Gender transition

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Transition occurs when individuals change their sex characteristics and/or gender presentation to reflect their gender identity, not due to social pressures or mental disorders, but due to an acute feeling of fundamental discontent with the sex to which they have been assigned (gender dysphoria). Individuals who transition (or wish to transition) from one major sex to another are termed transsexual, though some people may prefer the more general term transgender or simply "trans." Transitioning is a complex process consisting of social, medical, and legal aspects, and not all trans people may desire to go through all elements.

Initial[1] results[2] support transition as an effective treatment. Major medical associations have made statements in support of gender transition.[3] The latest DSM, the APA's comprehensive list of psychological conditions, depathologized gender dysphoria (formerly "gender identity disorder"), by declassifying it as a disorder.[4]

Definitions[edit]

  • Although definitions of "transsexual" and related terms like "transgender" are currently in something of a state of flux, the general tendency is for "transgender" to refer to all gender-variant people, and for "transsexual" to refer to the more specific cases of women who were assigned male at birth (transsexual women) and men who were assigned female at birth (transsexual men). "Transsexual" has largely fallen out of favor, mainly because the "sexual" part implies sex and sexuality. The shortened form "trans" can be short for either "transgender" or "transsexual." These terms are also preferably used as adjectives (i.e., transgender people) rather than as nouns (i.e. transgenders).
  • "Transition" can be used as either a verb ("She has been transitioning since last month") or a noun ("I will begin my transition"). There is no fixed definition of when a transition is over, since not all trans folks desire to do everything. Transition is often an ongoing process that can take years of adjustments. Never ask a trans person "Is your transition complete?"
  • Being trans is not an acquired state. There is no such thing as "becoming trans." One does not become trans when one gets a certain surgery, starts hormones, or changes one's name. One is trans from birth. However, one does begin transitioning.
  • The terms "Trans(gender) man/woman" are used with respect to a person's gender identity; a trans woman is one who was assigned male at birth, but identifies as a woman.
  • Gender and sexuality are separate concepts; transgender people can have any sexuality that cis (non-trans) people can. Also, sexuality is defined in terms of a trans person's gender identity; a trans man (FTM) attracted to women is straight, and a trans woman (MTF) attracted to women is a lesbian.
  • A social transition is a gender transition that doesn't involve any medical or surgical interventions. It is common among people who are waiting for hormones, who are younger, or who are not sure if they want to medically transition.

Misconceptions[edit]

  • Trans women are simply men who are so enamored with femininity that they go so far as surgery to emulate it ("autogynephilia") This is a recent point of view floated most notably by weirdos and trolls such as Ray Blanchard, Ann Lawrence and J. Michael Bailey, based largely on junk science and speculation. Aside from a great many criticisms of the concept that this is simply a love of women taken too far, it utterly ignores the existence of female-assigned-at-birth transsexual individuals.[5] Although autogynephilia is widely rejected for rational reasons, some people do openly identify as autogynephiliacs as it describes their personal experience quite well.[6] The more important thing is to remember that theories advancing this idea assert that all transsexual people are either homosexuals or autogynephiles. Also of note is that some radical feminists assert this same idea, and feel that transsexuals are the male 5th column coming in to literally rape the last sacrament of femininity, their very bodies.[7]
  • Another claim frequently repeated radical feminists is: Trans men are really butch lesbians. While many trans men do start their lives by identifying as lesbian, this is certainly not universal.
  • Trans men are simply women who want to profit from male privilege. While trans men who "pass" do profit from male privilege, this is a by-product of transition and not its primary aim. Similar to the myth about immigrants coming here to live off benefits (wherever "here" is), it paints people as parasites and erases their contribution to society.
  • Trans people are really homosexuals who wish to avoid social stigma by actually becoming the "opposite" sex[8] This is often presented together with the above AGP concept, and is no more well founded. Proponents tend to note though that "homosexual transsexual people" are so effeminate that they are unable to function in life as men, and are typically able to pass so well, that they can live in "stealth" afterwards. Again, it does not recognize the existence of trans men, but further suggests that homosexual men would try to escape the social stigma of homosexuality by embracing the far greater stigma associated with transsexuality. Further, this misconception suggests that a homosexual male would go through a process that by definition would make him impotent, and thus unable to have homosexual sex. This is a bizarre concept at best.[9] Why a person would flee a socially stigmatised identity to take up an even more stigmatised identity is a question as yet unanswered.
  • A little therapy or a good fuck is all they need to snap out of it. This misconception ignores that the psychiatric community requires transsexual people to have extensive therapy in order to receive treatment, and many who transition later in life have led a fairly successful sexual life. This view is commonly shared about homosexual people too, as people believing this misconception have difficulty distinguishing the two subjects of transsexuality and homosexuality. Medical treatment for transsexual people is typically dependent upon a course of therapy. Whilst originally introduced to hinder trans people, this now serves to prevent harm due to misdiagnosis and to help transsexual people through the process of transition.[10] It should be noted that recently there is a trend for informed consentWikipedia's W.svg clinics that provide hormone replacement therapy without requiring psychological evaluation. This is widely seen as a good thing among trans rights activists.
  • Gender and physical sex are the same thing. There is a distinction between a person's identification and personality (gender), and their physical features and properties (sex). Most people perceive them to match enough that they assume they match for everyone else. Transsexual people undergo procedures to alter their sexual characteristics to bring them in line with their gender identity.
  • Transsexual people may satisfy their urges with occasional role-playing or crossdressing.[11] This is often akin to reparative therapy in homosexual people, where the individual suppresses natural urges or identification in order to appear "fine". This can be due to a number of reasons, such as fear, family pressure, or simple uncertainty about the concept or transitioning. However, many find they cannot maintain this false front, and proceed to transition at some later date. It is also notable that crossdressers are seldom transsexual, though some crossdressers may later realize that they are better served by transitioning.
  • Transsexual and transgender are interchangeable terms. Like LGBT, transgender is an umbrella term, whose exact definition is subject to much debate, but generally covers any person whose gender expression or identity is considered abnormal by society. Transsexual, on the other hand, has a more defined and restricted meaning, and does not cover gender expressions which are recreational or do not involve medical transition, such as drag queens. Some transsexual people do not wish to be identified under the "transgender" umbrella and find it highly offensive to be referred to as "transgenders" or "trans," though others accept umbrella terms for the purposes of political alliance and do not find them offensive. Still other individuals object to the term "transsexual," believing that it makes their identity seem sexualized.
  • Transsexual persons are gender variant. Many transsexual people prefer to conform to gender norms. Even those that have criticisms of their cultures gender norms often would prefer not to have to assert their gender to every individual they encounter 24/7, or to risk violence and street harassment for their transgressions. In the past, medical professionals actually required transsexual patients to dress and act in an extremely stereotypical way for their target sex in order to qualify for treatment, though currently such standards are relaxed so that transsexual people do not have to adopt an exaggerated presentation.
  • "Tranny" is an endearing and acceptable term for trans people. The term "tranny" is very often used as a slur for transsexual people, and as such, many find it highly offensive, on the level of calling a gay person a "faggot." Some trans people reclaim the term and use it for themselves, but as with other minorities that reclaim slurs in this way, it is not a polite or universally-acceptable term for non-trans people to use.
  • It is acceptable to use "transgender" as a noun. Referring to somebody simply as "a transgender" is generally perceived as offensive, just as referring to someone as merely "a cisgender" would be. There are trans men, trans women, people who are gender fluid, etc.

Relationship to homosexuality and bisexuality[edit]

Trans sexuality is usually expressed in terms of gender identity, for example, a trans woman attracted to women would be a lesbian (not straight), and a trans woman attracted to men would be straight (not gay). Similar standards apply for trans men. Of course, a bisexual is a bisexual no matter what. It is thus possible for an individual to have multiple "letters" on the LGBT spectrum.

Due to oppression, violence, lack of legal protections and misunderstanding, most people in these rarer sexual sub-categories tend to try to work together for legal rights and social acceptance, hence the LGBT (etc.) umbrella "label". The symbol of the Rainbow Flag indicates the range of healthy expression of sexuality in humans, and the political need for us to accept each other equally.

However, despite the symbolism of the Rainbow Flag, transsexual people are often not afforded the same inclusion as other groups under the umbrella. One recent example of this in the USA is the Human Rights Campaign's willingness to jettison demands for transsexual rights in order to ensure passage of a bill ensuring rights for gays and lesbians. During the same situation, the Lesbian and Gay Task Force explicitly said that they are not supporting protection for "gender identity and expression" for transsexual or transgender individuals, but rather solely for the personal goal of ensuring that there would be no loophole for discriminating against gay or lesbians for the way that they act, when incongruous to the stereotypes of their sex.

Also, Washington HB 2661 which granted discrimination protection to the GLBT community, only added protection for "sexual orientation", which was defined to include "gender identity and expression." While whatever argument can be made to justify this action, it still shows an ignorance of the gay and lesbian community about what motivates transsexuals to change.

Medical aspects of transition[edit]

Sex reassignment therapy, or medical transition, involves generally three stages, therapy, hormones and then surgery. This three tier approach is designed to keep a person from going further than they would be comfortable with in their life. Recently there is a trend for informed consentWikipedia's W.svg clinics providing hormones without prior therapy, although surgery continues to require diagnosis.

Phase 1: Psychiatric therapy[edit]

In some instances the therapy is designed in a way almost like reparative therapy. The first stance that the therapist is to take is skepticism, and attempting to help the patient resolve their feelings without hormones, transition, or surgery. A patient is informed that transsexual people face a real threat of harm, and death simply from being transsexual. There should not be any intent to dissuade genuine individuals from transition, but rather to ensure that transition happens only when medically necessary, and not on whim or pretense. In some countries, a psychiatrist has to certify that the patient suffers from gender dysphoria and has no other mental health problems before hormone therapy can be started.

In the past, psychologists would require "Real-Life Experience", i.e., living "full-time" as their identified gender, before starting hormones. This could include getting one's name legally changed, changing one's wardrobe completely, and often presenting as one's desired sex to every friend and stranger for up to a year. Proponents for this step often point out that it could show whether or not a person is serious about transition. However, there are a few problems. First, it can be humiliating. Trans people often need hormones to "pass." Being perceived as a cross-dresser is different than being perceived as a woman or man, and hormones often make that difference. Second, it plays on gender stereotypes and ignores the fact that gender dysphoria often goes back to the body, not social roles. Third, it can be seen as a form of hazing ritual. As such, the WPATH no longer requires real-life experience for hormones, just therapy. Still, some psychologists (particularly in Europe[citation needed]) still require it.

There are a number of hypothetical examples that demonstrate individuals for whom transition would be the wrong treatment to take:

  • A woman who had been sexually abused, and viewed transition as the only way to regain control over her sexuality.
  • Crossdressers may originally approach a therapist seeking sex reassignment surgery, but such a surgery would actually cause negative psychological impact.
  • Crossdressers may also become complacent with their erotic fantasies, and begin to suspect that this means they should transition, even though this surgery would still cause negative psychological impact.
  • Felons fleeing from justice, and view transition as a way to evade prosecution.

None of the preceding patients should be encouraged to transition, as they have a distinct gender identity conforming with their biology, and actual transition will result in serious negative consequences. Thus patients are originally recommended to find expressive, non-permanent ways to express themselves and relieve the stress caused by their transgender feelings. This gives the therapist time in order to evaluate and review the indications and counter-indications of whether medical intervention is actually medically necessary.

A (somewhat) famous example of an individual for whom sex reassignment was not the right thing to do, but who went through with it anyway and later regretted it, was Dan/Danielle BuntenWikipedia's W.svg, the author of M.U.L.E.. It didn't help that, in her case, the surgery ended up making her incapable of achieving orgasm, as can happen when the surgeon isn't extremely careful about preserving the nerves intact.

Phase 2: Hormone replacement[edit]

In cases where psychiatric therapy leads to the conclusion that a person genuinely suffers dysphoria and should undergo physical gender transition, the Standards of Care used internationally suggest hormone therapy be given. Some people undergoing the therapy seek maximum feminization/masculinization, while others will experience relief with an androgynous presentation resulting from hormonal minimization of existing secondary sex characteristics (Factor & Rothblum, 2008). Hormones can be prescribed either by an endocrinologist or a general practitioner, and users have the option of pills, injections, gel, and patches.

Hormone therapy can provide significant comfort to patients who do not wish to make a social gender role transition or undergo surgery, or who are unable to do so (Meyer, 2009). Hormone therapy is a recommended criterion for some, but not all, surgical treatments for gender dysphoria.

Physical Effects of Hormone Therapy[edit]

Feminizing/masculinizing hormone therapy will induce physical changes that are more congruent with a patient’s gender identity.

In FtM patients, treatment usually consists of testosterone. The effects include, but are not limited to:

  • Deepened voice
  • Clitoral enlargement (variable)
  • Growth of facial and body hair
  • Cessation of menstruation
  • Atrophy of breast tissue
  • Decreased percentage of body fat compared to muscle mass
  • In some individuals, male pattern baldness

In MtF patients, treatment often includes both estrogen and an anti-androgen (testosterone blocker). Effects include, but are not limited to:

  • Breast growth (variable)
  • Decreased erectile function
  • Decreased testicular size
  • Increased percentage of body fat compared to muscle mass
  • Redistribution of fat in a more feminine pattern
  • Softening of skin
  • Thinning of body hair
  • Change in body odor
  • Changes of one's face

Though it is generally impossible for MtF's to reverse all of the effects of their original puberty, such as male pattern baldness, deepened voices, and facial hair, testosterone blockers can prevent said features from becoming worse. Also, many trans women look into permanent hair removal options to remove their beards.

Most physical changes, whether feminizing or masculinizing, occur over the course of two years. The amount of physical change and the exact timeline of effects can be highly variable.

In female to males, the effects of testosterone on menstruation and fat distribution will generally revert if stopped within a few weeks. For male-to-females, the effects of hormone treatments become irreversible only after about 3 months.

Within the transgender community there's a considerable amount of debate over the value of gatekeeping protocols; self-medicating with hormones is surprisingly common for those who feel that they're being forced to jump through hoops, and quite a few transgender people have felt forced to overpresent as their target gender -- to express what to them seems to be unacceptable levels of bimbosity or machismo, frequently -- in order to be taken seriously as transgender by their doctors and to continue receiving hormone therapy. As a result, there's a number of clinics that will provide hormones to those who ask for them, given a statement of informed consent and medical clearance.

Phase 3: Surgery[edit]

Reassignment surgery is a form of cosmetic surgery which changes aspects of a transgender person's body to make them physically resemble the opposite gender. It is usually divided between "top" surgery (breasts) and "bottom" surgery (genitals) In transsexual men, this is usually limited to a breast reduction, as the results of creating genitalia for them are typically poor. However, significant work has been done in creating realistic genitalia for transsexual women. Transsexual women may also receive a breast enlargement if hormone therapy has not led to the growth of full breasts. Both forms of genital surgery are generally irreversible; reversing surgeries for transsexual men may find some success, but reversing MtF surgeries is impossible.

Another popular surgery among trans women is facial feminization surgery, which sculpts facial features such as the jaw, chin, brow bone, nose, forehead, and Adam's apple into a more feminine configuration. A less common procedure is voice feminization surgery, which modifies the voice box or vocal chords. The surgery may produce favorable results for some people, but it can leave others with a raspy voice, a "Mickey Mouse" voice, or no voice at all! Most trans women simply "train" their voices instead.

Social and legal aspects of transition[edit]

In addition to hormones and surgery, many transsexual and transgender people change their social presentation, aesthetics, and legal status. Common aspects of this include:

  • Legally changing one's name
  • Legally changing one's sex marker
  • Updating one's wardrobe
  • Asking others to use one's preferred pronouns, name, and title
  • Adopting new techniques of grooming, such as makeup
  • For pre-op trans men, using a breast binder

Some countries, like France, make undergoing reassignment surgery mandatory before being able to petition for an official identity change, so before being able to insert in society (good luck finding a mainstream job presenting as female while your ID says you're a man). That is often viewed by LGBT activist as an effort to "punish" fully committed trans individuals by making sure they will be sterile. Other countries and US states simply require time spent on hormones, and still others simply require a note from a therapist. The requirements often depend on what document needs to be updated. Most US states allow driver's license changes without surgery, but fewer allow people to change their birth certificates without surgery. Some areas don't allow birth certificates to be changed at all, since they are treated as historical documents that were correct at the time they were written. Federally, sex can be changed on US passports and in the Social Security database, and no surgery is required.

The UK offers a "gender recognition certificate" (GRC) that does not require reassignment surgery, but does require two years of living as one's identified gender. Upon receiving the GRC, one will also receive a new short-form birth certificate, free of charge.

In some countries (like the US), people can choose any name they want for themselves. (The bassist from The Bangles changed her name to Michael, despite not being trans). In other countries, name changes have similar requirements to changing one's sex marker. There are no unisex names in Italy or Germany, and the process for changing one's name can only be done at the same time as changing one's sex. Some countries even require a court order before one begins medically transitioning.

Some US states make name changes simpler for trans people by waiving the newspaper publication requirement and/or the in-person hearing.

Prejudice and violence[edit]

One father described the challenge of empathizing with his child’s fear this way: How would it feel if someone told him that one day soon he would start growing breasts and a vagina?
“I’d try to stop that from happening,” he said.[12]

Until 2010 and the passage of the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, the FBI did not collect information to determine the prevalence of hate crimes against transgender or transsexual people. So it is difficult to guess at how common they are out of the entire population, although most are certain that the violence rate is significantly higher than any other group.[13] Combined with a substantially higher-than-normal suicide attempt rate (41%, more than 25 times the rate of the general population[14]), and the rarity of the condition in the first place - the number of successful transitions is often outweighed by those who do not transition.

The common value given by trans advocates is that a transsexual has a 50% chance to have a successful transition, and the rest primarily die, commit suicide, or are killed before they have the chance to transition completely. Go team, eh?[citation needed]

The transsexual community abounds with tragic stories of individuals killed by others simply for being transsexual persons, and police or health care providers refusing to treat. Of particular note, one transsexual woman involved in an accident was laughed at and mocked once the police and rescue personnel learned that she was a preoperative transsexual; the delay in her care and treatment was the primary cause of her death. Gwen Araujo is a well-known transsexual woman, who was brutally murdered by bludgeoning force when some men, who committed statutory rape against her and forced her to give them oral sex, found out that she was either transgender or a preoperative transsexual woman.[15][16] Another heartbreaking story, is of a trans woman, who was run over repeatedly by her former boyfriend with his car immediately after their break up. The police later classified this tragedy as an accident, even when witnesses insisted that it was deliberate.[17] Trans men also face significant discrimination by doctors when they are diagnosed with cervical, uterine, or ovarian cancer, there may be refusal by the doctors or even the insurance company to treat that cancer.

Bathroom Bills[edit]

In the U.S., there have been recent controversies over "bathroom bills" - laws that say transgender people must use the restroom matching their birth sex. [18] [19] [20]

Proponents cite public safety and privacy. On safety, "Journalists may cite the 18 states and 200 municipalities with explicit transgender protections, none of which have shown an increase in public safety incidents [21]. Predators - whether transgender or using it as a pretext - have not come out of the woodwork (save for a dick in Seattle, WA trying to make a point[22]). Privacy is less of an issue in public restrooms, where people use stalls and men at urinals avoid looking at each other. Proponents also don't seem to consider that hairy, burly trans men would be using the women's restroom.

In contrast, of transgender respondents to the National Transgender Discrimination Survey, 53% reported verbal harassment and 8% physically assault in public places[23].

See also: Sexual identity

Notable transsexual people[edit]

  • Leelah Alcorn, American transgender teen who committed suicide because her parents ostracized her.
  • Thomas Beatie, the "pregnant man"
  • Kristin Beck, former United States Navy SEAL
  • Chaz Bono, son of Sonny & Cher and LGBT activist
  • Wendy Carlos, composer of music for two Stanley Kubrick films and Tron
  • Laverne Cox, actress and transgender advocate
  • Sasha "Scarlett" Hostyn, a professional gamer and a world champion in Starcraft 2
  • Caitlyn Jenner, formerly known as Bruce Jenner, an Olympic gold medalist in track and field.
  • Chelsea Manning, WikiLeaks leaker
  • Geena Rocero, model and transgender activist.
  • Lana Wachowski, formerly known as Larry Wachowski, co-director of The Matrix and Cloud Altas
  • Lilly Wachowski, formerly known as Andy Wachowski, co-director of The Matrix and Cloud Altas
  • Laura Jane Grace, lead singer of anarcho punk band Against Me! was known as Tom Gabel until coming out in 2012.
  • Buck Angel, adult actor/producer and transgender advocate

References[edit]

  1. Murad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., Erwin, P. J., & Montori, V. M. (2010). Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology, 72(2), 214–231. http://doi.org/10.1111/j.1365-2265.2009.03625.x
  2. White Hughto, J. M., & Reisner, S. L. (2016) A Systematic Review of the Effects of Hormone Therapy on Psychological Functioning and Quality of Life in Transgender Individuals. Transgender Health. http://doi.org/10.1089/trgh.2015.0008
  3. Lambda Legal. Professional Organization Statements Supporting Transgender People in Health Care. http://www.lambdalegal.org/sites/default/files/publications/downloads/fs_professional-org-statements-supporting-trans-health_1.pdf
  4. Heffernan, D. (2012) The APA Removes "Gender Identity Disorder" From Updated Mental Health Guide. GLAAD. http://www.glaad.org/blog/apa-removes-gender-identity-disorder-updated-mental-health-guide
  5. Critique of The Man Who Would Be Queen, a landmark book regarding AGP, at TS Roadmap
  6. The most important example being Anne Lawrence, a medical doctor who is also one of the main proponents of this theory
  7. Originally advanced by Janice Raymond in The Transsexual Empire; popularly pushed in the UK press by Julie Bindel.
  8. Review of The Man Who Would Be Queen
  9. See above reference at TS Roadmap
  10. See "Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity", by Julia Serano
  11. One of our well-meaning editors had to be schooled on this
  12. Green, Jesse. 2012. "S/He" New York Times Magazine
  13. Southern Poverty Law Center on transgender murders
  14. [1]
  15. Hate Crimes: Causes, Controls, and Controversies by Phyllis B. Gerstenfeld
  16. What's On Tonight
  17. Philadelphia Police Fail To Investigate Suspicious Death of a Transgender Woman
  18. Steinmetz, K. (2015). States Battle Over Bathroom Access for Transgender People. Time Magazine. http://time.com/3734714/transgender-bathroom-bills-lgbt-discrimination/
  19. Berke, J., & Sterbenz, C. (2016). The 'bathroom myth' is fueling North Carolina’s new anti-LGBTQ law. Business Insider. http://www.businessinsider.com/nc-republicans-citing-bathroom-myth-2016-3
  20. Botelho, G., & Drash, W. (2016). South Dakota governor vetoes transgender bathroom bill. CNN. http://www.cnn.com/2016/03/01/us/south-dakota-transgender-bathroom-bill/index.html
  21. Ellis, S. K. (2016). Debunking the Bathroom Bill Myth. GLAAD. http://www.glaad.org/sites/default/files/Debunking_the_Bathroom_Bill_Myth_2016.pdf
  22. Laura Bilt, "[http://www.nydailynews.com/news/national/wa-man-women-bathroom-test-transgender-ruling-article-1.2535150 Seattle man undresses in women's locker room at local pool to test new transgender bathroom rule ]", New York Daily News
  23. The National LGBTQ Task Force, the National Center for Transgender Equality. (2011) Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf