Asked what they know about transsexuals, most people are likely to recall an appearance of a garish drag queen, a transgendered sex-worker or some television show or film depicting a comedic role. Rarely do they consider the possibility that male and female transsexuals could be upstanding members of the community where many hold professional positions. Perhaps because of this perceived rarity of occurrence, there has been a great deal of variation in the reception and acceptance of such persons and their continued participation in the greater society. back to top
To fully understand the spectrum of transgender types we need to understand the language of gender. It is as important to understand the differences between gender and, say, sexuality as it is to understand the differences in transgender types. To do this we should first define the differences between sex, gender and sexuality.
SEX is anatomical and concerns genetic determinants such as chromosomes that trigger the development of external genitalia, usually (but not exclusively) either male or female. In point of fact, there are a great number of individuals who physically or genetically do not fit neatly into the sexual “dichotomy” of either male or female. More on that later.
GENDER IDENTITY is socially constructed and is what a person feels they are, either masculine or feminine. Again, some do not fit into these two categories and manifest varying degrees of androgyny.
GENDER PRESENTATION is constructed by outward appearances. These include grooming and clothing choices, mannerisms, social interaction activities, types of play and speech patterns. These tend to produce an image that is usually either that of a man or a woman but in a number of cases, either by choice or chance, the person may appear androgynous.
SEXUALITY concerns who a person objectifies as romantically or sexually desirable. Sexuality, also referred to as sexual orientation, is tied to the anatomical sex of the individual and is predominantly either heterosexual or homosexual but also includes bisexuals and asexuals.
As depicted in the following chart, all four of these categories are independent. As an example, an anatomical male may have a gender identity as masculine, an outward appearance of a woman and who is heterosexual. Alternatively, an anatomical female could have a gender identity of masculine, a gender presentation of female and be homosexual. There are examples of all the combinations in our population. It can be confusing, but the matter is generally not as complex as one may initially think. In our society today, an individuals’ gender and sexuality can and should be a non-issue.
The following definitions cover the spectrum of transgender types. Some may be more familiar than others, but all need to be carefully defined to ensure complete understanding of each and the significant differences between them.
TRANSSEXUALITY is a common term for gender identity disorder (GID). This is a persistent, lifelong feeling within an individual that their anatomical sex and their gender self-image are incongruent (APA, 1999; Benjamin, 1966; Green & Money, 1968). This has been popularly described as, 'a woman trapped in a man's body,' and vice versa. This is no recent phenomena as transgendered individuals have been a part of human experience since ancient times (Schleiser, 1987; Williams, 1986). It is, however, only recently that modern medicine has been able to provide the means for transsexuals to attain congruence between body and mind. This is accomplished through the process of sexual reassignment surgery (SRS) sometimes referred to as genital (not gender) reassignment surgery (GRS). Therapists and psychoanalysts have studied such persons for decades and the overwhelming consensus is that in the case of the true transsexual there are no lesser therapies that have proven effective in treating this condition. Transsexuality is not a mental illness but is defined by the American Psychological Association as a psychological condition (APA, 1999). These people do not pose any threat to themselves or others. By the time they come to the attention of friends and family, they have often undergone years of testing and therapy to confirm the diagnosis. Their gender identity is firmly established as opposite their anatomical sex. Although studies vary in proportion, a generally accepted ratio is one transsexual in 12,000 people in the general population in the United States (Ettner, 1999; W.H.O., 1993).
INTERSEXUALS have previously referred to as hermaphrodites, and naturally occur in as many as one in 100 live births. These individuals generally born with ambiguous genitalia and may have both male and female organs, or virtually none (Anhalt, Neely & Hintz, 1996). Previously, physicians were taught to regard intersexuality as a medical emergency requiring immediate corrective surgery (Adkins, 1999). Such surgery was highly dependent on the genitalia present in the individual case. More often than not, the child was assigned as a female because the surgery, being subtractive rather than additive, was relatively easier to accomplish. This medical protocol has been criticized by intersexuals who maintain that surgical intervention needs to be delayed until the child develops physically and/or makes a personal decision in the matter. These individuals make a compelling case for nature rather than nurture being paramount in the development of self-image as a gendered individual (Anhalt, Neely & Hintz, 1996; Bock, 1993). As aforesaid, there are many intersexuals presently living in the U.S. as statistics show as many as 1 in 100 live births result in an intersexual child. A subset of this category includes those affected by a congenital resistance to masculinizing or feminizing hormones and those that have a chromosomal deviation from the usual 46XX for females and 46XY for males. Among those affected are people with androgen insensitivity syndrome (1 in 20,000 live births), Kleinfelter’s syndrome (1 in 500), and Turner’s syndrome (1 in 3,000).
CROSS-DRESSERS previously referred to as transvestites, are usually men who obtain either sexual pleasure or a sense of personal well being by wearing female clothing (Hirschfeld, 1991). These individuals almost routinely possess a masculine gender identity, but can, and often do manifest a feminine appearance. The vast majority of cross-dressers are heterosexual and they go to great lengths to keep this aspect of their lives secret (Brown, 1996). Unless it becomes obsessive or compulsive behavior, this generally does not require professional intervention (Docter, 1988; King, 1996). Family and friends’ knowledge of this behavior is often the result of an inadvertent or accidental discovery of the individual while dressed “en-femme,” the discovery of the individuals “stash” of feminine clothing, or by being inadvertently or purposely “outed” by another individual. The exact number of cross dressers in the U.S. is unknown but theorized as being roughly 1 in 12 (Ettner, 1999).
DRAG QUEENS and DRAG KINGS are generally actors engaging in paid performance art. They are often homosexual and dress as women (or men) only when engaged in their performance. Some may also “do drag” to make a political statement, as a costume or comedic gesture, to shock others or parody women (Perkins, 1996). These individuals pose no concern for society aside from the often negative picture they paint of gender variant individuals. back to top
The following table provides a “census” of transgendered people using the aforementioned ratios. What emerges is an appreciably large estimated population of gender variant people in the US and world.
Prevalence of Transgender Types
|
|
|
US Population |
World Population |
|
|
|
275,000,000 |
6,000,000,000 |
|
|
Prevalence, |
|
|
|
Condition |
one in: |
|
|
|
Crossdressing |
12 |
22,916,667 |
500,000,000 |
|
Intersexuals |
100 |
2,750,000 |
60,000,000 |
|
Klinefelter 47XXY |
500 |
550,000 |
12,000,000 |
|
Turner 45X |
3,000 |
91,667 |
2,000,000 |
|
Transsexuality |
12,000 |
22,917 |
500,000 |
|
Androgen Insensitive 46XY |
20,000 |
13,750 |
300,000 |
|
|
|
|
|
|
TOTAL GENDER VARIANT |
|
26,345,000 |
574,800,000 |
|
|
|
US Population |
World Population |
|
By 1988 10,000 surgeries |
|
|
|
As aforesaid, transsexuality is a relatively rare condition, but one that is increasingly encountered in our modern society. back to top
Transsexuals are usually treated by therapists who adhere to a treatment protocol that combines a conservative approach with care and concern for the dignity and needs of the individual. These standards stipulate a broad range of diagnostic and therapeutic procedures and a minimal timetable for completion (HBIGDA, 2000). In most cases, by the time a transsexual comes to the attention of the community, they have been thoroughly evaluated and are seeking support for their transition.
Using the case of the male to female transsexual the following description is relatively common. The individual has known virtually lifelong that they are gender incongruent. (S)he has wrestled with the issues and sought professional assistance. (S)he has completed a series of diagnostic procedures, often including standardized psychological tests to rule-out any other psychological disorder or pathology (Miach, Berah, Butcher & Rouse, 2000). In point of fact, most transsexuals will have more complete psychological testing and evaluation than most employees (Caroll, 2000; Ettner, 1996). In many cases their work with therapists has been ongoing for a year or more. (S)he has been on hormone replacement therapy for a number of months, perhaps even years, and to the astute observer, may have begun to exhibit female secondary sex characteristics, most notably breast development. After serious consultation with the gender therapist, the individual is required to complete a real life test (RLT). This “test” requires the transsexual to live and work as a woman 24/7 for a period of time usually no less than one year. This procedure is to test the individual’s personal resolve and preconceptions regarding life in the targeted gender role. It is designed to thrust the individual into the role and let them, with the assistance of their therapist, experience life as the woman they project (HBIGDA, 2000). In this test the individual characteristics of personality and physical presentation make the RLT a uniquely individual experience. For those who can manifest a decidedly feminine personage this process can be relatively smoother than those with masculine features difficult to mask.
After the RLT has been completed the individual is provided with a letter from the therapist that allows them to seek genital reassignment surgery (GRS). There are a small number of surgeons who provide such specialized surgery and this often requires the individual to travel to the surgeon and medical facility. Recovery is variable, but most do not recommend a return to work for anything less than a month after the surgery. Physical fitness appears to make recovery somewhat easier for the individual. At this point the individual is legally considered a female in most states (Kirk & Rothblatt, 1996). Immediately prior to or during the RLT the individual will have petitioned the courts for a change of name and sex. While the name change is relatively routine, many states will require actual GRS before issuing an order for changing the sex designation on official documents (Oregon is a notable exception by allowing a change in sex designation while undergoing hormone replacement therapy (HRT)). back to top
By Rachel A. Stewart