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Transsexual people experience a
gender identity Gender identity is the personal sense of one's own gender. Gender identity can correlate with a person's assigned sex or can differ from it. In most individuals, the various biological determinants of sex are congruent, and consistent with the ...
that is inconsistent with their
assigned sex Sex assignment (sometimes known as gender assignment) is the discernment of an infant's sex at or before birth. A relative, midwife, nurse or physician inspects the external genitalia when the baby is delivered and, in more than 99.95% of birt ...
, and desire to permanently transition to the sex or
gender Gender is the range of characteristics pertaining to femininity and masculinity and differentiating between them. Depending on the context, this may include sex-based social structures (i.e. gender roles) and gender identity. Most culture ...
with which they identify, usually seeking medical assistance (including
sex reassignment therapies Transgender health care, also known as gender-affirming care, includes the prevention, diagnosis and treatment of physical and mental health conditions, as well as sex reassignment therapies, for transgender individuals.Gorton N, Grubb HM (201 ...
, such as hormone replacement therapy and
sex reassignment surgery Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a transgender or transsexual person's physical appearance and sexual characteristics to resemble those associated with their identified gender, and a ...
) to help them align their body with their identified sex or gender. The term ''transsexual'' is a subset of ''
transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through ...
'', but some transsexual people reject the label of ''transgender''. A medical diagnosis of
gender dysphoria Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identitytheir personal sense of their own genderand their sex assigned at birth. The diagnostic label gender identity disorder (GID) was used unti ...
can be made if a person experiences marked and persistent incongruence between their experienced their personal sense of their own and their assigned sex. Understanding of transsexuality has changed very quickly in the 21st century. Many 20th century medical beliefs and practices around transsexuality are now considered deeply outdated. It was once classified as a mental disorder and subject to extensive gatekeeping by the medical establishment, and remains so in much of the world.


Terminology

Transsexual has had different meanings throughout time. In modern usage, it refers to "a person who desires to or who has modified their body to transition from one gender or sex to another through the use of medical technologies such as hormones or surgeries." It is considered an antiquated term, and is sometimes pejorative. The general shift is to instead use the term ''
transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through ...
'' or the abbreviated form ''trans'', but due to its historical usage, transsexual remains in the modern vernacular. In understanding the subject, it is noted that there is a difference between
gender Gender is the range of characteristics pertaining to femininity and masculinity and differentiating between them. Depending on the context, this may include sex-based social structures (i.e. gender roles) and gender identity. Most culture ...
and sex. Gender is defined as a "set of social, cultural, and linguistic norms that can be attributed to someone’s identity, expression, or role as masculine, feminine, androgynous, or nonbinary." Sex is defined as being "assigned at birth by medical professionals based on the appearance of genitalia, and related assumptions about chromosomal makeup, gender identity, expressions, and roles emerge over the life span, sometimes changing over time."


Origins

Norman Haire Norman Haire, born Norman Zions (21 January 1892, Sydney – 11 September 1952, London) was an Australian medical practitioner and sexologist. He has been called "the most prominent sexologist in Britain" between the wars. Life When Norman was ...
reported that in 1921 Dora R of
Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwee ...
began a surgical transition, under the care of Magnus Hirschfeld, which ended in 1930 with a successful genital reassignment surgery (GRS). In 1930, Hirschfeld supervised the second genital reassignment surgery to be reported in detail in a peer-reviewed journal, that of Lili Elbe of
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. In 1923, Hirschfeld introduced the (German) term "Transsexualismus", after which David Oliver Cauldwell introduced "transsexualism" and "transsexual" to English in 1949 and 1950. Cauldwell appears to be the first to use the term to refer to those who desired a change of physiological sex. In 1969, Harry Benjamin claimed to have been the first to use the term "transsexual" in a public lecture, which he gave in December 1953. Benjamin went on to popularize the term in his 1966 book, '' The Transsexual Phenomenon'', in which he described transsexual people on a scale (later called the " Benjamin scale") of three levels of intensity: "Transsexual (nonsurgical)", "Transsexual (moderate intensity)", and "Transsexual (high intensity)". In his book, Benjamin described "true" transsexualism as the following:


Relationship to ''transgender''

The term ''transgender'' was coined by John Oliven in 1965. By the 1990s, ''transsexual'' had come to be considered a subset of the
umbrella term In linguistics, semantics, general semantics, and ontologies, hyponymy () is a semantic relation between a hyponym denoting a subtype and a hypernym or hyperonym (sometimes called umbrella term or blanket term) denoting a supertype. In othe ...
''
transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through ...
''. The term ''transgender'' is now more common, and many transgender people prefer the designation ''transgender'' and reject ''transsexual''. Some people who pursue medical assistance (for example,
sex reassignment surgery Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a transgender or transsexual person's physical appearance and sexual characteristics to resemble those associated with their identified gender, and a ...
) to change their sexual characteristics to match their gender identity prefer the designation ''transsexual'' and reject ''transgender''. One perspective offered by transsexual people who reject a transgender label for that of ''transsexed'' is that, for people who have gone through sexual reassignment surgery, their anatomical sex has been altered, whilst their gender remains constant. Historically, one reason some people preferred ''transsexual'' to ''transgender'' is that the medical community in the 1950s through the 1980s encouraged a distinction between the terms that would only allow the former access to medical treatment. Other self-identified transsexual people state that those who do not seek sex reassignment surgery (SRS) are fundamentally different from those who do, and that the two have different concerns, but this view is controversial, and others argue that merely having some medical procedures does not have such far-reaching consequences as to put those who have them and those who have not (e.g. because they cannot afford them) into such distinctive categories. Some have objected to the term ''transsexual'' on the basis that it describes a condition related to
gender identity Gender identity is the personal sense of one's own gender. Gender identity can correlate with a person's assigned sex or can differ from it. In most individuals, the various biological determinants of sex are congruent, and consistent with the ...
rather than
sexuality Human sexuality is the way people experience and express themselves sexually. This involves biological, psychological, physical, erotic, emotional, social, or spiritual feelings and behaviors. Because it is a broad term, which has varied wit ...
. For example, Christine Jorgensen, the first person widely known to have sex reassignment surgery (in this case,
male-to-female A trans woman or a transgender woman is a woman who was assigned male at birth. Trans women have a female gender identity, may experience gender dysphoria, and may transition; this process commonly includes hormone replacement therapy and some ...
), rejected ''transsexual'' and instead identified herself in newsprint as ''trans-gender'', on this basis. The trans community has generally taken issue with the term transsexual because it over-medicalizes the trans experience, and focuses too much on diagnosis. The term transgender emerged in part in an attempt to break the "medical monopoly" on transitioning that transsexual implied.
GLAAD GLAAD (), an acronym of Gay & Lesbian Alliance Against Defamation, is an American non-governmental media monitoring organization originally founded as a protest against defamatory coverage of gay and lesbian demographics and their portrayal ...
's media reference guide offers the following distinction on the use of ''transsexual'':
An older term that originated in the medical and psychological communities. As the gay and lesbian community rejected homosexual and replaced it with gay and lesbian, the transgender community rejected transsexual and replaced it with transgender. Some people within the trans community may still call themselves transsexual. Do not use transsexual to describe a person unless it is a word they use to describe themself. If the subject of your news article uses the word transsexual to describe themself, use it as an adjective: transsexual woman or transsexual man.


Terminological variance

The word ''transsexual'' is most often used as an adjective rather than a noun – a "transsexual person" rather than simply "a transsexual". , use of the noun form (e.g. referring to people as ''transsexuals'') is often deprecated by those in the transsexual community. Like other trans people, transsexual people prefer to be referred to by the gender pronouns and terms associated with their gender identity. For example, a trans man is a person who was assigned the female sex at birth on the basis of his genitals, but despite that assignment, identifies as a man and is transitioning or has transitioned to a male gender role; in the case of a ''transsexual'' man, he furthermore has or will have a masculine body. Transsexual people are sometimes referred to with directional terms, such as "female-to-male" for a transsexual man, abbreviated to "F2M", "FTM", and "F to M", or "male-to-female" for a transsexual woman, abbreviated "M2F", "MTF" and "M to F". Individuals who have undergone and completed sex reassignment surgery are sometimes referred to as ''transsexed'' individuals; however, the term ''transsexed'' is not to be confused with the term ''transsexual'', which can also refer to individuals who have not yet undergone SRS, and whose anatomical sex (still) does not match their psychological sense of personal gender identity. The terms ''gender dysphoria'' and ''gender identity disorder'' were not used until the 1970s, when Laub and Fisk published several works on transsexualism using these terms. "Transsexualism" was replaced in the DSM-IV by "gender identity disorder in adolescents and adults". Male-to-female transsexualism has sometimes been called "Harry Benjamin's syndrome" after the endocrinologist who pioneered the study of dysphoria. As the present-day medical study of gender variance is much broader than Benjamin's early description, there is greater understanding of its aspects, and use of the term ''Harry Benjamin's syndrome'' has been criticized for delegitimizing gender-variant people with different experiences.


Sexual orientation

Since the middle of the 20th century, ''homosexual transsexual'' and related terms were used to label individuals' sexual orientation based on their birth sex. Many sources criticize this choice of wording as confusing, " heterosexist", "archaic",Wahng SJ (2004). Double Cross: Transmasculinity Asian American Gendering in ''Trappings of Transhood''. in Aldama AJ (ed.) ''Violence and the Body: Race, Gender, and the State''. Indiana University Press. and demeaning because it labels people by sex assigned at birth instead of their
gender identity Gender identity is the personal sense of one's own gender. Gender identity can correlate with a person's assigned sex or can differ from it. In most individuals, the various biological determinants of sex are congruent, and consistent with the ...
. Sexologist John Bancroft also recently expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women. He says that he now tries to choose his words more sensitively. Sexologist Charles Allen Moser is likewise critical of the terminology. Sociomedical scientist Rebecca Jordan-Young challenges researchers like
Simon LeVay Simon LeVay (born 28 August 1943 in Oxford, England) is a British-American neuroscientist. He received a bachelor's degree in natural sciences from the University of Cambridge in 1966, a Ph.D. in Neuroanatomy at the University of Göttingen ...
, J. Michael Bailey, and
Martin Lalumiere Martin may refer to: Places * Martin City (disambiguation) * Martin County (disambiguation) * Martin Township (disambiguation) Antarctica * Martin Peninsula, Marie Byrd Land * Port Martin, Adelie Land * Point Martin, South Orkney Islands Austr ...
, who she says "have completely failed to appreciate the implications of alternative ways of framing sexual orientation." The terms ''androphilia'' and ''gynephilia'' to describe a person's sexual orientation without reference to their gender identity were proposed and popularized by psychologist
Ron Langevin Ronald Lindsay André "Ron" Langevin (born September 28, 1940) is a Canadian forensic psychologist at the University of Toronto. He is the founding editor of ''Annals of Sex Research'', now titled '' Sexual Abuse: A Journal of Research and Treatmen ...
in the 1980s. The similar specifiers ''attracted to men'', ''attracted to women'', ''attracted to both'' or ''attracted to neither'' were used in the DSM-IV. Many transsexual people choose the language of how they refer to their sexual orientation based on their gender identity, not their birth
assigned sex Sex assignment (sometimes known as gender assignment) is the discernment of an infant's sex at or before birth. A relative, midwife, nurse or physician inspects the external genitalia when the baby is delivered and, in more than 99.95% of birt ...
.


Surgical status

Several terms are in common use, especially within the community itself relating to the surgical or operative status of someone who is transsexual, depending on whether they have already had
sex reassignment surgery Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a transgender or transsexual person's physical appearance and sexual characteristics to resemble those associated with their identified gender, and a ...
(SRS), have not had SRS but still intend to, or do not intend to have SRS. They are, post-op, pre-op, and non-op, respectively.


Pre-operative

A pre-operative transsexual person, or simply pre-op for short, is someone who intends to have SRS at some point, but has not yet had it.


Post-operative

A post-operative transsexual person, or post-op for short, is someone who has had SRS.


Non-operative

A non-operative transsexual person, or non-op, is someone who has not had SRS, and does not intend to have it in the future. There can be various reasons for this, from personal to financial. Having SRS is not a requirement of being transsexual. Evolutionary biologist and trans woman
Julia Serano Julia Michelle Serano (; born 1967) is an American writer, musician, spoken-word performer, trans– bi activist, and biologist. She is known for her transfeminist books ''Whipping Girl'' (2007), ''Excluded'' (2013), and ''Outspoken'' (2016). ...
criticizes the societal preoccupation with SRS as phallocentric, objectifying of transsexuals, and an invasion of privacy.


Historical understanding

Transgender people are known to have existed since ancient times. A wide range of societies had traditional third gender roles, or otherwise accepted trans people in some form. However, a precise history is difficult because the modern concept of being transgender, and gender in general, did not develop until the mid-1900s. Historical understandings are thus inherently filtered through modern principles, and were largely viewed through a medical lens until the late 1900s.


20th century medical understanding

Benjamin suggested that moderate intensity male to female transsexual people may benefit from estrogen medication as a "substitute for or preliminary to operation." Some people have had
sex reassignment surgery Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a transgender or transsexual person's physical appearance and sexual characteristics to resemble those associated with their identified gender, and a ...
(SRS) but do not meet the above definition of transsexual. Other people do not desire SRS although they meet the other elements of Benjamin's definition of a "true transsexual". Transsexuality was included for the first time in the
DSM-III The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langu ...
in 1980 and again in the DSM-III-R in 1987, where it was located under ''Disorders Usually First Evident in Infancy, Childhood or Adolescence''. Beyond Benjamin's work, which focused on male-to-female (MTF) transsexual people, there are cases of the female to male transsexual, for whom genital surgery may not be practical. Benjamin gave certifying letters to his MTF transsexual patients that stated "Their anatomical sex, that is to say, the body, is male. Their psychological sex, that is to say, the mind, is female." Starting in 1968 Benjamin abandoned his early terminology and adopted that of "gender identity."


Medical diagnosis

Transsexualism no longer is classified as a mental disorder in the
International Statistical Classification of Diseases and Related Health Problems The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...
(ICD). The
World Professional Association for Transgender Health The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and ...
(WPATH) and many transsexual people had recommended this removal, arguing that at least some mental health professionals are being insensitive by labelling transsexualism as a "disease" rather than as an inborn trait, as many transsexuals believe it to be. Now, instead, it is classified as a sexual health condition; this classification continues to enable healthcare systems to provide healthcare needs related to gender. The eleventh edition was released in June 2018. The previous version, ICD-10, had incorporated ''transsexualism'', ''dual role transvestism,'' and ''gender identity disorder of childhood'' into its
gender identity disorder Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identitytheir personal sense of their own genderand their sex assigned at birth. The diagnostic label gender identity disorder (GID) was used unti ...
category. It defined transsexualism as " desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex." ICD-11 renamed Transexualism as Gender incongruence of adolescence or adulthood (), and Gender identity disorder of childhood was renamed Gender incongruence of childhood (). HA60 of the ICD-11 reads:
Gender Incongruence of Adolescence and Adulthood is characterised by a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, which often leads to a desire to ‘transition’, in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual´s body align, as much as desired and to the extent possible, with the experienced gender. The diagnosis cannot be assigned prior the onset of puberty. nowiki> applies before pubertyGender variant behaviour and preferences alone are not a basis for assigning the diagnosis.
Historically, transsexualism has also been included in the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are invo ...
's ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langu ...
'' (DSM). With the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
, transsexualism was removed as a diagnosis, and a diagnosis of
gender dysphoria Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identitytheir personal sense of their own genderand their sex assigned at birth. The diagnostic label gender identity disorder (GID) was used unti ...
was created in its place. This change was made to reflect the consensus view by members of the APA that transsexuality is not in and of itself a disorder and that transsexual people should not be stigmatized unnecessarily. By including a diagnosis for gender dysphoria, transsexual people are still able to access medical care through the process of transition. The current diagnosis for transsexual people who present themselves for medical treatment is gender dysphoria (leaving out those who have sexual identity disorders without gender concerns). According to the ''Standards of care'' formulated by WPATH, formerly the Harry Benjamin International Gender Dysphoria Association, this diagnostic label is often necessary to obtain sex reassignment therapy with health insurance coverage, and the designation of gender identity disorders as mental disorders is not a license for stigmatization or for the deprivation of gender patients' civil rights.


Causes, studies, and theories


Causes


Focus on trans women over trans men

Historically, formal efforts by the medical community to provide transsexual healthcare were extremely focused on transsexual women, with little thought for transsexual men. Julia Serano suggests that
effemimania ''Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity'' is a 2007 book by the gender theorist, biologist, and writer Julia Serano. The book is a transfeminist manifesto that makes the case that transphobia is rooted ...
(the idea that male femininity is more psychopathological than female masculinity) was the driving factor. She sees this as a kind of
transmisogyny Transmisogyny, otherwise known as trans-misogyny and transphobic misogyny, is the intersection of transphobia and misogyny as experienced by trans women and transfeminine people. The term was coined by Julia Serano in her 2007 book ''Whip ...
(hatred of trans women as an extension of sexism). This effimimania conflates male homosexuality, MTF transsexuality, and feminine gender expression, while treating them all as a disease. She points to the medical community's long love of now outdated theories such as autogynephilia.


Medical assistance

Individuals make different choices regarding sex reassignment therapy, which may include hormones, minor to extensive surgery, social changes, and psychological interventions. The extent of medical intervention is a highly personal decision: there is no one-size-fits-all solution.


Hormone replacement therapy

Transsexual individuals frequently opt for masculinizing or feminizing hormone replacement therapy (HRT) to modify secondary sex characteristics.


Sex reassignment therapy

''Sex reassignment therapy'' (SRT) is an umbrella term for all medical treatments related to sex reassignment of both transgender and
intersex Intersex people are individuals born with any of several sex characteristics including chromosome patterns, gonads, or genitals that, according to the Office of the United Nations High Commissioner for Human Rights, "do not fit typical b ...
people.
Sex reassignment surgery Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a transgender or transsexual person's physical appearance and sexual characteristics to resemble those associated with their identified gender, and a ...
(such as orchiectomy) alters primary sex characteristics, including chest surgery such as top surgery or breast augmentation, or, in the case of trans women, a trachea shave,
facial feminization surgery Facial feminization surgery (FFS) is a set of reconstructive surgical procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features. FFS can include various bony and soft tissue proced ...
or permanent hair removal. To obtain sex reassignment therapy, transsexual people are generally required to undergo a psychological evaluation and receive a diagnosis of gender identity disorder in accordance with the Standards of Care (SOC) as published by the World Professional Association for Transgender Health. This assessment is usually accompanied by counseling on issues of adjustment to the desired gender role, effects and risks of medical treatments, and sometimes also by psychological therapy. The SOC are intended as guidelines, not inflexible rules, and are intended to ensure that clients are properly informed and in sound psychological health, and to discourage people from transitioning based on unrealistic expectations.


Gender roles and transitioning

After an initial psychological evaluation, trans men and trans women may begin medical treatment, starting with hormone replacement therapy or hormone blockers. In these cases, people who change their gender are usually required to live as members of their target gender for at least one year prior to genital surgery, gaining real-life experience, which is sometimes called the "real-life test" (RLT). Transsexual individuals may undergo some, all, or none of the medical procedures available, depending on personal feelings, health, income, and other considerations. Some people posit that transsexualism is a physical condition, not a psychological issue, and assert that sex reassignment therapy should be given on request. (Brown 103) Like other trans people, transsexual people may refer to themselves as trans men or trans women. Transsexual people desire to establish a permanent gender role as a member of the gender with which they identify, and many transsexual people pursue medical interventions as part of the process of expressing their gender. The entire process of switching from one physical sex and social gender presentation to another is often referred to as transitioning, and usually takes several years. Transsexual people who transition usually change their social gender roles, legal names and legal sex designation. Not all transsexual people undergo a physical transition. Some have obstacles or concerns preventing them from doing so, such as the expense of surgery, the risk of medical complications, or medical conditions which make the use of hormones or surgery dangerous. Others may not identify strongly with another binary gender role. Still others may find balance at a midpoint during the process, regardless of whether or not they are binary-identified. Many transsexual people, including binary-identified transsexual people, do not undergo genital surgery, because they are comfortable with their own genitals, or because they are concerned about nerve damage and the potential loss of sexual pleasure, including orgasm. This is especially so in the case of trans men, many of whom are dissatisfied with the current state of phalloplasty, which is typically very expensive, not covered by health insurance, and commonly does not achieve desired results. For example, not only does phalloplasty not result in a completely natural erection, it may not allow for an erection at all, and its results commonly lack penile sexual sensitivity; in other cases, however, phalloplasty results are satisfying for trans men. By contrast, metoidioplasty, which is more popular, is significantly less expensive and has far better sexual results. Transsexual people can be heterosexual, gay, lesbian, or bisexual; many choose the language of how they refer to their sexual orientation based on their gender identity, not their birth
assigned sex Sex assignment (sometimes known as gender assignment) is the discernment of an infant's sex at or before birth. A relative, midwife, nurse or physician inspects the external genitalia when the baby is delivered and, in more than 99.95% of birt ...
.


Psychological treatment

Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex, aka
conversion therapy Conversion therapy is the pseudoscientific practice of attempting to change an individual's sexual orientation, gender identity, or gender expression to align with heterosexual and cisgender norms. In contrast to evidence-based medicine and clin ...
, are ineffective. The widely recognized Standards of Care note that sometimes the only reasonable and effective course of treatment for transsexual people is to go through sex reassignment therapy. The need for treatment of transsexual people is emphasized by the high rate of
mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles Stress (biology), stress, interpersonal relationships, and decision-maki ...
problems, including depression,
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, and various addictions, as well as a higher
suicide Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and ...
rate among untreated transsexual people than in the general population. These problems are alleviated by a change of gender role and/or physical characteristics. Many transgender and transsexual activists, and many caregivers, note that these problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-variant individuals. Some transsexual people reject the counseling that is recommended by the Standards of Care because they do not consider their gender identity to be a cause of psychological problems. Brown and Rounsley noted that "some transsexual people acquiesce to legal and medical expectations in order to gain rights 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 difficult to obtain without a doctor or therapist's approval. Because of this, some transsexual people feel coerced into affirming outdated concepts of gender to overcome simple legal and medical hurdles.


Regrets and detransitions

People who undergo sex reassignment surgery can develop regret for the procedure later in life, largely predicted by a lack of support from family or peers, with data from the 1990s suggesting a rate of 3.8%. In a 2001 study of 232 MTF patients who underwent GRS, none of the patients reported complete regret and only 6% reported partial or occasional regrets. A 2009 review of
Medline MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online) is a bibliographic database of life sciences and biomedical information. It includes bibliographic information for articles from academic journals covering med ...
literature suggests the total rate of patients expressing feelings of doubt or regret is estimated to be as high as 8%. A 2010 meta-study, based on 28 previous long-term studies of transsexual men and women, found that the overall psychological functioning of transsexual people after transition was similar to that of the general population and significantly better than that of untreated transsexual people.


Prevalence

Estimates of the prevalence of transsexual people are highly dependent on the specific case definitions used in the studies, with prevalence rates varying by orders of magnitude. In the United States, the ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langu ...
'' (DSM-V 2013) gives the following estimates: "For natal adult males TF prevalence ranges from 0.005% to 0.014%, and for natal females TM from 0.002% to 0.003%." It states, however, that these are likely underestimates since the figures are based on referrals to specialty clinics. The Amsterdam Gender Dysphoria Clinic over four decades has treated roughly 95% of Dutch transsexual clients, and it suggests (1997) a prevalence of 1:10,000 among assigned males and 1:30,000 among assigned females. Olyslager and Conway presented a paper at the WPATH 20th International Symposium (2007) arguing that the data from their own and other studies actually imply much higher prevalence, with minimum lower bounds of 1:4,500 male-to-female transsexual people and 1:8,000 female-to-male transsexual people for a number of countries worldwide. They estimate the number of post-op women in the US to be 32,000 and obtain a figure of 1:2500 male-to-female transsexual people. They further compare the annual instances of sex reassignment surgery (SRS) and male birth in the U.S. to obtain a figure of 1:1000 MTF transsexual people and suggest a prevalence of 1:500 extrapolated from the rising rates of SRS in the US and a "common sense" estimate of the number of undiagnosed transsexual people. Olyslager and Conway also argue that the US population of assigned males having already undergone reassignment surgery by the top three US SRS surgeons alone is enough to account for the entire transsexual population implied by the 1:10,000 prevalence number, yet this excludes all other US SRS surgeons, surgeons in countries such as Thailand, Canada, and others, and the high proportion of transsexual people who have not yet sought treatment, suggesting that a prevalence of 1:10,000 is too low. A 2008 study of the number of New Zealand passport holders who changed the sex on their passport estimated that 1:3,639 birth-assigned males and 1:22,714 birth-assigned females were transsexual. A 2008 presentation at the LGBT Health Summit in Bristol, UK, showed that the prevalence of transsexual people in the UK was increasing (14% per year) and that the mean age of transition was rising. Though no direct studies on the prevalence of
gender identity disorder Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identitytheir personal sense of their own genderand their sex assigned at birth. The diagnostic label gender identity disorder (GID) was used unti ...
(GID) have been done, a variety of clinical papers published in the past 20 years provide estimates ranging from 1:7,400 to 1:42,000 in assigned males and 1:30,040 to 1:104,000 in assigned females. In 2015, the
National Center for Transgender Equality The National Center for Transgender Equality (NCTE) is a nonprofit social equality organization founded in 2003 by transgender activist Mara Keisling in Washington, D.C. The organization works primarily in the areas of policy advocacy and med ...
conducted a National Transgender Discrimination Survey. Of the 27,715 transgender and
genderqueer Non-binary and genderqueer are umbrella terms for gender identities that are not solely male or femaleidentities that are outside the gender binary. Non-binary identities fall under the transgender umbrella, since non-binary people typicall ...
people who took the survey, 35% identified as "non-binary", 33% identified as transgender women, 29% identified as transgender men, and 3% said that "crossdresser" best described their gender identity. A 2016 systematic review and meta-analysis of "how various definitions of transgender affect prevalence estimates" in 27 studies found a meta-prevalence (mP) estimates per 100,000 population of 9.2 (95% CI = 4.9–13.6), equal to 1:11,000 for surgical or hormonal gender affirmation therapy and 6.8 (95% CI = 4.6–9.1), equal to 1:15,000 for transgender-related medical condition diagnoses. Of studies assessing self-reported transgender identity, prevalence was 355 (95% CI = 144–566), equal to 1 in 282. However, a single outlier study would have influenced the result to 871 (95% CI = 519–1,224), equal to 1 in 115; this study was removed. "Significant heterogeneity was observed in most analyses."


Society and culture

A number of Native American and First Nations cultures have traditional social and ceremonial roles for individuals who do not fit into the usual roles for males and females in that culture. These roles can vary widely between tribes, because gender roles, when they exist at all, also vary considerably among different Native cultures. However, a modern, pan-Indian status known as
Two-Spirit Two-spirit (also two spirit, 2S or, occasionally, twospirited) is a modern, , umbrella term used by some Indigenous North Americans to describe Native people in their communities who fulfill a traditional third-gender (or other gender-varia ...
has emerged among LGBT Natives in recent years.


Legal and social aspects

Laws regarding changes to the legal status of transsexual people are different from country to country. Some jurisdictions allow an individual to change their name, and sometimes, their legal gender, to reflect their gender identity. Within the US, some states allow amendments or complete replacement of the original birth certificates. Some states seal earlier records against all but court orders in order to protect the transsexual person's privacy. In many places, it is not possible to change birth records or other legal designations of sex, although changes are occurring. Estelle Asmodelle’s book documented her struggle to change the Australian birth certificate and passport laws, although there are other individuals who have been instrumental in changing laws and thus attaining more acceptance for transsexual people in general. Medical treatment for transsexual and transgender people is 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. In 1999 Brandon was memoralised in the first
Transgender Day of Remembrance The Transgender Day of Remembrance (TDoR), also known as the International Transgender Day of Remembrance, has been observed annually (from its inception) on November 20 as a day to memorialize those who have been murdered as a result of transp ...
. The Transgeder Day of Rembrance is observed annually on November 20 by members of the transgender community and LGBT+ organisations across the world. Jurisdictions allowing changes to birth records generally allow trans people to marry members of the opposite sex to their gender identity and to adopt children. Jurisdictions which prohibit
same sex marriage Same-sex marriage, also known as gay marriage, is the marriage of two people of the same sex or gender. marriage between same-sex couples is legally performed and recognized in 33 countries, with the most recent being Mexico, constituting ...
often require pre-transition marriages to be ended before they will issue an amended birth certificate. Health-practitioner manuals, professional journalistic
style guide A style guide or manual of style is a set of standards for the writing, formatting, and design of documents. It is often called a style sheet, although that term also has multiple other meanings. The standards can be applied either for gene ...
s, and LGBT advocacy groups advise the adoption by others of the name and pronouns identified by the person in question, including present references to the transgender or transsexual person's past. Family members and friends who may be confused about pronoun usage or the definitions of sex are commonly 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 transsexual person's desired pronouns consistently. According to
Julia Serano Julia Michelle Serano (; born 1967) is an American writer, musician, spoken-word performer, trans– bi activist, and biologist. She is known for her transfeminist books ''Whipping Girl'' (2007), ''Excluded'' (2013), and ''Outspoken'' (2016). ...
, deliberate mis-gendering of transsexual people is "an arrogant attempt to belittle and humiliate trans people." Both "transsexualism" and "gender identity disorders not resulting from physical impairments" are specifically excluded from coverage under the
Americans with Disabilities Act The Americans with Disabilities Act of 1990 or ADA () is a civil rights law that prohibits discrimination based on disability. It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964 ...
Section 12211. Gender dysphoria is not excluded.


Employment issues

Openly transsexual people can have difficulty maintaining employment. Most find it necessary to remain employed during transition in order to cover the costs of living and transition. However,
employment discrimination Employment discrimination is a form of illegal discrimination in the workplace based on legally protected characteristics. In the U.S., federal anti-discrimination law prohibits discrimination by employers against employees based on age, race, ...
against trans people is rampant and many of them are fired when they come out or are involuntarily outed at work. Transsexual people must decide whether to transition on-the-job, or to find a new job when they make their social transition. Other stresses that transsexual people face in the workplace are being fearful of coworkers negatively responding to their transition, and losing job experience under a previous name—even deciding which rest room to use can prove challenging. Finding employment can be especially challenging for those in mid-transition. Laws regarding name and gender changes in many countries make it difficult for transsexual people to conceal their trans status from their employers. Because the Harry Benjamin Standards of Care requires one-year of real life experience prior to SRS, some feel this creates a
Catch-22 ''Catch-22'' is a satirical war novel by American author Joseph Heller. He began writing it in 1953; the novel was first published in 1961. Often cited as one of the most significant novels of the twentieth century, it uses a distinctive non- ...
situation which makes it difficult for trans people to remain employed or obtain SRS. In many countries, laws provide protection from workplace discrimination based on gender identity or gender expression, including masculine women and feminine men. An increasing number of companies are including "gender identity and expression" in their non-discrimination policies. Often these laws and policies do not cover all situations and are not strictly enforced.
California California is a state in the Western United States, located along the Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the most populous U.S. state and the 3rd largest by area. It is also the m ...
's
anti-discrimination law Anti-discrimination law or non-discrimination law refers to legislation designed to prevent discrimination against particular groups of people; these groups are often referred to as protected groups or protected classes. Anti-discrimination laws ...
s protect transsexual persons in the workplace and specifically prohibit employers from terminating or refusing to hire a person based on their transsexuality. The
European Union The European Union (EU) is a supranational union, supranational political union, political and economic union of Member state of the European Union, member states that are located primarily in Europe, Europe. The union has a total area of ...
provides employment protection as part of gender discrimination protections following the
European Court of Justice The European Court of Justice (ECJ, french: Cour de Justice européenne), formally just the Court of Justice, is the supreme court of the European Union in matters of European Union law. As a part of the Court of Justice of the European U ...
decisions in ''
P v S and Cornwall County Council ''P v S and Cornwall County Council'' was a landmark case of the European Court of Justice (ECJ) which extended the scope of sex equality to discrimination against transsexuals. The case concerned a United Kingdom (UK) trans woman, referred t ...
''. In the United States National Transgender Discrimination Survey, 44% of respondents reported not getting a job they applied for because of being transgender. 36% of trans women reported losing a job due to discrimination compared to 19% of trans men. 54% of trans women and 50% of trans men report having been harassed in the workplace. Transgender people who have been fired due to bias are more than 34 times likely than members of the general population to attempt suicide.


Stealth

Many transsexual men and women choose to live completely as members of their gender without disclosing details of their birth-assigned sex. This approach is sometimes called ''stealth.'' Stealth transsexuals choose not to disclose their past for numerous reasons, including fear of discrimination and fear of physical violence. There are examples of people having been denied medical treatment upon discovery of their trans status, whether it was revealed by the patient or inadvertently discovered by the doctors.


In the media

Before transsexual people were depicted in popular movies and television shows,
Aleshia Brevard Aleshia Brevard (December 9, 1937 – July 1, 2017) was an American author and actress of stage, screen, and television. She worked as an entertainer, actress, model, Playboy bunny, professor of theater, and author. She also underwent one o ...
—a transsexual woman whose surgery took place in 1962—was actively working as an actress and model in Hollywood and New York throughout the 1960s and '70s. Aleshia never portrayed a transsexual person, though she appeared in eight Hollywood-produced films, on most of the popular variety shows of the day, including ''
The Dean Martin Show ''The Dean Martin Show'', not to be confused with the ''Dean Martin Variety Show'' (1959–1960), is a TV variety-comedy series that ran from 1965 to 1974 for 264 episodes. It was broadcast by NBC and hosted by Dean Martin. The theme song to the ...
'', and was a regular on ''
The Red Skelton Show ''The Red Skelton Show'' is an American television comedy/variety show that aired from 1951 to 1971. In the decade prior to hosting the show, Richard "Red" Skelton had a successful career as a radio and motion pictures star. Although his televi ...
'' and ''
One Life to Live ''One Life to Live'' (often abbreviated as ''OLTL'') is an American soap opera broadcast on the ABC television network for more than 43 years, from July 15, 1968, to January 13, 2012, and then on the internet as a web series on Hulu and iTunes ...
'' before returning to university to teach drama and acting.


In pageantry

Since 2004, with the goal of crowning the top transsexual of the world, a beauty pageant by the name of ''
The World's Most Beautiful Transsexual Contest The World's Most Beautiful Transsexual Contest is a beauty pageant that was held in Las Vegas in 2004 that selected the "most beautiful" transsexual in the world. Jahna Steele was the mistress of ceremonies for the pageant, in which 35 trans wome ...
'' was held in
Las Vegas Las Vegas (; Spanish for "The Meadows"), often known simply as Vegas, is the 25th-most populous city in the United States, the most populous city in the state of Nevada, and the county seat of Clark County. The city anchors the Las Veg ...
,
Nevada Nevada ( ; ) is a U.S. state, state in the Western United States, Western region of the United States. It is bordered by Oregon to the northwest, Idaho to the northeast, California to the west, Arizona to the southeast, and Utah to the east. N ...
. The pageant accepted pre-operation and post-operation trans women, but required proof of their gender at birth. The winner of the 2004 pageant was a woman named
Mimi Marks Mimi Marks (born February 11, 1967) is an American entertainer. Early life Mimi was born in Waterloo, Iowa, but grew up in Oelwein, Iowa. As a child, she recalls feeling "uncomfortable in her body," and had the "most difficult time" in her ph ...
.
Jenna Talackova Jenna Talackova (born October 15, 1988) is a Canadian model, television personality and beauty pageant titleholder who gained media attention in 2012 when she successfully waged a legal battle to be allowed to compete in the Miss Universe Canada ...
, the 23-year-old woman who forced
Donald Trump Donald John Trump (born June 14, 1946) is an American politician, media personality, and businessman who served as the 45th president of the United States from 2017 to 2021. Trump graduated from the Wharton School of the University of P ...
and his Miss Universe Canada pageant to end its ban on transgender contestants, competed in the pageant on May 19, 2012, in Toronto. On January 12, 2013, Kylan Arianna Wenzel was the first transgender woman allowed to compete in a Miss Universe Organization pageant since Donald Trump changed the rules to allow women like Wenzel to enter officially. Wenzel was the first transgender woman to compete in a Miss Universe Organization pageant since officials disqualified 23-year-old Miss Canada Jenna Talackova the previous year after learning she was transgender.


See also

* List of transgender-related topics * List of transgender-rights organizations * List of LGBT-related organizations * List of transgender people *
Transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through ...


References


Bibliography

* * * * * * * *


External links


The International Journal of Transgenderism
nbsp;– The Official Journal of the
World Professional Association for Transgender Health The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and ...
(formerly HBIGDA)
An archive of IJT Volumes I through V
is available, as ar

including Harry Benjamin's ''The Transsexual Phenomenon'' {{Authority control Transgender