Transgender

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Transgender people experience a mismatch between their gender identity or gender expression and their assigned sex.[1][2][3] Transgender is also an umbrella term,[2] as, in addition to including trans men and trans women whose binary gender identity is the opposite of their assigned sex (and who are sometimes specifically termed transsexual if they desire medical assistance to transition), it may include genderqueer people (whose identities are not exclusively masculine or feminine, but may, for example, be bigender, pangender or agender).[4][5] Other definitions include third-gender people as transgender or conceptualize transgender people as a third gender,[6][7] and infrequently the term is defined very broadly to include cross-dressers.[8]

Many transgender people experience a period of identity development that includes gaining better understanding their self-image, self-reflection, and self-expression. The degree to which individuals feel genuine, authentic, and comfortable within their external appearance and accept their genuine identity is referred to as transgender congruence.[9]

Being transgender is independent of sexual orientation; transgender people may identify as heterosexual, homosexual, bisexual, asexual, etc., or may consider conventional sexual orientation labels inadequate or inapplicable.

Evolution of transgender terminology

In his 1965 reference work Sexual Hygiene and Pathology, psychiatrist John F. Oliven of Columbia University coined the term transgender, writing that the term which had previously been used, transsexualism, "is misleading; actually, "transgenderism" is meant, because sexuality is not a major factor in primary transvestism."[10][11] The term transgender was then popularized with varying definitions by various transgender, transsexual and transvestite people, including Virginia Prince,[12] who used it in the December 1969 issue of Transvestia, a national magazine for cross dressers she founded.[13] By the mid-1970s both trans-gender and trans people were in use as umbrella terms,[note 1] and 'transgenderist' was used to describe people who wanted to live cross-gender without sex reassignment surgery (SRS).[14] By 1976, transgenderist was abbreviated as TG in educational materials.[15]

By 1984, the concept of a "transgender community" had developed, in which transgender was used as an umbrella term;[16] in 1985, Richard Elkins established the "Trans-Gender Archive" at the University of Ulster.[13] By 1992, the International Conference on Transgender Law and Employment Policy defined transgender as an expansive umbrella term including "transsexuals, transgenderists, cross dressers" and anyone transitioning.[17]

The term trans man refers to a man who has transitioned from female-to-male, and trans woman refers to a woman who has transitioned male-to-female. Health-practitioner manuals, professional journalistic style guides, and LGBT advocacy groups advise the adoption by others of the name and pronouns identified by the person in question, including present references to the transgender person's past;[18][19] many also note that transgender should be used as an adjective, not a noun (for example, "Max is transgender" or "Max is a transgender man", not "Max is a transgender"), and that transgender should be used, not transgendered.[20][21][22]

People who are neither transgender nor genderqueer — people whose sense of personal identity corresponds to the sex and gender assigned to them at birth — are termed cisgender.[23]

Transsexual and its relationship to transgender

See also Transsexual, especially Transsexual § The terms transsexual and transgender

The term transsexual was introduced to English in 1949 by David Oliver Cauldwell,[note 2] and popularized by Harry Benjamin in 1966, around the same time transgender was coined and began to be popularized.[12] Since the 1990s, transsexual has generally been used to describe the subset of transgender people[12][24][25] who desire to transition permanently to the gender with which they identify and who seek medical assistance (for example, SRS) with this. However, the concerns of the two groups are sometimes different; for example, transsexual men and women who can pay for medical treatments (or who have institutional coverage for their treatment) are likely to be concerned with medical privacy and establishing a durable legal status as their gender later in life.

Distinctions between the terms transgender and transsexual are commonly based on distinctions between gender (psychological, social) and sex (physical).[26][27] Hence, transsexuality may be said to deal more with material aspects of one's sex, while transgender considerations deal more with one's internal gender disposition or predisposition, as well as the related social expectations that may accompany a given gender role.[28] Many transgender people prefer the designation transgender and reject transsexual.[29][30][31] For example, Christine Jorgensen publicly rejected transsexual in 1979, and instead identified herself in newsprint as trans-gender, saying, "gender doesn't have to do with bed partners, it has to do with identity."[32][33] This refers to the concern that transsexual implies something to do with sexuality, when it is actually about gender identity.[34][note 3] Some transsexual people (those who desire or have undergone), however, object to being included in the transgender umbrella.[35][36][37][38] The definitions of both terms have historically been variable.

In his 2007 book Transgender, an Ethnography of a Category, anthropologist David Valentine asserts that transgender was coined and used by activists to include many people who do not necessarily identify with the term, and states that people who do not identify with the term transgender should not be included in the transgender spectrum.[35] Leslie Feinberg likewise asserts that transgender is not a self-identifier (for some people) but a category imposed by observers to understand other people.[36] However, these assertions are contested by the Transgender Health Program (THP) at Fenway Health in Boston. It notes that there are no universally accepted definitions, and terminology confusion is common because terms that were popular in at the turn of the 21st century may now be deemed offensive. The THP recommends that clinicians ask clients what terminology they prefer, and avoid the term transsexual unless they are sure that a client is comfortable with it.[34]

Harry Benjamin invented a classification system for transsexuals and transvestites, called the Sex Orientation Scale (SOS), in which he assigned transsexuals and transvestites to one of six categories based on their reasons for cross-dressing and the relative urgency of their need (if any) for sex reassignment surgery.[39] Benjamin considered a moderate intensity "true transsexual" to need either estrogen or testosterone as a "substitute for or preliminary to operation";[39] people who meet Benjamin's definition of a "true transsexual" but do not desire SRS include Miriam Rivera. There are also people who have had SRS but do not meet the definition of "transsexual", such as Gregory Hemingway.[40][41]

Other identities

In addition to trans men and trans women whose binary gender identity is the opposite of their assigned sex, and who form the core of the transgender umbrella, being included in even the narrowest definitions of it, several other groups are included in broader definitions of the term. These include people whose identities are not exclusively masculine or feminine but may for example be androgynous, bigender, pangender or agender — often grouped under the alternative umbrella term genderqueer[4] — and third-gender people (alternatively, some references and some societies conceptualize transgender people as a third gender).[6][7] Although some references define transgender very broadly to include transvestites / cross-dressers,[8] they are usually excluded, as are transvestic fetishists (because they are considered to be expressing a paraphilia rather than a gender identification) and drag kings and drag queens (who are performers and cross-dress for the purpose of entertaining). Intersex people have genitalia or other physical sexual characteristics that do not conform to strict definitions of male or female, but intersex people are not necessarily transgender, since they do not all disagree with their assigned sex at birth. Transgender and intersex issues often overlap, however, because they both challenge the notion of rigid definitions of sex and gender.

Genderqueer, including androgynous and bigender

Main articles: Genderqueer, Bigender and Androgyny

Genderqueer or non-binary identities, which are not exclusively masculine or feminine but instead are agender, androgynous, bigender, pangender or gender fluid,[42] exist outside of cisnormativity.[43][44] Bigender and androgynous are overlapping categories; bigender individuals may identify as moving between male and female roles (genderfluid) or as being both male and female simultaneously (androgynous), and androgynes may similarly identify as beyond gender or genderless (postgender, agender), between genders (intergender), or moving across genders (genderfluid) or simultaneously exhibiting multiple genders (pangender). Limited forms of androgyny are common (women wearing pants, men wearing earrings) and are not seen as transgender behaviour. Androgyne is also sometimes used as a medical synonym for an intersex person.[45] Genderqueer identities are independent of sexual orientation.

Transvestite or cross-dresser

Main article: Transvestism

A transvestite is a person who cross-dresses, or dresses in clothes of the opposite sex.[46][47] The term "transvestite" is used as a synonym for the term "cross-dresser",[48][49] although "cross-dresser" is generally considered the preferred term.[49][50] The term 'cross-dresser' is not exactly defined in the relevant literature. Michael A. Gilbert,[51] professor at the Department of Philosophy, York University, Toronto, offers this definition: "[A cross-dresser] is a person who has an apparent gender identification with one sex, and who has and certainly has been birth-designated as belonging to [that] sex, but who wears the clothing of the opposite sex because it is that of the opposite sex." This definition excludes people "who wear opposite sex clothing for other reasons," such as "those female impersonators who look upon dressing as solely connected to their livelihood, actors undertaking roles, individual males and females enjoying a masquerade, and so on. These individuals are cross dressing but are not cross dressers."[52] Cross-dressers may not identify with, or want to be the opposite gender, nor adopt the behaviors or practices of the opposite gender, and generally do not want to change their bodies medically. The majority of cross-dressers identify as heterosexual.[53] People who cross-dress in public can have a desire to pass as the opposite gender, so as not to be detected as a cross-dresser, or may be indifferent.

The term "transvestite" and the associated outdated term "transvestism" are conceptually different from the term "transvestic fetishism", as "transvestic fetishist" describes those who intermittently use clothing of the opposite gender for fetishistic purposes.[54][55] In medical terms, transvestic fetishism is differentiated from cross-dressing by use of the separate codes 302.3[55] in the DSM and F65.1[54] in the ICD.

Drag kings and queens

Drag is a term applied to clothing and make-up worn on special occasions for performing or entertaining, unlike those who are transgender or who cross-dress for other reasons. Drag performance includes overall presentation and behavior in addition to clothing and makeup. Drag can be theatrical, comedic, or grotesque. Drag queens have been considered caricatures of women by second-wave feminism. Drag artists have a long tradition in LGBT culture. Generally the terms drag queen covers men doing female drag, drag king covers women doing male drag, and faux queen covers women doing female drag. Nevertheless, there are drag artists of all genders and sexualities who perform for various reasons. Some drag performers, transvestites, and people in the gay community, have embraced the pornographically-derived term tranny to describe drag queens or people who engage in transvestism or cross-dressing, however this term is widely considered offensive if applied to transsexual people.[56]

LGBT community

See also: LGBT

The concepts of gender identity and transgender identity differ from that of sexual orientation.[57] Sexual orientation describes an individual's enduring physical, romantic, emotional, or spiritual attraction to another person, while gender identity is one's personal sense of being a man or a woman.[20] Transgender people have more or less the same variety of sexual orientations as cisgender people.[58] In the past, the terms homosexual and heterosexual were incorrectly used to label transgender individuals' sexual orientation based on their birth sex.[59] Professional literature now uses terms such as attracted to men (androphilic), attracted to women (gynephilic), attracted to both (bisexual) or attracted to neither (asexual) to describe a person's sexual orientation without reference to their gender identity.[60] Therapists are coming to understand the necessity of using terms with respect to their clients' gender identities and preferences.[61] For example, a person who is assigned male at birth, transitions to female, and is attracted to men would be identified as heterosexual.

Despite the distinction between sexual orientation and gender, throughout history the gay, lesbian, and bisexual subculture was often the only place where gender-variant people were socially accepted in the gender role they felt they belonged to; especially during the time when legal or medical transitioning was almost impossible. This acceptance has had a complex history. Like the wider world, the gay community in Western societies did not generally distinguish between sex and gender identity until the 1970s, and often perceived gender variant people more as homosexuals who behaved in a gender-variant way than as gender-variant people in their own right. Today, members of the transgender community often continue to struggle to remain part of the same movement as lesbian, gay and bisexual citizens, and to be included in rights protections. And in fact, the role of the transgender community in the history of LGBT rights is often overlooked, as shown in Transforming History.[62]

Pride symbols

Main article: LGBT symbols
Transgender Pride flag

A common symbol for the transgender community is the Transgender Pride flag, which was designed by Monica Helms, and was first shown at a pride parade in Phoenix, Arizona, United States in 2000.

The flag consists of five horizontal stripes, two light blue, two pink, with a white stripe in the center.

Helms describes the meaning of the flag as follows:

The light blue is the traditional color for baby boys, pink is for girls, and the white in the middle is for those who are transitioning, those who feel they have a neutral gender or no gender, and those who are intersexed. The pattern is such that no matter which way you fly it, it will always be correct. This symbolizes us trying to find correctness in our own lives.[this quote needs a citation]

Other transgender symbols include the butterfly (symbolizing transformation or metamorphosis), and a pink/light blue yin and yang symbol.

Several gender symbols have been used to represent transgender people, including and .

Feminism

Main article: Transfeminism

Some feminists and feminist groups are supportive of transgender people. Others are not.

Though second-wave feminism argued for the sex and gender distinction, some feminists believed there was a conflict between transgender identity and the feminist cause; e.g., they believed that male-to-female transition abandoned or devalued female identity, and that transgender people embraced traditional gender roles and stereotypes. Many transgender feminists, however, viewed themselves as contributing to feminism by questioning and subverting gender norms. Third wave and contemporary feminism more greatly accepts transgender people.[63]

Feminist writer Janice Raymond asserts that sex determines gender, and that no practical difference is between the two. In her view, genitalia or "birth sex" or chromosomes deeply and permanently determine one's essential identity as a woman or man; trying to violate this divide is impossible, unnatural, and unhealthy. She argues that although transsexuals may claim to feel like a certain gender, only a biological female can genuinely feel what occupying a woman's body is; e.g., such experiences as childbirth.[64]

Healthcare

Mental healthcare

Most mental health professionals recommend therapy for internal conflicts about gender identity or discomfort in an assigned gender role, especially if one desires to transition. People who experience discord between their gender and the expectations of others or whose gender identity conflicts with their body may benefit by talking through their feelings in depth; however, research on gender identity with regard to psychology, and scientific understanding of the phenomenon and its related issues, are relatively new.[65] The terms transsexualism, dual-role transvestism, gender identity disorder in adolescents or adults and gender identity disorder not otherwise specified are listed as such in the International Statistical Classification of Diseases (ICD) or the American Diagnostic and Statistical Manual of Mental Disorders (DSM) under codes F64.0, F64.1, 302.85 and 302.6 respectively.[66] The DSM-5 refers to the topic as gender dysphoria.

Transgender people may meet the criteria for a diagnosis of gender identity disorder (GID) "only if [being transgender] causes distress or disability."[67] This distress is referred to as gender dysphoria and may manifest as depression or inability to work and form healthy relationships with others. This diagnosis is often misinterpreted as implying that transgender people suffer from GID; this misinterpretation has greatly confused transgender people and those who seek to either criticize or affirm them. Transgender people who are comfortable with their gender and whose gender is not directly causing inner frustration or impairing their functioning do not suffer from GID. Moreover, GID is not necessarily permanent and is often resolved through therapy or transitioning. Feeling oppressed by the negative attitudes and behaviors of such others as legal entities does not indicate GID. GID does not imply an opinion of immorality; the psychological establishment holds that people with any kind of mental or emotional problem should not receive stigma. The solution for GID is whatever will alleviate suffering and restore functionality; this solution often, but not always, consists of undergoing a gender transition.[65]

Clinical training lacks relevant information needed in order to adequately help transgender clients, which only produces a series of practitioners who are not prepared to sufficiently work with this population of individuals.[68] Many mental healthcare providers know little about transgender issues. Those who seek help from these professionals often educate the professional without receiving help.[65] Many therapists who profess to know about transgender issues believe that transitioning from one sex to another – the standard transsexual model – is the best or only solution.[citation needed] This solution usually is good for transsexual people but is not the solution for other transgender people, particularly genderqueer people who lack an exclusively male or female identity. Instead, therapists can support their clients in whatever steps they choose to take to transition or support their decision to not transition while also addressing their clients' sense of congruence between gender identity and appearance.[9]

Acknowledgment of the lack of clinical training has increased; however, research on the specific problems faced by the transgender community in mental health has focused on diagnosis and clinicians' experiences instead of transgender clients' experiences.[69] Therapy was not always sought out by people due to mental health needs. Prior to the seventh version of the Standards of Care (SOC), an individual had to be diagnosed with gender identity disorder in order to proceed with hormone treatments or sexual reassignment surgery. The new version decreased the focus on diagnosis and instead emphasized the importance of flexibility in order to meet the diverse health care needs of transsexual, transgender, and all gender nonconforming people.[70]

The purposes for seeking mental health services vary according to the individual, and simply because a transgender person seeks treatment does not mean their gender identity is problematic. The emotional strain on dealing with stigma and experiencing transphobia pushes many transgender people to seek treatment to improve their quality of life, as one transwoman reflected: "Transgendered individuals are going to come to a therapist and most of their issues have nothing to do, specifically, with being transgendered. It has to do because they've had to hide, they've had to lie, and they've felt all of this guilt and shame, unfortunately usually for years!"[69] Struggling to deal with the stigma still attached to identifying as transgender, many people also seek mental health treatment for depression and anxiety, and some transgender people have stressed the importance of acknowledging their gender identity with a therapist in order to discuss other quality of life issues.[69]

Problems still remain surrounding misinformation about transgender issues that hurt transgender people's mental health experiences. One transman who was enrolled as a student in a psychology graduate program highlighted the main concerns with modern clinical training: "Most people probably are familiar with the term transgender, but maybe that’s it. I don’t think I've had any formal training just going through [clinical] programs . . . I don’t think most [therapists] know. Most therapists—Master’s degree, PhD level—they've had . . . one diversity class on GLBT issues. One class out of the huge diversity training. One class. And it was probably mostly about gay lifestyle."[69] Many health insurance policies do not cover treatment associated with gender transition, and numerous people are under or not insured, which raises concerns about the insufficient training most therapists receive prior to working with transgender clients, potentially increasing financial strain on clients without providing the treatment they need.[69] Many clinicians who work with transgender clients only receive mediocre training on gender identity, but recently introductory training on interacting with transgender people have been made available to health care professionals to help remove barriers and increase the level of service for the transgender population.[71]

The issues around psychological classifications and associated stigma (whether based in paraphilia or not) of cross dressers, transsexual men and women (and lesbian and gay children, who may resemble trans children early in life) have become more complex since CAMH (Centre for Addiction and Mental Health) colleagues Kenneth Zucker and Ray Blanchard were announced to be serving on the DSM-V's Sexual and Gender Identity Disorders Work Group.[72] CAMH aims to 'cure' transgender people of their 'disorder', especially in children. Within the trans community, this intention has mostly produced shock and outrage with attempts to organize other responses.[73] In February 2010, France became the first country in the world to remove transgender identity from the list of mental diseases.[74][75]

Physical healthcare

Medical and surgical procedures exist for transsexual and some transgender people. (Most categories of transgender people as described above are not known for seeking the following treatments.) Hormone replacement therapy for trans men induces beard growth and masculinises skin, hair, voice, and fat distribution. Hormone replacement therapy for trans women feminises fat distribution and breasts. Laser hair removal or electrolysis removes excess hair for trans women. Surgical procedures for trans women feminise the voice, skin, face, adam's apple, breasts, waist, buttocks and genitals. Surgical procedures for trans men masculinise the chest and genitals and remove the womb and ovaries and fallopian tubes. The acronyms "GRS" and "SRS" refer to genital surgery. The term "sex reassignment therapy" (SRT) is used as an umbrella term for physical procedures required for transition. Use of the term "sex change" has been criticized for its emphasis on surgery, and the term "transition" is preferred.[2][76] Availability of these procedures depends on degree of gender dysphoria, presence or absence of gender identity disorder,[77] and standards of care in the relevant jurisdiction.

Trans men who have not had a hysterectomy and who take testosterone are at increased risk for endometrial cancer because androstenedione, which is made from testosterone in the body, can be converted into estrogen, and external estrogen is a risk factor for endometrial cancer.[78]

Law

Dr. Camille Cabral, a French transgender activist at a demonstration for transgender people in Paris, October 1, 2005

Legal procedures exist in some jurisdictions, allowing individuals to change their legal gender or name to reflect their gender identity. Requirements for these procedures vary from an explicit formal diagnosis of transsexualism to a diagnosis of gender identity disorder to a letter from a physician that attests the individual's gender transition or having established a different gender role.[79] In 1994, the DSM IV entry was changed from "Transsexual" to "Gender Identity Disorder." In many places, transgender people are not legally protected from discrimination in the workplace or in public accommodations.[80] A report released in February 2011 found that 90% of transgender people faced discrimination at work and were unemployed at double the rate of the general population. Over half had been harassed or turned away when attempting to access public services.[81] Members of the transgender community also encounter high levels of discrimination in health care on an everyday basis.[82]

In Canada, a private members bill protecting the rights of freedom of gender expression and gender identity passed in the House of Commons on February 9, 2011. It amends the Canada Human Rights code to help protect gender-variant people from discrimination by including gender identity and expression in the list of prohibited grounds for discrimination, as well as including gender identity and expression in the description of identifiable group, so that offences deliberately against gender-variant people can be punished to a similar extent as a racial-based crime.[83] The bill may or may not be passed by the Senate.[84]

In the U.S., a federal bill to protect workers from discrimination based on sexual orientation and gender identity—called the Employment Non-Discrimination Act—has stalled and failed several times over the past two decades.[85] Still, individual states and cities have begun passing their own non-discrimination ordinances. In New York, for example, Governor David Paterson passed the first legislation to include transgender protections in September 2010.[86]

Nicole Maines took a case of whether she is allowed to use her high school's girls' bathroom, as a transgender girl, to Maine's Supreme Court in June, 2013. She claims being denied such access is a violation of Maine's Human Rights Act, though a state judge has already disagreed with her.[87]

Nicole Maines won her lawsuit against the Orono school district in January 2014 before the Maine Supreme Judicial Court.[88]

In April 2014, the Supreme Court of India declared transgender to be a 'third gender' in Indian law.[89][90][91] The transgender community in India (made up of Hijras and others) has a long history in Indian history and in Hindu mythology.[92][93] Justice KS Radhakrishnan noted in his decision that, "Seldom, our society realizes or cares to realize the trauma, agony and pain which the members of Transgender community undergo, nor appreciates the innate feelings of the members of the Transgender community, especially of those whose mind and body disown their biological sex", adding:

Non-recognition of the identity of Hijras/transgender persons denies them equal protection of law, thereby leaving them extremely vulnerable to harassment, violence and sexual assault in public spaces, at home and in jail, also by the police. Sexual assault, including molestation, rape, forced anal and oral sex, gang rape and stripping is being committed with impunity and there are reliable statistics and materials to support such activities. Further, non-recognition of identity of Hijras /transgender persons results in them facing extreme discrimination in all spheres of society, especially in the field of employment, education, healthcare etc.

Hijras/transgender persons face huge discrimination in access to public spaces like restaurants, cinemas, shops, malls etc. Further, access to public toilets is also a serious problem they face quite often. Since, there are no separate toilet facilities for Hijras/transgender persons, they have to use male toilets where they are prone to sexual assault and harassment. Discrimination on the ground of sexual orientation or gender identity, therefore, impairs equality before law and equal protection of law and violates Article 14 of the Constitution of India.[94]

Transgender people are also prohibited from serving in the US military, but United States Secretary of Defense Chuck Hagel is quoted as stating that the military should "continually" review its prohibition on transgender individuals and stating: "Every qualified American who wants to serve our country should have an opportunity if they fit the qualifications and can do it."[95]

Religion

James D. Whitehead and Evelyn Eaton Whitehead, educators and authors, discuss[96] the links between spirituality and sexuality, and the frequent absence of compassion within the church community, in their case, the Catholic Church, in ministering to this community.[97]

Transsexual people and science

Brain-based studies

Several studies have concentrated on whether sexually dimorphic brain structures in transsexuals are more similar to their preferred sex or to their birth sex. Researchers caution that there are known brain differences between homosexual and heterosexual persons and that the brain changes in response to hormone-treatment, which many transsexuals use. In order to know what in the brain is related to what feature of the person, studies of more uniform groups give clearer results than do studies of more mixed groups.

It has been assumed that there are more trans women than trans men, but a Swedish study estimated a ratio of 1.4:1 in favour of trans women for those requesting sex reassignment surgery and a ratio of 1:1 for those who proceeded.[98]

Androphilic male-to-female transsexuals

Studies have consistently shown that specifically androphilic male-to-female transsexuals (sometimes called homosexual MtF transsexuals in studies) show a shift towards the female direction in brain anatomy. In 2009, the German team of radiologists led by Gizewski compared 12 androphilic transsexuals with 12 biological males and 12 biological females. Using functional magnetic resonance imaging (fMRI), they found that when shown erotica, the biological men responded in several brain regions that the biological women did not, and that the sample of androphilic transsexuals was shifted towards the female direction in brain responses.[99]

Rametti and colleagues used diffusion tensor imaging (DTI) to compare 18 androphilic male-to-female transsexuals with 19 gynephilic males and 19 typical (heterosexual) females. The androphilic transsexuals differed from both control groups in multiple brain areas, including the superior longitudinal fasciculus, the right anterior cingulum, the right forceps minor, and the right corticospinal tract. The study authors concluded that androphilic transsexuals are halfway between the patterns exhibited by male and female controls.[100]

Gynephilic male-to-female transsexuals

Conversely, gynephilic male-to-female transsexuals also show differences in the brain from non-transsexual males, but in a unique pattern different from being shifted in a female direction. Researchers of the Karolinska Institute of Stockholm used MRI to compare 24 gynephilic male-to-female transsexuals with 24 non-transsexual male and 24 non-transsexual female controls. None of the study participants were on hormone treatment. The researchers found sex-typical differentiation between the MtF transsexuals and non-transsexual males, and the non-transsexual females; but the gynephilic transsexuals "displayed also singular features and differed from both control groups by having reduced thalamus and putamen volumes and elevated GM volumes in the right insular and inferior frontal cortex and an area covering the right angular gyrus."

These researchers concluded that:

Contrary to the primary hypothesis, no sex-atypical features with signs of 'feminization' were detected in the transsexual group....The present study does not support the dogma that [male-to-female transsexuals] have atypical sex dimorphism in the brain but confirms the previously reported sex differences. The observed differences between MtF-TR and controls raise the question as to whether gender dysphoria may be associated with changes in multiple structures and involve a network (rather than a single nodal area).[101]

In Sweden, non-androphilic transsexual women were tested when they were smelling odorous steroids. The results showed that the transsexual women demonstrated "a pattern of activation away from the biological sex, occupying an intermediate position with predominantly female-like features."[102]

Anne Lawrence, a sexologist, physician, and self-identified autogynephilic transsexual, has hypothesized that the desire by persons with autogynephilia, including some cross dressers and some transsexuals, to alter their body can be compared with apotemnophilia (alternately body integrity identity disorder if framed as an identity issue rather than a fetish).[103] Some transsexuals argue that explanations that base on libido the desire to transition are unscientific[104] or transphobic.[105]

Mixed samples of male-to-female transsexuals

Several teams of researchers have examined the brains or brain functioning of MtF transsexuals without separating the samples into androphilic (or homosexual) and gynephilic (or heterosexual) types. Such studies have yielded contradictory results: some report differences between the (mixed groups of) MtF transsexuals and the non-transsexual controls, but other studies found no differences.

The corpus callosum was studied in MtF transsexuals because it is larger and differently shaped in men than in women. In 1991, a University of Texas team reported comparing the corpora callosa of 10 MtF transsexuals, 10 FtM transsexuals, 20 control males, and 20 control females. No significant differences were found.[106]

In a pair of reports, the Dutch team that Dick Swaab led examined the volume[107] and neuron count[108] in the bed nucleus of the stria terminalis in six estrogen-treated transsexuals and one pre-treatment transsexual. They found the BSTc to be female-shifted (smaller) among the transsexuals than among the male control subjects. A subsequent study by Swaab found that the BSTc becomes sexually dimorphic only in adulthood, suggesting that differentiation of the BSTc does not cause transsexualism.[109] Rather, the difference in the BSTc might instead be the result of a "failure to develop a male-like gender identity" (p. 1032). The BSTc has also been reported to be smaller in other sexually atypical populations unrelated to transsexualism.[110]

Another team of Dutch researchers examined the effects of cross-gender hormone treatment on the brain in 8 male-to-female transsexuals and in 6 female-to-male transsexuals, finding that the hormones changed the sizes of the hypothalamus in a gender consistent manner. Treatment with male hormones shifted the hypothalamus towards the male direction in the same way as in male controls, and treatment with female hormones shifted the hypothalamus towards the female direction in the same way as female controls.[111]

A 2003 study by Haraldsen and colleagues compared the performance of 52 persons with Gender Identity Disorder (33 from Norway and 19 from the U.S.) with that of 29 control subjects on a series of tests that tap into the functioning of different parts of the brain and on which men and women perform differently. The people in the GID sample "were either homosexually attracted by males or females (n=38), by both (n=3) or by neither (n=9)." No effects of transsexual status were detected.[112]

Johns Hopkins researchers in 2005 reported on another test of brain functioning using test performance. The study subjects included 27 MtF transsexuals and 16 control men, and the authors reported that no female-typical patterns in cerebral lateralization or cognitive performance were found within the transsexual sample.[113]

In 2009, UCLA researchers used MRIs to examine a mixed sample of 24 non-hormone-treated male-to-female transsexuals (6 were androphilic, and 18 were gynephilic), comparing them with 30 non-transsexual males and 30 non-transsexual females. The results "revealed that regional gray matter variation in MTF transsexuals is more similar to the pattern found in men than in women," except for the "right putamen.". They concluded that "These findings provide new evidence that transsexualism is associated with distinct cerebral pattern, which supports the assumption that brain anatomy plays a role in gender identity."[114]

Gynephilic female-to-male transsexuals

Brain-based research has repeatedly shown that female-to-male transsexuals have several male-like characteristics in neuroanatomy. In 2010, a team of neuroscientists compared 18 female-to-male transsexuals with 24 male and 19 female gynephilic controls, using an MRI technique called diffusion tensor imaging or DTI.[115] DTI is a specialized technique for visualizing white matter of the brain, and white matter structure is one of the differences in neuroanatomy between men and women. The study found that the white matter pattern in female-to-male transsexuals was shifted in the direction of biological males, even before the female-to-male transsexuals started taking male hormones (which can also modify brain structure).

Another team of neuroscientists, led by Nawata in Japan, used a technique called single-photon emission computed tomography (SPECT) compare the regional cerebral blood flow (rCBF) of 11 female-to-male transsexuals (attracted to women) with that of 9 biological females (attracted to men). Although the study did not include a sample of biological males so that a conclusion of "male shift" could be made, the study did reveal that the female-to-male transsexuals showed significant decrease in blood flow in the left anterior cingulate cortex and a significant increase in the right insula, two brain regions known to respond during sexual arousal.[116]

Related developments in other fields

Brain structure differences associated with transsexualism do not exist in isolation. Similar brain structure differences have been noted between gay and heterosexual men, and between lesbian and heterosexual women.[117][118]

More recent studies have found that circumstance, such as parenting, and repeated activities such as meditation modify brain structures in a process called brain plasticity or neuroplasticity. In May 2014, the Proceedings of the National Academy of Sciences reported that for fathers parenting "rewires the male brain".[119]

Gene-related studies

In 2008, a study was performed to attempt to find a link between genes and transsexuality. The researchers compared 112 male-to-female transsexuals (both androphilic and gynephilic), mostly already undergoing hormone treatment, with 258 cisgender male controls. The male-to-female transsexuals were more likely than non-transsexual males to have a longer version of a receptor gene for the sex hormone androgen or testosterone. The research suggests reduced androgen and androgen signaling contributes to the female gender identity of male to female transsexuals. The authors say that a decrease in testosterone levels in the brain during development might prevent complete masculinization of the brain in male to female transsexuals and thereby cause a more feminized brain and a female gender identity.[120][121]

A twin study was subsequently published which examined pairs of twins where either one or both of the twins had undergone, or had plans and had received medical approval to undergo, gender transition (both types of people were classified as trans in the study). The study combined a survey of such twins, with a literature review of published reports mentioning transgender twins. The study found that one third of identical twin pairs in the sample were both transgender, whereas among the non-identical twin pairs, there were almost no pairs where both were transgender.[122]

Terms and typology

The use of homosexual transsexual and related terms have been applied to transgender people since the middle of the 20th century, though concerns about the terms have been voiced since then. Harry Benjamin said in 1966:

...it seems evident that the question "Is the transsexual homosexual?" must be answered "yes" and " no." "Yes," if his anatomy is considered; "no" if his psyche is given preference.

What would be the situation after corrective surgery has been performed and the sex anatomy now resembles that of a woman? Is the "new woman" still a homosexual man? "Yes," if pedantry and technicalities prevail. "No" if reason and common sense are applied and if the respective patient is treated as an individual and not as a rubber stamp.[123]

Many sources, including some supporters of the typology, criticize this choice of wording as confusing and degrading. Biologist Bruce Bagemihl writes "..the point of reference for "heterosexual" or "homosexual" orientation in this nomenclature is solely the individual's genetic sex prior to reassignment (see for example, Blanchard et al. 1987[24], Coleman and Bockting, 1988[25], Blanchard, 1989[26]). These labels thereby ignore the individual’s personal sense of gender identity taking precedence over biological sex, rather than the other way around."[124] Bagemihl goes on to take issue with the way this terminology makes it easy to claim transsexuals are really homosexual males seeking to escape from stigma.[124] Leavitt and Berger stated in 1990 that "The homosexual transsexual label is both confusing and controversial among males seeking sex reassignment.[125][126] Critics argue that the term "homosexual transsexual" is "heterosexist",[124] "archaic",[127] and demeaning because it labels people by sex assigned at birth instead of their gender identity.[128] Benjamin, Leavitt, and Berger have all used the term in their own work.[123][125] Sexologist John Bancroft also recently expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women.[129] He says that he now tries to choose his words more sensitively.[129][129] Sexologist Charles Allen Moser is likewise critical of the terminology.[130]

Use of androphilia and gynephilia was proposed and popularized by psychologist Ron Langevin in the 1980s.[131] Psychologist Stephen T. Wegener writes, "Langevin makes several concrete suggestions regarding the language used to describe sexual anomalies. For example, he proposes the terms gynephilic and androphilic to indicate the type of partner preferred regardless of an individual's gender identity or dress. Those who are writing and researching in this area would do well to adopt his clear and concise vocabulary."[132]

Psychiatrist Anil Aggrawal explains why the terms are useful in a glossary:

Androphilia – The romantic and/or sexual attraction to adult males. The term, along with gynephilia, is needed to overcome immense difficulties in characterizing the sexual orientation of transmen and transwomen. For instance, it is difficult to decide whether a transman erotically attracted to males is a heterosexual female or a homosexual male; or a transwoman erotically attracted to females is a heterosexual male or a lesbian female. Any attempt to classify them may not only cause confusion but arouse offense among the affected subjects. In such cases, while defining sexual attraction, it is best to focus on the object of their attraction rather than on the sex or gender of the subject.[133]

Psychologist Rachel Ann Heath writes, "The terms homosexual and heterosexual are awkward, especially when the former is used with, or instead of, gay and lesbian. Alternatively, I use gynephilic and androphilic to refer to sexual preference for women and men, respectively. Gynephilic and androphilic derive from the Greek meaning love of a woman and love of a man respectively. So a gynephilic man is a man who likes women, that is, a heterosexual man, whereas an androphilic man is a man who likes men, that is, a gay man. For completeness, a lesbian is a gynephilic woman, a woman who likes other women. Gynephilic transsexed woman refers to a woman of transsexual background whose sexual preference is for women. Unless homosexual and heterosexual are more readily understood terms in a given context, this more precise terminology will be used throughout the book. Since homosexual, gay, and lesbian are often associated with bigotry and exclusion in many societies, the emphasis on sexual affiliation is both appropriate and socially just."[134] Author Helen Boyd agrees, writing, "It would be much more accurate to define sexual orientation as either "androphilic" (loving men) and "gynephilic" (loving women) instead."[135] Sociomedical scientist Rebecca Jordan-Young challenges researchers like Simon LeVay, J. Michael Bailey, and Martin Lalumiere, who she says "have completely failed to appreciate the implications of alternative ways of framing sexual orientation."[136]

Blanchard's typology

Blanchard's transsexualism typology characterizes trans women as having one of two motivations for transition.[137][138][139] Whereas previous descriptions of transgender people included very many combinations of sexual orientation, gender identity, and the desire to cross-dress, Blanchard interprets his evidence as suggesting that there were only two basic phenomena. One phenomenon was androphilia (male homosexuality), which ranged from typical gay men to, when extreme, androphilic or homosexual transsexualism. The other phenomenon was autogynephilia, which ranged from typical cross-dressers to, when extreme, autogynephilic transsexualism (or non-homosexual transsexualism). Androphilic male-to-female transsexuals are characterized by sexual attraction to males and by overt and obvious femininity since childhood, whereas autogynephilic transsexuals are characterized by sexual attraction to females (or sometimes to females and males, or by asexuality) and whose presentations are internal and typically unremarkable until they choose to disclose them, typically later in life. There are community activists who dislike the theory.[140]

Scientific criticism of the theory includes papers from Veale, Nuttbrock, Moser, and others who argue that the theory is poorly representative of MTF transsexuals, non-instructive, the experiments poorly controlled, or contradicted by other data.[141][142][143][144] Many sources, including some supporters of the theory, criticize Blanchard's choice of wording as confusing or degrading.

Also the DSM V workgroup has been quoted as saying:

In contemporary clinical practice, sexual orientation per se plays only a minor role in treatment protocols or decisions. Also, changes as to the preferred gender of sex partner occur during or after treatment (DeCuypere, Janes, & Rubens, 2005; Lawrence, 2005; Schroder & Carroll, 1999). It can be difficult to assess sexual orientation in individuals with a GI diagnosis, as they preoperatively might give incorrect information in order to be approved for hormonal and surgical treatment (Lawrence, 1999). Because sexual orientation subtyping is of interest to researchers in the field, it is recommended that reference to it be addressed in the text, but not as a specifier. It should also be assessed as a dimensional construct.[145]

Blanchard is a member of the DSM V Sexual and Gender Identity Disorders Work Group chaired by Kenneth J. Zucker. Though it has supporters, the transsexual community has for the most part vehemently rejected Blanchard's typology theory.

By region

Latin America

In Latin American cultures, the travestis generally undergo hormonal treatment, use female gender expression including new names and pronouns from the masculine ones they were given when assigned a sex, and might use breast implants, but they are not offered or do not desire sex-reassignment surgery, and might be regarded as a gender in itself (a "third gender"), a mix between man and woman ("intergender/androgynes") or the presence of both masculine and feminine identities in a single person ("bigender").

They are framed as something entirely separate from transgender women, who possess the same gender identity of people assigned female at birth.

More recently, other transgender identities are becoming more widely known, as a result of contact with other cultures of the Western world.[146] These newer identities, sometimes known under the umbrella use of the term "genderqueer",[146] along with the older travesti term, are known as non-binary, and go along with binary transgender identities (those traditionally diagnosed under the now obsolete label of "transsexualism") under the single umbrella of transgender, but are distinguished from crossdressers and drag queens and kings, that are held as nonconforming gender expressions rather than transgender gender identities when a distinction is made.

Nevertheless, deviating from the societal standards for sexual behavior, sexual orientation/identity, gender identity and gender expression have a single umbrella term that is known as sexodiverso or sexodiversa in both Spanish and Portuguese, with its most approximate translation to English being "queer".

Non-western cultures

Nong Tum, a Kathoey internationally recognized for her portrayal in the film Beautiful Boxer

Asia

In Thailand and Laos,[147] the term kathoey is used to refer to male-to-female transgender people[148] and effeminate gay men.[149] The cultures of the Indian subcontinent include a third gender, referred to as hijra[150] in Hindi. Transgender people have also been documented in Iran,[151] Japan,[152] Nepal,[153] Indonesia,[154] Vietnam,[155] South Korea,[156] Singapore,[157] and the greater Chinese region, including Hong Kong,[158][159] Taiwan,[160] and the People's Republic of China.[161][162][163]

In India, the Supreme Court on April 15, 2014, recognized a third gender that is neither male nor female, stating "Recognition of transgenders as a third gender is not a social or medical issue but a human rights issue."[164]

On January 5, 2015, Reuters stated that the first transgender mayor was elected in central India.[165]

North America

In what is now the United States and Canada, many Native American and First Nations peoples recognised[166] the existence of more than two genders, such as the Zuñi male-bodied Ła'mana,[167] the Lakota male-bodied winkte[168] and the Mohave male-bodied alyhaa and female-bodied hwamee.[169] Such people were previously[170] referred to as berdache but are now referred to as Two-Spirit,[171] and their spouses would not necessarily have been regarded as gender-different.[169] In Mexico, the Zapotec culture includes a third gender in the form of the Muxe.[172]

Other

In early Medina, gender-variant[173] male-to-female Islamic people were acknowledged[174] in the form of the Mukhannathun. In Ancient Rome, the Gallae were castrated[175] followers of the Phrygian goddess Cybele and can be regarded as transgender in today's terms.[176][177]

Among the ancient Middle Eastern Akkadian people, a salzikrum was a person who appeared biologically female but had distinct male traits. Salzikrum is a compound word meaning male daughter. According to the Code of Hammurabi, salzikrūm had inheritance rights like that of priestesses; they inherited from their fathers, unlike regular daughters. A salzikrum's father could also stipulate that she inherit a certain amount.[178]

Mahu is a traditional status in Polynesian cultures. Also, in Fa'asamoa traditions, the Samoan culture allows a specific role for male to female transgender individuals as Fa'afafine.

Coming out

Main article: Coming out

Transgender people vary greatly in choosing when, whether, and how to disclose their transgender status to family, close friends, and others. The prevalence of discrimination[179] and violence[180] against the transgender community can make coming out a risky decision. Fear of retaliatory behavior, such as being removed from the parental home while underage, is a cause for transgender people to not come out to their families until they have reached adulthood.[181] Parental confusion and lack of acceptance of a transgender child may be met with an effort to change their children back to "normal" by utilizing mental health services to alter the child's sexual orientation and what is seen as a "phase".[182]

Events

Transgender Day of Remembrance

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

  • it memorializes all of those who have been victims of hate crimes and prejudice
  • it raises awareness about hate crimes towards the transgender community
  • and it honors the dea and their relatives[183]

Trans March

The Trans March is one of three protests held in San Francisco, California during "Pride Weekend", the last weekend of June. Every year, people from the transexual community gather in San Francisco, California, to protest for social justice and equality. The event features comedians, music, and dancing at the park, and is often followed by after parties.[184]

See also

Notes

  1. ^
    • In April 1970, TV Guide published an article which referenced a post-operative transsexual movie character as being "transgendered."("Sunday Highlights". TV Guide. April 26, 1970. Retrieved 28 May 2012. [R]aquel Welch (left), moviedom’s sex queen soon to be seen as the heroine/hero of Gore Vidal's transgendered "Myra Breckinridge"… )
    • In the 1974 edition of Clinical Sexuality: A Manual for the Physician and the Professions, transgender was used as an umbrella term and the Conference Report from the 1974 "National TV.TS Conference" held in Leeds, West Yorkshire, UK used "trans-gender" and "trans.people" as umbrella terms.(Oliven, John F. (1974). Clinical sexuality: A Manual for the Physician and the Professions (3rd ed.). University of Michigan (digitized Aug 2008): Lippincott. pp. 110, 484–487. ISBN 9780397503292. "Transgender deviance" p 110, "Transgender research" p 484, "transgender deviates" p 485, Transvestites not welcome at "Transgender Center" p 487 ), (2006). The Transgender Phenomenon (Elkins, Richard; King, Dave (2006). The Transgender Phenomenon. Sage. p. 13. ISBN 9780761971634. )
    • However A Practical Handbook of Psychiatry (1974) references "transgender surgery" noting, "The transvestite rarely seeks transgender surgery, since the core of his perversion is an attempt to realize the fantasy of a phallic woman."(Novello, Joseph R. (1974). A Practical Handbook of Psychiatry. University of Michigan, digitized August 2008: C. C. Thomas. p. 176. ISBN 9780398028688. )
  2. ^ Magnus Hirschfeld coined the German term "Transsexualismus" in 1923, which Cauldwell translated into English.
  3. ^ The recurring concern that transsexual implies sexuality stems from the tendency of many informal speakers to ignore the sex and gender distinction and use gender for any male/female difference and sex for sexual activity. (Liberman, Mark. "Single-X Education". Language Log. Retrieved 28 June 2012. )

References

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  3. ^ "USI LGBT Campaign - Transgender Campaign" (retrieved 11 January 2012) defines transgender people as "People who were assigned a sex, usually at birth and based on their genitals, but who feel that this is a false or incomplete description of themselves."
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  20. ^ a b Gay and Lesbian Alliance Against Defamation. "GLAAD's Transgender Resource Page", "GLAAD", USA. Retrieved on 2011-02-24. "Problematic: "transgendered". Preferred: transgender. The adjective transgender should never have an extraneous "-ed" tacked onto the end. An "-ed" suffix adds unnecessary length to the word and can cause tense confusion and grammatical errors. It also brings transgender into alignment with lesbian, gay, and bisexual. You would not say that Elton John is "gayed" or Ellen DeGeneres is "lesbianed," therefore you would not say Chaz Bono is "transgendered."
  21. ^ Dan Savage, Savage Love: Gayed, Blacked, Transgendered (Creative Loafing, 11 January 2014)
  22. ^ Guardian and Observer style guide: use transgender [...] only as an adjective: transgender person, trans person; never "transgendered person" or "a transgender"
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  26. ^ For example, Virginia Prince used transgender to distinguish cross-dressers from transsexual people ("glbtq >> social sciences >> Prince, Virginia Charles". glbtq.com. ), writing in Men Who Choose to Be Women (in Sexology, February 1969) that "I, at least, know the difference between sex and gender and have simply elected to change the latter and not the former."
  27. ^ "Sex -- Medical Definition". medilexicon.com. : defines sex as a biological or physiological quality, while gender is a (psychological) "category to which an individual is assigned by self or others...".
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Further reading

External links