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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, and desires to establish a permanent social role as a member of the gender with which they identify. Transsexual men and women make or desire to make a transition from their birth sex to the opposite sex/gender, often with some type of medical alteration (sex reassignment therapy) to their body. The stereotypical explanation is of a "woman trapped in a man's body" or vice versa, although many members of the transsexual community, as well as some outside the community, reject this model. For information on the formal diagnosis, see gender identity disorder.

HARRY BENJAMIN SYNDROME - (previously considered as transsexualism)

Harry Benjamin’s Syndrome is an intersex biological condition developed in the early stages of pregnancy affecting the process of sexual differentiation between male and female. This happens when the brain develops as a certain sex but the rest of the body takes on the physical characteristics of the opposite sex. The difference between this and most other intersex conditions is that there is no apparent evidence until much later after the baby is born or even as late as adolescence. Some with HBS actually have other intersex indicators not apparent until later testing and some not found until testing done even after surgery during later years. This Syndrome was known in the past under many different names; the most common being transsexualism and by some even as a sub-set of transgenderism, (a term coined by a tranvestite and the publisher of a transvestic magazine). Neither of these is appropriate since one deals with just trans sex and the other lists under its umbrella many sexual variances and elements; none deal with the actual condition of Harry Benjamin Syndrome which is an intersexed anomaly. As you might imagine, this dichotomy of having a brain of one sex and a body of the other causes great stress in the affected individual. Since medical science is powerless to realign the brain to match the body, the only way to relieve this stress, (described as a dyphoria), and allow the individual to live a more normal life, is to homonally prepare the body for surgery to alter the body to match the brain. Today this Syndrome is still wrongly classified as Transsexualism by the ICD-10 or Gender Identity Disorder by the DSM-IV-TR. More info at following link: http://sindromebenjamin.tk/

Definitions

The definition of "transsexual" is debated. Many within the trans community feel that a person is transsexual if they personally identify as such. However, some, especially health care providers and some transsexual people, believe there is a certain set of procedures that must always be completed for a person to be called "transsexual". The general public often defines "a transsexual" as someone who has had or plans to have "sex change" surgery, although this term is generally considered inaccurate for reasons discussed in its article. The term currently in widest use for modification of primary sex characteristics is sex reassignment surgery (SRS), a term which reflects the belief that transsexual people do not consider themselves to be changing their sex, but to be correcting their bodies. However, it is accepted in the Diagnostic and Statistical Manual of Mental Disorders that expression of desire to be of the opposite sex, or assertion that one is of the sex opposite to the one with which they were identified at birth, constitutes being transsexual. (This does not include delusions about one's current physical sex.) The ICD-10 also states that transsexualism is defined by "the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment." In contrast, some transgender people often do not identify as being of or desiring to be the opposite sex, but as being of or wanting to be another gender.

Transsexualism (also known as transsexuality) is one of a number of behaviours or states collectively referred to as transgender, which is generally considered an umbrella term for people who do not conform to typical gender roles. However, some in the transsexual community do not identify as transgender, or see transsexualism not as a sub-division of transgender. Often, those people complain that non-transsexual transgender people are somehow "degrading" transsexual people by first describing them as "just tranvestites" (this refers to the assumption, that gender variant people can neatly be divided into "transsexuals" and "transvestites") or "perverts" or similar, and then claiming that this is not what transsexual people are. This is usually accompanied by demanding that medical treatment and legal change of name and legal gender should be reserved only for transsexual people. Some also see the term 'transgender' as subsuming and erasing their identity, rejecting it for themselves because to them it implies a breaking down of gender roles, when in fact they see themselves as fitting a gender role -- just not the one they were assigned at birth. Those contesting this view point out that the idea of a more inclusive "Gender identity disorder" has long replaced the idea of dividing gender variant people into "transsexuals" and "transvestites", that classifying transsexualism as a sub-division of transgender does not automatically erase any transsexual identity, that not all transgender people wish to break down gender barriers, and that any marginalized group trying to gain acceptance of those opposed to them by trying to oppress another group has not only never been successful, it is also ethically questionable.

Transsexual people are usually referred to by the gender pronouns and terms associated with their target gender. For example, a transsexual man is a person who was identified as female at birth on the basis of his genitals, but who identifies as a man and is transitioning or has transitioned to a male gender role and has or will have a masculine body. Transsexual people are sometimes referred to with "assigned-to-target" gender terms such as "female-to-male" for a transsexual man or "male-to-female" for a transsexual woman. These terms may be abbreviated as "M2F", "F2M", "MTF", "F to M", etc. These terms help to prevent confusion, as some people are oblivious as to whether a "transsexual woman" is a female transitioning to become a male or a male transitioning to become a female. Transsexual men and women are also sometimes referred to as transmen and transwomen.

Transsexual people are often construed as belonging to the LGBT or the Queer community, and many identify with the community; others do not, or prefer not to use the terms. It should be noted that transsexualism is not associated with or dependent on sexual orientation. Transsexual men and women exhibit a range of sexual orientations just as non-transsexual (cissexual) people do. They almost always use terms for their sexual orientation that relate to their target gender. For example, someone assigned to the male gender at birth but who identifies as a woman, and who is attracted solely to men, will identify as heterosexual, not gay; likewise, someone who was assigned female sex at birth, identifies as a man, and prefers male partners will identify as gay, not heterosexual. Transsexual people, like other people, can be bisexual or asexual as well.

Older medical texts often referred to transpeople as members of their original sex; in other words referring to a male-to-female transsexual as a "male transsexual". They also described sexual orientation in relation to the person's assigned sex, not their gender of identity; in other words, referring to a male-to-female transsexual who is attracted to men as a "homosexual male transsexual." This dwindling usage is considered by many to be scientifically inaccurate and clinically insensitive today, and such a person would now be called and most likely identify herself as a heterosexual transwoman. Some medical textbooks still refer to transsexual people as members of their assigned sex, but many now use "assigned-to-target" terms.

A number of people outside the transsexual community still refer to transsexual people with terms associated with their birth sex (for example calling a male-to-female transsexual "him"). This usage, generally considered insensitive, has been (though not exclusively) based on biological arguments such as the unchanged karyotype, which is usually consistent with the sex assigned to the person at birth, or the absence of reproductive capability after transition and sex reassignment surgery. Arguments for this usage have also been based on religious dogma. Conservative groups such as the Traditional Values Coalition are among those to refer to transsexual people as members of their original sex.

Transsexualism should not be confused with cross dressing or 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.

Terminology

Among the transsexual community, the short form trans is sometimes used, e.g. trans guy, trans dyke, trans folk. Some use the controversial terms tranny and/or trans, though others consider these terms to be offensive. Those who use these terms claim that they are diminishing the power of the term as an insult. Others feel that the terms are insulting or inaccurate regardless of the context.

Some people prefer to spell transexual with one s, in an attempt to divorce the word from the realm of psychiatry and medicine and place it in the realm of identity, but this trend is most common in the United States and, for example, is almost never used in the United Kingdom. Some consider this usage to be silly.

Some prefer the term transsexed over transsexual, as they believe the term sexual found in transsexual is misleading and implies that transsexualism is a sexual orientation. Another justification made for this preference is that they feel it is more in line with the term intersex, as more transsexual groups are welcoming them because they feel both groups have much in common. It is, by some definitions, possible to be both intersexed and transsexed. Other attempts to avoid the misleading -sexual have been the increasing acceptance of transgender or trans* and in some areas, transidentity.

It is often assumed, particularly by transsexual people, that transsexualism is simply a subset of intersex. "Intersex" previously referred only to those who are genitally intersexed, i.e., with genitals that don't look classically male or female (in spite of the fact that human genitals show an extremely wide variation in general). However, since sex in humans is composed of many different attributes, such as genes, chromosomes, regulatory proteins, hormones, hormone receptors, body morphology, brain sex, and gender identity, any variation among any of those attributes falls under the rubric of "intersex." Transsexualism, in this view, simply becomes neurological intersexuality. (See below for research of physiological causes of transsexualism).

Additionally, some transsexual people who have successfully and completely changed gender roles prefer the term 'neo' as a prefix to their new gender. For example, 'neo-woman' or 'neo-man'. This removes both 'trans' and 'sexual', which some people feel is misleading.

Some people also refer to transsexualism as Harry Benjamin's Syndrome, named for Harry Benjamin, a pioneer in the field of sex reassignment.

Causes of transsexualism

There is no scientifically proven cause of transsexualism. However, in recent years, many theories have been proposed which suggest that the cause of transsexualism has its roots in biology. Because of this, the medical profession has slowly come to view transsexualism as a physical issue, rather than a psychological one. However, at this time, physiological causes of transsexualism have not been proven.

Proposed psychological causes

Many psychological causes for transsexualism have been proposed; including "overbearing mothers and absent fathers", "parents who wanted a child of the other sex", "repressed homosexuality", "emotional disturbance", "sexual abuse", or a variety of sexual "perversions". (Compare autogynephilia.)

None of these theories, however, could be applied successfully to a majority of transsexual people, and often not even to a significant minority. Many theories developed to describe transsexual women were even less useful when applied to transmen. One such example was Ray Blanchard's theory that all transwomen could be divided into the categories of "autogynephilic" and "homosexual". Many psychological theories had also been applied to homosexual people, also usually without success. This led to theories which considered physical reasons for transsexualism.

Experience with individuals who were sexually reassigned at birth, in order to correct deformities such as those caused by accidental castration or intersex conditions, suggests strongly that one's mental gender identification is determined at birth - individuals born male but raised as female (or vice versa) often show the same symptoms of gender dysphoria as transsexual people. One notable example was David Reimer.

"Curing" transsexualism

Psychological treatments aimed at curing transsexualism are historically known to be unsuccessful. In 1972, the American Medical Association Committee on Human Sexuality published the medical opinion that psychotherapy was generally ineffectual for transsexual adults and that sex reassignment therapy was more useful. (Human Sexuality; The American Medical Association Committee on Human Sexuality; Chicago; 1972.) A number of other treatments have been tested on transsexual people, including aversion therapy, psychoactive medications, electroconvulsive therapy, hormone treatments consistent with the patient's birth sex, and hypnosis. These treatments have also been shown to be ineffective.

Reparative therapy, which is usually aimed at gay or lesbian people, has also been applied to transsexual and transgender people. The Kinsey scale once expressed a view of transsexualism as an extreme form of homosexuality; the scientific community now rejects this part of Kinsey's theory. Reparative therapy is generally ineffective for transsexual and transgender people as well as gay and lesbian people. Even though many major medical and psychological associations have condemned reparative therapy as not only ineffective, but actually harmful, it continues to be advocated as a treatment for both homosexual and transsexual people by various organizations in the Western World, often with ties to the conservative Christian movement or other conservative religious movements.

However, for certain transsexual persons, therapies aimed at resolving gender conflicts, other than somatic treatments to reassign physical sex, may be effective and useful. Some people may have milder conflicts between their gender identity and physical sexual characteristics. These individuals may not wish to pursue sex reassignment therapy, but may seek care to help deal with the conflicts they face. If individuals express this desire for psychological care without SRS, supportive and psychoeducational counseling may be helpful. Additionally, some transsexual people, who may have a significant lifelong conflict between gender identity and their sexed-body may present for care without requesting SRS. Their reasons for forgoing transition and/or SRS may include family or professional concerns, perceptions of difficulty of transition, fear of loss of social standing or role, religious beliefs, real or perceived inability to finance transition, and advanced age or chronic medical problems, which may, in some cases, be considered medical contraindications to hormone therapy and/or sex reassignment surgery. Regardless of their reasoning, if their decision is consistent, it should be respected. These individuals often seek alternative methods with which they can improve their functional status, promote acceptance of their gender identity as valid, and ameliorate mood symptoms caused by gender conflict, through psychotherapy, and sometimes with medications. Additionally, these individuals sometimes benefit from partial somatic treatment. Low dose hormonal therapy, validation of patients desire to dress and live partially in the gender role appropriate to their gender, and even simply allowing the person a safe outlet to express themselves as a male or female can provide a great deal of comfort to patients who, for any reason, choose not to fully transition.

Physical causes

Many transsexual (and also many other transgender) people assume that there is a physical cause of their transsexualism, because they claim to have had the feeling of being a girl or a boy for as long as they can remember. Several studies have shown evidence that such a physical cause may exist.

One study by Zhou et. al has been touted as strong evidence that transsexualism is based in structural and neurochemical similarities between the brains of transsexual people and brains typical of their gender identity; this study has been alleged to have numerous flaws. A second study by Kruijver, et al replicated the results of the first study and included controls to help eliminate many of the alleged flaws.

Numerous animal studies have demonstrated that exposure to cross-sex hormones during development can reliably produce cross-sex behaviors in animals. In addition, twin studies have demonstrated a strong heritability for transsexualism. (Concordance for Gender Identity Among Monozygotic and Dizygotic Twin Pairs. Diamond, M and Hawk, S. American Psychological Association 2004 Annual Meeting. July 28 - August 1, 2004, Honolulu, Hawaii.) This research provides additional evidence that transsexualism may be caused by genetics and in utero hormonal environment.

A recent study from Germany provides additional evidence for a physical basis for transsexualism. The study found a correlation between digit ratio and male-to-female transsexualism. Male-to-female transsexual people were found to have a higher digit ratio than control males, but one that was comparable to control females. Because digit ratio is directly related to prenatal hormone exposure, this tends to support theories linking such to male-to-female transsexualism. (Schneider, Pickel & Stalla 2005)

There is also evidence from transsexual people born between the 1930s and 1970s that a powerful synthetic estrogen known as diethylstilbestrol (DES), which was routinely used at the time to prevent miscarriage and treat morning sickness, may have contributed to disrupting the hormonal balance within the womb. Evidence suggests that an unusually high percentage of physical males whose mothers were known to have taken this medication present as transgender or transsexual, either in childhood or in later life.

Due to incidents of birth defects and other side effects, the use DES and other synthetic estrogen compounds has been largely abandoned or replaced with natural estrogens. Today, with widespread use of certain plastics and other substances, there are likely to be many environmental pollutants which closely mimic the chemical structures of the withdrawn drugs. This suggests that prenatal environmental factors could also influence the development of this condition.

A 2005 study found that prenatal exposure to phthalates reduced the anogenital distance in males. Shorter anogenital distances in males were found to be associated with smaller penises, cryptorchidism, and lower levels of aggressiveness. Although no transsexual patients were included in this study, it suggests that environmental pollutants can affect sexual development in physical males.

All of the studies suggesting physical causes of transsexualism have been criticized as being flawed due to methodological problems, erroneous conclusions, or both.

Objections against research of causes

Many scholars of gender theory, gender professionals, and transsexual and transgender rights activists contest the very rationale of searching for a cause of transsexualism. An assumption behind this quest for causes is that gender dimorphism (the idea that there are only two discrete, well defined and dichotomous genders) is an established fact. The critics cite, among other things, historiographic and anthropological findings pointing to the fact that different cultures had diverse concepts of gender, some of them including three or more genders (see berdache, hijra, and xanith for examples).

One argument against the search for a cause of transsexualism is that it assumes a priori the legitimacy of normative gender identity, i.e. gender identity congruent with the external genitalia. This, affirm the critics, is an unproven contention. Historical research shows that the relation between genitals and gender identity changes across cultures. Assuming a priori that variant gender identity is anomalous (and therefore that its causes should be investigated) distorts science's view of gender and contributes to the stigmatization of gender non-conformists.

Additionally, many people do not consider transsexualism to be a disease or disorder. It should also be noted that the search for a physiological cause of transsexualism is similar to the search for a physiological cause of homosexuality. Many consider such research to be irrelevant, because they feel that, even if such a cause were established, it would not promote social acceptance of transsexual people, which is, for most transsexual people, the primary reason behind this quest for a physiological cause of their condition.

Sex reassignment therapy

Most transsexual men and women suffer from psychological and emotional pain due to the conflict between their gender identity and their original gender role and anatomy. They often find that their only recourse is to change their gender role and 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 been shown to be ineffective, as stated above. Therefore, it is generally accepted that the only effective course of treatment for transsexual people is sex reassignment therapy.

The need for physical treatment is emphasized by the high rate of mental health problems, including depression, anxiety, and various addictions, as well as a much higher suicide rate among untreated transsexual people than in the general population. Many of these problems, in the majority of cases, disappear or decrease significantly after a change of gender role and physical characteristics.

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. These professionals routinely evaluate their patients for mental health problems.

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. This can cause them significant problems when they attempt to obtain physical treatment.

Therapists' records reveal that most transsexual people do not believe they need psychological counseling, but acquiesce to legal and medical demands in order to gain rights which are granted through the medical/psychological hierarchy. Legal needs such as a change of sex on legal documents, and medical needs, such as sex reassignment surgery, are usually impossible to obtain without a doctor's and/or therapist's approval. Because of this, many transsexual people feel coerced into confirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference, in order to see simple legal and medical hurdles overcome. Transsexual people who do not submit to this medical hierarchy likely face the option of remaining invisible, with no legal rights and possibly, identification documents incongruent with gender presentation.

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 obtaining hormones from black market sources, such as internet pharmacies which ship from overseas.

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.

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.

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, nowadays, 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. In the United States, November 20 has been set aside as the "Day of Remembrance" for all murdered transgender people.

Transsexual people often have difficulty obtaining and maintaining employment because of workplace discrimination. Government policies regarding name and gender changes in many countries result in a high likelihood that the status of transsexual people who are still in transition will be discovered by their employers. Laws are increasingly providing workplace protection in some countries, and an increasing number of employers are including "gender identity" in their non-discrimination policies. However, these protections often have significant gaps, and implementation is haphazard.

Some people who have switched their gender role will 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. Societies are, in some instances, challenged to assimilate these men and women into their social institutions such as marriage and the role of parenting. 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. Recent research shows that this does not harm the development of these children in any way. To the dismay of many transpeople, older children frequently reject their transsexual parents and refuse to live with them. Equally distressing to transsexual parents, many younger children are barred from visiting their transsexual parents by other family members or by court order.

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.

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. 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.

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

Different individuals come to terms with their gender identity during many different stages of life. In most cases, the transsexual condition becomes apparent at some time in childhood, when the child may express behaviour incongruent with, and dissatisfaction related to, their assigned gender. However, many of these children hide their differences from an early age; therefore, acquaintances, friends, and even parents of these children may be unaware of their differences. Many of these children fear coming out, often justifiably. Some, but not all, parents react negatively when they learn that their child is transsexual. Because most children and adolescents are dependent on their parents, coming out has potential consequences.

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. Puberty is agonizing for most transsexual adolescents, as the physical androgyny of childhood is lost and these teenagers experience bodily changes with which they are uncomfortable. However, in recent years, more parents have come to accept transsexual children, and more doctors are willing to offer them medical treatment, though most are still reluctant to do so.

Regrets and retransitions

After transitioning, transsexual people sometimes regret their transition, or even choose to retransition to their original sex. However, every recent study done on the number of retransitions states that their number is well below 1%, and that the reasons for retransitioning are very diverse. The majority, but not all transsexual people who retransition consider themselves regretful.

Although the incidence of regret is not known, there are many documented cases of regret. Evidence suggests 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. Jerry Leach, a Christian minister who backed out of SRS a few weeks before his scheduled surgery date, and reverted to living as a man, claims that he is contacted by many post-op transsexual people with stories of regret. He runs a website on which he has posted some stories of regretful trans patients. . Among notable regretful trans patients are Renee Richards and Danielle Bunten Berry.

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-transsexuality, nor supportive psychological therapy, if necessary.

Depictions of transsexualism in the media

Transsexual women are commonly featured in pornographic works. When depicted without having undergone vaginoplasty, they are usually referred to as "shemales". While some pre-op transwomen call themselves and others like them "shemales," the term is regarded as offensive by many transsexual people.

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. Addams has appeared in numerous movies and television shows, including the 2005 comedy Transamerica.

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 in Iran, and the viewpoint is that males who are attracted to other males should become women.

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.

See also Transgender in non-Western contexts.

References

• Schneider, Harald J. Pickel, Johanna and Stalla,Günter 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,

• 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.

• Harry Benjamin International Gender Dysphoria Association (2001); Standards of Care for Gender Identity Disorders, Sixth Version.

• 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.

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
• What transsexuality Is
• The Gender Trust - The UK Charity for the support of trans individuals, their friends & family, employers and professionals
• 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.
• Our Trans Children A Publication of the Transgender Network of Parents, Families, and Friends of Lesbians and Gays (PFLAG). Third Edition, 2001.
• 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.

Specific to trans-women

• Mom, I Need to Be a Girl - a book by the mother of a transsexual child
• 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."
• Annelawrence.com Medical and Other Resources for Transsexual Women - often considered to be a controversial figure within the community due to her support for the autogynephilia theory
• Older Tees Medical, support and general articles for the transsexual community.
• 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.

Specific to trans-men

• FTM International - Female To Male International: practical and medical information
• Men's Ts Resources, Australia (also known as FTM Australia) - Australian-wide network providing up to date contact, support and information.
• Transster - A photo repository of female-to-male surgery, with patient surveys on quality of care experiences with different surgeons.
• Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers - Guidebook available free online.
• The Transitional Male - a Comprehensive, Educational Personal Website for Transmen, FTM's, Spouses, Family & Friends.
• Why Don't You Tell Them I'm A Boy? - Raising a Gender- Nonconforming Child, by Florence Dillon. A mother's experience with raising a transgender (FtM) son.
• Hudson's FTM Resource Guide - A basic guide including information about testosterone, health, surgeries, binding, packing, shaving, acne, hair loss, STP/bathrooms, clothing and shoes, and other topics, as well as FTM-related product links.

• Gender
• LGBT
• Transgender people and behavior
• Transgender