Hundreds of thousands of people have a condition known by medical professionals as gender identity
disorder (GID). The condition is characterized by feelings of inappropriateness in the gender one is assigned as birth. It may manifest as crossdressing, frequent or occasional, or in the case of transsexualism, as a desire to change sex.
Gender Identity Disorder
GID is a late 20th-Century term of a condition which has existed in all cultures throughout history. In many societies, transgendered and transsexual people have played important and
respected roles. In the West, many professionals have come to view transgendered behavior as a normal variation of the human condition rather than as a disorder.
Crossdressers
The desire to wear the clothing of the other sex
is independent of one's sexual orientation. Many gay, bisexual,
and heterosexual men like to wear womens' clothing in public, and
may even fantasize on occasion about becoming a woman. Most,
however, have no desire to change their sex. These men are
called crossdressers or transvestites. Women also crossdress in
larger numbers than has previously been acknowledged.
Transsexualism
Men and women who desire to rid themselves of
their primary sexual characteristics and live as members of the
other sex are called transsexual. Many transsexuals undergo sex
reassignment, in which they come to live as members of the
"other" biological sex. Hormonal and surgical techniques make
this possible, but sex reassignment is a difficult, disruptive,
and costly process, and must not be undertaken without
psychological counseling and careful planning and a realistic
understanding that medical technology has its limits.
Transgenderists
Many men and women prefer to steer away from
male/female extremes and prefer
an androgenous presentation of gender. They incorporate elements
of both masculinity and femininity in their appearance. They may
be seen by some persons as male and by others as female. They
may live part of their life as a man and part as a woman, or they
may live entirely in the new gender, but without plans for
surgery.
Many individuals who self-identify as crossdressers and
transgenderists seek medical treatment to masculinize or feminize
their bodies. These persons are on average less likely than
transsexuals to have worked through the profound financial,
social, and medical implications of obtaining such treatment.
Anyone who seeks hormonal therapy and genital sex reassignment
surgery (SRS) is subject to the same medical and psychological
safeguards that have been set up for transsexual men and women.
Medical Procedures
The Harry Benjamin International Gender
Dysphoria Association Standards of Care (SOC) safeguard both
transsexual people and the men and women who provide professional
services for them. The SOC divide the transition process into a
series of discrete steps. Following those steps maximizes the chance
that SRS will be successful and minimizes the chances of regrets.
The first step a transsexual should make is to locate a therapist
who is familiar with the SOC. It is also important to find a
good support group.
Hormonal Therapy
Sex hormones can masculinize female bodies and
feminize male bodies. The changes take place over a period of
years, but eventually can become quite profound. Hormones have
global effects on one's emotional state, fertility, and
sexuality, and can have severe medical consequences, especially
when self-administered.
Hormones should never be taken without a prior period of therapy
and should be used only when under the supervision of a physician
who periodically monitors these medications.
Real-Life Test
The SOC mandate a real-life test (RLT) period in
which the individual must live 24 hours a day and work as a
member of the other sex for a minimum of one year. The RLT gives
the individual an opportunity to see what life will be like after
transition, but before SRS, which is a non-reversible procedure.
As transsexuals risk job discrimination, rejection from their
friends and families, and ridicule or harassment from the general
public, the RLT can be an eye-opening experience.
Sex Reassignment Surgery
SRS is the culmination of a long
process, and should never be performed before the person has
established a viable life in the gender of choice; nor should it
be forced upon a transgendered person by a helping professional.
It should not be the primary focus of one's transition, but
merely the final confirmation of the new gender.
Persons with gender identity issues should realize that SRS is
not a requirement in order to live in the gender of choice.
Genitals are private areas, hidden from the view of the general
public. Many transgendered and transsexual persons crosslive
happily with no plans to have SRS; however, SRS is available for
those who successfully cross-live for a minimum of one year, can
provide two letters from therapists, and do not have a
contraindicating health condition.
When performed by an experienced, competent surgeon,
male-to-female (MtF) SRS can result in a cosmetically pleasing
and functional neovagina. Vaginoplasty is usually a one-stage
procedure (with an optional follow-up for minor revision); cost
in the US is $13,000 and up.
Penile inversion surgery is the most common MtF SRS procedure.
Some surgeons use a section of colon to line the neovagina, but
other surgeons have expressed concern about this procedure for
primary vaginoplasty.
The ability to have orgasm is not universal in post-operative MtF
transsexuals. Independent studies have found a self-reported
orgasm rate of 25%.
Female-to-Male (FtM) transsexuals undergo top surgery, a
procedure in which a male chest contour is created. The SOC
consider this to be genital surgery (thus requiring a RLT), but
many FtMs, especially those with large breasts, find it difficult
to live in the male role before top surgery.
Bottom surgeries include phalloplasty, in which tissue from other
areas of the body is used to fashion a penis (which is incapable
of erection); metadioiplasty, which creates a small, erectile
phallus; and scrotoplasty, in which the labia are fashioned into
a scrotum. Silicone testicular prostheses are sometimes
implanted. Metadioiplasty costs from $12,000 up; phalloplasty
can range in price from $50,000 to more than $100,000.
The Transgender Community
Transgender is a term used to refer
to the entire constellation of persons who transgress traditional
gender norms. The transgender community is a loose association
of support groups, advocacy agencies, activists, and information
services. While the term transgender does not have universal
acceptance, it has come to have widespread recognition in recent
years.
Society and Gender Identity
Transgendered and transsexual people are really no different from other
individuals of their age and social situation; however, society does
not generally recognize or acknowledge this. Gender-nonconforming
children and adults are at grave risk for bias and harassment. Even
walking down the street can be dangerous. Job discrimination is often
overt and basic medical care and social services may be denied.
Many individuals, even helping professionals and police officers,
react viscerally at the sight of a transgendered or transsexual
person.
In the past several decades, transgendered persons have made
astonishing gains in the social arena. However, inaccurate media
portrayals remain the rule.
Banyan Counseling Center wishes to thank the American Educational Gender Information
Service(AEGIS) for allowing it to use information from its Gender Identity Brochure
for this home page. You can contact them at aegis@gender.org.
