Talk:Transsexual/Draft transsexuality

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. Transsexualism is considered a taboo subject in many parts of the world. The justifications for negative beliefs about transsexualism may be perceived as being supported by religious beliefs or cultural norms. It has become more widely known in Western nations in the late 20th century due to the sexual revolution, but remains a highly controversial topic.

Gender dysphoria
Transsexualism often manifests itself as a dysphoria toward one's biological birth sex, as well as conflict living in one's social role. If untreated, it can lead to mental and emotional problems, and sometimes, suicide. Dutch researcher Peggy Cohen-Kettenis estimates that 40% of untreated transsexual people are either institutionalized or die prematurely. However, with proper treatment, transsexual people often become fully functional members of society. The suicide statistics of treated transsexual people (Cohen-Kettenis et al, 1988) do not differ remarkably from non-transsexual populations.

Most transsexual men and women desire to establish a permanent social role as a member of the gender with which they identify. Many transsexual people also desire various types of medical alterations to their bodies. These physical alterations are collectively referred to as sex reassignment therapy and often include hormones and sex reassignment surgery. The entire process of switching from one physical and social gender presentation to the other is often referred to as transition, and usually takes several years.

To obtain sex reassignment therapy, transsexual people are usually required to receive psychological therapy and a diagnosis of gender identity disorder. They must also live as members of their target sex for at least one year prior to surgery, but this time may be longer if the psychotherapist has concerns about the transsexual person's readiness. This time is known as the Real-Life Test or Real-Life Experience, and is one of a number of requirements that a transsexual person must meet, which are specified by protocols known as Standards of Care. These requirements are intended to prevent those individuals, who are not genuinely transsexual persons, from transitioning and later regretting having done so. These standards are however often criticized as being either ineffective or too strict. The intentions of the standard are to prevent people from transitioning when such a transition would be inappropriate (as a dramatic example, a person seeking to transition in order to veil their identity from police), or ill-advised (as an example a strong crossdresser, who still identifies themselves as their assigned gender). Although the intentions of the standards may be good, they have been suggested as discouraging genuinely transsexual people from seeking treatment. Despite concerns about the protocols, comprehensive meta-reviews of post-operative transsexuals prior to 1991 reveal a rate of serious regrets of <1% for transsexual men and <2% for transsexual women. Studies published after 1991 have reported a decrease in the rates for both, likely due to improved psychological and surgical treatments.

Currently, the causes of transsexualism are unknown and estimates of prevalence vary substantially.

Defining transsexualism
Transsexualism (also known as transsexuality) is a complex condition that is defined differently by different people. Many terms have been proposed through the years to describe transsexual people and the processes they go through. As with any terms used by a group, or to refer to a particular group, some of these terms are controversial, or have become controversial, not only to society at large, but even among the transsexual community.

The definition of "transsexuality" is somewhat debated. One common definition is that a transsexual is a person who believes that his or her body does not reflect his true 'inner' gender. Another common definition is that a transsexual is a person who has had or plans to have medical or surgical treatments that alter his or her body to better reflect what the individual believes is his or her true gender. The first definition allows greater freedom for individuals to self-identify as a transsexual. The latter defines the term based on actual or planned operative status and makes it more an external label than a term of self-definition.

When surgery is undertaken it is commonly referred to as sex reassignment surgery by health care providers and community members. An older term, sex change surgery may be seen as disrespectful.

The Diagnostic and Statistical Manual of Mental Disorders accepts the expression of desire to be of the opposite sex, or assertion that one is of the sex opposite from the one with which they were assigned at birth, as sufficient for being transsexual. The ICD-10 states in a similar way 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 has been variously described as a trait, disease, behavior, desire, mental illness, perversion, paraphilia, political identity and sin. The terms perversion and sin are obviously derogatory, and many people consider the use of such labels offensive whether they or not they are themselves transsexual.

Transsexualism is often included within the broader term transgender, which is generally considered an umbrella term for people who do not conform to typical accepted gender roles, for example cross-dressers, drag queens, and people who identify as genderqueer. However, some transsexuals object to this inclusion. Historically the reason that transsexuals rejected associations with the transgender or broader LGBT community is largely that the medical community in the 1950s through the late 1980s encouraged (and in many ways required) this rejection of one's queer kin in order to be a 'good transsexual' who would thus be allowed to access medical and surgical care. The animosity that is present today is not still currently fed by this same kind of pressure from the medical community (indeed, today many gender therapists actively encourage their clients to explore support within the broader community.) However the current animosity is reflective of this historical division. (Denny 176.)

Regardless of definition, transsexualism should not be confused with cross dressing or with the behaviour of drag queens and drag kings, which can be described as transgender but not transsexual. Also, transvestic fetishism usually has little, if anything, to do with transsexualism. As a general rule, transsexual people tend to dress and behave in a manner consistent with the gender they identify with, crossdressers tend to dress (and sometimes behave) in a manner consistent with stereotypical ideals of the opposite gender as opposed to the real-life behavior of that gender, and "drag queens" or "drag kings" tend to dress and behave in a flamboyant manner which parodies rather than emulates the opposite gender.

Gender terminology for transsexual people
Transsexual people almost universally prefer to be referred to by the gender pronouns and terms associated with their target gender. For example, a transsexual man is a person who was assigned the female gender 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 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 are particularly helpful in preventing confusion, because to some people the term "transsexual woman" is a female transitioning to become a male, and to others a male transitioning to become a female. When the terms transmen and transwomen are used though, it is typical for them to be used to refer to the gender that the person identifies with, regardless of their appearance or state of transition.

Transsexual people are often considered as part of the LGBT community, and although many do identify with this community, others do not, or prefer not to use the terms at all. Transsexual people typical feel it important that transsexualism does not depend upon, nor related to sexual orientation. Transsexual men and women exhibit a range of sexual orientations just as non-transsexual (some times referred to as cissexual) people do, and they will almost always use terms for their sexual orientation that relate to the gender that they identify with. For example, someone assigned 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 the female gender 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 transsexual people as members of their original sex by 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 usage is considered by many to be scientifically inaccurate and clinically insensitive today. As such someone who would have been referred to as a "homosexual male transsexual" would now be called and most likely identify herself as a heterosexual transsexual woman. Although this usage is dwindling, some medical textbooks still refer to transsexual people as members of their assigned sex, but now many use "assigned-to-target" terms.

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

Alternative terminology
The transsexual community typically use the short form "trans", or simply "T" as a substitution for the full word "transsexual", e.g. TS, trans guy, trans dyke, T-folk, trans folk. Some may even use term that have become controversial to some, such as tranny and/or trans, despite others considering these terms to be offensive. Those who do use these terms claim that they are diminishing the power of the term as an insult, just as some members of the gay and African-American communities have embraced slurs directed at them. Others feel that the terms are insulting or inaccurate regardless of the context. Some feel that such words are problematic because they do not differentiate between transsexual people, and people who are merely "playing" with gender.

Some people may prefer to spell transsexual with only one s, thus writing transexual. They will typically assert that they are attempting to divorce the word from the realm of psychiatry and medicine and place it in the realm of identity. This trend is most common in the United States, and is almost never used in the United Kingdom. Some consider this usage to be silly and/or incorrect.

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 more closely parallels with the term intersex, which is considered by them to be important 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.

Some transsexual people may also prefer transgendered over transsexual, because the issue is about gender rather than sexuality. They make a parallel with intergender, whose issue is about being between (inter) the genders rather than "intersexual". It is often assumed, particularly by transsexual people, that transsexualism is 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. (Despite the fact that human genitals show an extremely wide variation in general, intersexed people typically have quite obviously ambiguous genitalia that frustrate attempts to assign them within a binary sex system.) 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 could fall under the rubric of "intersex." Transsexualism, in this view, simply becomes a form of being neurological intersexed. (See below for research of physiological causes of transsexualism).

Some people prefer that transsexualism be referred to as Benjamin's syndrome, as it follows the naming conventions of other intersex conditions. This term is named for Harry Benjamin, a pioneer in sex reassignment and research on transsexual people. Many transsexual people who prefer this term assert that scientific research has strongly suggested that their condition is biological rather than psychological in nature. They also feel that 'trans' is misleading, as they believe that their gender was fixed in their brains, and has never changed. Thus that nothing about their steps in correcting themselves is actually "trans" at all, but rather they are simply taking steps to assert what they feel that they are already.

While the above gives a fairly comprehensive view of terminology, it's imporant to note that some people may feel that both 'trans' and 'sexual', are misleading, and others may take objections to terminology that are unique to their perspective. While a large variety of other terms exist from those presented here, they have not been excluded with bias, although almost all of them are somewhat controversial.

Prevalence
There are no reliable statistics on the prevalence of transsexualism. The DSM-IV (1994) quotes prevalence of roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek sex reassignment surgery in the USA. The most reliable population based estimate of the incidence occurrence is from the Amsterdam Gender Dysphoria Clinic. The data, spanning more than four decades in which the clinic has treated roughly 95% of Dutch transsexuals, gives figures of 1:10,000 assigned males and 1:30,000 assigned females.

Related topics

 * Causes of transsexualism
 * Sex reassignment therapy
 * Standards of Care for Gender Identity Disorders
 * Hormone replacement therapy (trans)
 * Sex reassignment surgery
 * Legal aspects of transsexualism
 * Transgender in film and television
 * List_of_transgender-related_topics
 * List of transgender-related topics
 * List of transgender-rights organizations
 * List of LGBT-related organizations
 * List of transgendered people