep stealth and his status was unknown, even by his wife and (adopted) children. Tipton's death illustrates one of the dangers of going deep stealth. This fear of discovery as being transsexual may often keep people from seeking needed medical care. Tipton bled to death from an ulcer that could have been readily treated at the time had he been able to seek medical care without fear of discovery.
However, many believe that fear of discovery, as mentioned above, is justifiable. Several examples also exist of people who have been denied medical treatment upon discovery of their trans status, whether it was revealed by the patient or inadvertently discovered by the doctors. For example, Leslie Feinberg was once turned away from a hospital emergency room where s/he had sought treatment for encephalitis. (Feinberg 2) Like Tipton, Feinberg was presenting as a man but had female genital anatomy. S/he nearly died after being denied treatment. Feinberg's case demonstrates one of the many dangers of actually being discovered. Additionally, Tyra Hunter died after being denied care by paramedics and emergency room physicians after she was injured in an automobile accident.
The majority of the transsexual and transgender community has learned to accept that people choose, for many reasons, including political beliefs, religion, family responsibilities, career, perception of how well they will be accepted by others, and personal psychology, to live at a certain place on the spectrum from 'out and proud' to 'deep stealth'. By this view, Billy Tipton's decision to live deep stealth was no more or less valid than Jamison Green's decision to be out and politically active, as detailed in his book 'Becoming a Visible Man'. There are risks and benefits associated with every point on the spectrum and the decision is widely considered a personal one.
Transsexual youth
Main article: Transgender youth[original research?]
In the case of transsexual youths their condition becomes apparent at some time in childhood, when the child may express behavior incongruent with, and dissatisfaction related to, their assigned gender. These youths express their cross-gender behavior unconsciously, not on purpose.[citation needed] These youths come to understand the nature of their difference by puberty though they may delay action on this.[citation needed] They may think they are gay for period of time before coming to the conclusion that they are transsexual. According to the DSM-IV, the majority of children diagnosed with gender identity disorder establish a gender identity congruent with their physical sex by adulthood, and often in adolescence. Often these children are the subject of bullying and intimidation. Adolescence is rough for these youths as puberty eventually kicks in and removes the androgynous looks of childhood.
How well these youths fare varies greatly based on the acceptance of their parents and the tolerance of the community they live in. With accepting parents and a tolerant community these children typically fare as well as other children in their community.[citation needed] However if parents are unaccepting and the community is intolerant these children are driven from the mainstream. Education or career training may be delayed or never completed.[citation needed]
Some transgender youths who eventually transition will delay the process until very early adulthood and transition to "full time" while away at college.[citation needed] (see TransGeneration)
Regrets and detransitions
After transitioning, transsexual people sometimes regret their transition, or even choose to detransition to their original sex. However, every recent study done on the number of detransitions states that their number is well below 1%, and that the reasons for detransitioning are very diverse.[22] The majority, but not all transsexual people who detransition consider themselves regretful.
Although the incidence of regret is not known, there are many documented cases of regret. Evidence suggests [citation needed] that regret is more common among self-identified autogynephiles, transsexual people with co-existing psychiatric problems, patients with surgical complications, and patients having religious views that their transition was "wrong". 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. [23] Jerry Leach, a Christian minister who claims to have backed out of SRS a few weeks before his scheduled surgery date, and reverted to living as a man, also claims that he is contacted by many post-op transsexual people with stories of regret. There are some recent claims that examination of his own personal story of transition reveals some inconsistencies and implausibilities. [citation needed] He runs a website on which he has posted some stories of regretful trans patients. [24]. Among notable regretful trans patients are Renee Richards and Danielle Bunten Berry. [25]
These cases are often cited as reasons for the lengthy triadic process outlined in the Standards of Care, which specifies a treatment process combining psychological, hormonal, and surgical care. While many have criticized this process as being too slow for some, it is argued that without the safeguards within the Standards of Care, the incidence of unsuccessful surgical transitions would be much higher. This is also questioned by many critics, especially with regard to particular demands of some caregivers. The article above states that in some of these cases, transitioning could have been prevented if some demands made by caregivers, or demands perceived as coming from the caregivers, had been less rigid; particularly, if the patients had not felt that talking about any problems or doubts would jeopardize their further treatment. An unwavering demand for medical treatment and the absolute conviction of "doing the right thing" is often seen as a necessity for the diagnosis of transsexualism, and therefore the prerequisite for any further treatment; consequently, further treatment has been denied to people who uttered any doubts or even questions.
Critics claim that when patients cannot talk about problems or doubts, but have to present themselves as having neither, the patients, anxious to get treatment they perceive at this point to be absolutely necessary, will face these problems or doubts after transitioning, when dealing with them may be much more difficult, and this will often lead to social problems, depression, anxiety, or other problems. They believe that, in some cases, this may lead to a retransitioning. While there is no scientific study on the question, many trans*-organisations and groups claim that patients who feel less pressure to conform to any particular stereotype will have more satisfactory outcomes after transition. This does not preclude any screening for mental problems which might lead to pseudo-transsexualism, nor supportive psychological therapy, if necessary.
Additionally, some people detransition after SRS because their desire was to undergo SRS and continue living in the gender role assigned to them at birth. [26] However, they transition temporarily in order to satisfy the requirement of a real-life test.
Depictions of transsexualism in the media
Although many transsexual people are modest about their bodies, and are found in all walks of life and professions, transsexual women are commonly featured in pornographic works. When depicted without having undergone vaginoplasty, they are usually referred to as "shemales". While some pre-operative transwomen call themselves and others like them "shemales," the term is regarded as offensive by many transsexual people. [27]
Films depicting transgender issues include The World According to Garp 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.
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).
Transsexual people have also been depicted in some popular television shows. 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 a 1980s episode of The Love Boat, McKenzie Phillips portrays a transwoman who is eventually accepted as a friend by her old high school classmate, series regular Fred Grandy.
The series Law & Order and Nip/Tuck have had transsexual characters, but they were played by non-transsexual women or professional cross-dressers. The series Without a Trace featured an episode in which a transsexual woman went missing and is almost killed by her ex-wife's husband after visiting her family, which she abandoned before transtioning. CSI: Crime Scene Investigation had an episode dealing with a transsexual victim, Ch-Ch-Changes. Many transsexual actresses and extras appeared on the episode, including Marci Bowers and Calpernia Addams. The transwoman victim, Wendy, was played by Sarah Buxton, a cisgender woman. [28] Addams has appeared in numerous movies and television shows, including the 2005 movie Transamerica, in which Felicity Huffman portrays a pre-op transsexual woman. [29]
In fall 2005, the Sundance Channel aired a documentary series known as Transgeneration. This series focused on four transsexual college students, including two transwomen and two transmen, in various stages of transition. [30] 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. [31]
See also: Transgender in film and television
Transsexualism in non-Western cultures
Transsexual people enjoy varying degrees of acceptance in non-Western societies.
Before the Islamic Revolution in 1979, the issue of transsexualism in Iran had never been officially addressed by the government. Beginning in the mid-1980s, however, transgendered individuals have been officially recognized by the government and allowed to undergo sex reassignment surgery. (See Transsexuality in Iran)
This stance might be considered liberal from an American or European viewpoint, but some Iranian clerics use the stance to stress heteronormativity on the part of Iranian and Islamic society. Homosexuality is still forbidden and punishable by death in Iran, and the viewpoint is that males who are attracted to other males should become women. Furthermore, in many societies where homosexuality is poorly accepted, social acceptance of transsexual people is high, and many societies which accept homosexuality are not tolerant of transsexual people.
This heteronormative stance is also seen in countries such as Brazil and Thailand. Thailand is thought to have the highest prevalence of transsexualism in the world. In Thailand, kathoey (who are often, but not always, transsexual) are accepted to a greater extent than in most countries, but are not completely free of societal stigma. Feminine transsexual kathoey are much more accepted than gay male kathoey; this may be seen as an example of heteronormativity. Due to the relative prevalence and acceptance of transsexualism in Thailand, there are many accomplished Thai surgeons who are specialized in sex reassignment surgery. Thai surgeons are a popular option for Western transpeople seeking surgery, largely due to the lower cost of surgery in Thailand.
Transsexual people are gaining acceptance in much of Latin America, and gender reassignment surgeries are on the rise in Mexico, Argentina and Brazil. [citation needed]
Transgender-related issues remain largely taboo in much of Africa and in developing countries around the world. [citation needed]
See also Transgender in non-Western contexts.
References
- Brown, Mildred L. and Rounsley, Chloe Ann (1996); True Selves; Jossey-Bass.
- Feinberg, Leslie (1998); Trans Liberation; Beacon Press.
- Harry Benjamin International Gender Dysphoria Association (2001); Standards of Care for Gender Identity Disorders, Sixth Version. [32]
- Kruijver, Frank P. M. Zhou, Jiang-Ning Pool, Chris W. Hofman, Michel A. Gooren, Louis J. G. and Swaab, Dick F., (2000); Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic nucleus; J. Clin. Endocrinol. Metab., May 2000; 85: 2034 - 2041.
- Schneider, Harald J. Pickel, Johanna and Stalla, Gunter K., (2005); Typical female 2nd-4th finger length (2D:4D) ratios in male-to-female transsexuals--possible implications for prenatal androgen exposure; Psychoneuroendocrinology, In Press, Available online 2 September 2005. [33]
- Xavier, J., & Simmons, R. (2000). The Washington transgender needs assessment survey, Washington, DC: The Administration for HIV and AIDS of the District of Columbia Government. [34]
See also
- List of transgender-related topics
- List of transgender-rights organizations
- List of transgender-support organizations
- List of LGBT-related organizations
- List of transgendered people
External links
- HGIBDA "Standards Of Care" - The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, Sixth Version.
- The International Journal of Transgenderism - The Official Journal of the Harry Benjamin International Gender Dysphoria Association (HBIGDA)
- Basic TG/TS/IS Information - including Successful Transwomen and Successful Transmen
- Transsexuality - Jennifer Diane Reitz's Help & Support Site. Home of the COGIATI gender test, a controversial assessment of gender identity and transsexuality.
- How to Respect a Transsexual Person
- Anaesthetic Dream - The Art of Sex Change (due for international print release in 2007)
- What transsexuality Is
- The Gender Trust - The UK Charity for the support of trans individuals, their friends & family, employers and professionals
- Transgender Law Center - The Transgender Law Center (TLC) is a civil rights organization advocating for transgender, transsexual and gender-variant communities in California.
- Definition and Synopsis of the Etiology of Adult Gender Identity Disorder and Transsexualism - prepared by 24 internationally recognized experts, published by the Gender Identity Research and Education Society (GIRES)(See: http://www.gires.org.uk)
- The International Foundation for Gender Education Publishes Transgender Tapestry and provides information and programs to promote acceptance for transgender people.
- Gender.org - The home of Gender Education & Advocacy, a nonprofit corporation using the web to provide education and advocacy for transsexual and transgender issues.
- Dr. Becky's website - Lists of therapists and physicians, medical info, etc.
- Trans Family - A support group for transgendered and transsexual people, their parents, partners, children, other family members, friends, and supportive others. Based in Cleveland Ohio, but providing resources for transgender people and their families around the world.
- TransParentcy - Organization to support transgender parents and their advocates (lawyers, mental health professionals, friends, family) by providing information and resources to diffuse and/or disspell the myths about any adverse impact being transgendered/transsexual might have on one's children.
- Transsexual Road Map - practical and medical information
- Lynn Conway - her goal is to "illuminate and normalize the issues of gender identity and the processes of gender transition."
- Harry Benjamin Syndrome - An information site that supports the concept backed by indicative research that Harry Benjamin Syndrome,(HBS),(aka transsexualism),should be classified as an intersex medical condition.
- From Within - Online book based on real events aimed at younger transitioners. Follows the story of Vicky and her young transition in England.
- Saving Throw - Brenda Make's Saving Throw / Genderrain Project is a full-length autobiography, which also touches on bisexuality, abuse, recovery, drug abuse, gender ethics, and politics.
- FTM International - Female To Male International: practical and medical information