Transsexuality: What It Is; What It Isn't

Myths and Facts:

Myth: Transsexuality is a "sexual orientation."

Fact: Transsexuals might be attracted to men, women or both. Transsexuality is a question of identity; it does not dictate affection. Because they face similar discrimination, the gay, lesbian, bisexual and trans communities are allies.

Myth: Transsexuality is a sexual fetish.

Fact: Transsexuality is a question of identity: a sense of being misplaced in one's own body, as well as in society. In fact, hormone therapy affects the libido, and would be self-defeating in many cases. Instead, transition has an extremely high success rate.

Myth: Transsexuals are mentally ill.

Fact: Transsexality is treated through a mental health model, because of comorbidities such as depression and anxiety that are caused by living in gender dysphoric circumstances. Transsexuals tend to be high-function except for issues aquired from coping. In fact, current science strongly indicates a biological cause of transexuality.

Gender variance (transgender) can be seen as a continuum, with "cisgender" (non-trans) normativity at one end of the scale and transsexuality at the other. Most transgender people will fall near the middle, facing an issue of "gender expression" (a need to express themselves as different genders at different times or to blend expression, while still having a single identity). Transsexuals, meanwhile, are at an extreme end of the scale and need to live 24/7 as their identified gender.

"Gender Identity" variance (transsexuality) is when the mind is completely opposite in psychological gender to what the birth sex appears to be. While some people can struggle with and hide this for years, it eventually reaches a crisis point in which a person realizes that they cannot change their mind to match their body, and that transition is necessary. Transition can be from male-to-female (MTF) or female-to-male (FTM), as both forms of gender identity variance exist.

Just as non-trans people unquestioningly know their gender, people with a variance in gender identity often "just know," and are in a state of emotional distress and distraction until it is finally corrected. The experience is best understood by comparing to left-handedness. In the Middle Ages, left-handed people were prosecuted as witches, under the accusation that being "backwards" meant that they were demon-possessed. This caused many left-handed people to attempt to hide their dexterity, forcibly and consciously switching to their right hand, restricting their comfort, agility and co-ordination. Many lived in constant fear of being found out.

In the case of transsexuality this becomes extended to their entire identity: the sense that they are trying to be what society expects them to be and living a lie. Before transition, they have to hide gender role preferences - feminine-seeming or masculine-seeming inclinations - and live in fear of being found out to be different. Relationships can be complicated because they're not who they appear to be in the equation, and there are often issues with the body that make intimacy uncomfortable or impossible.

Gender Identity Disorder:
DSM-IV-TR Classification, diagnosed:
302.6 (child) or 302.85 (adolescent or adult)

The existing medical model has three criteria:

1) Evidence of a strong and persistent gross-gender identification.

2) Evidence of persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex.

3) Evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning

(a fourth criterion, stating that evidence of intersex disqualifies is now largely omitted as similar treatment is commonly made available to trans people of intersex origin if they seek it)

Medical studies are now being done with regard to:

• genetics,
• brain sex (physical structures of the brain, in which transsexuals' brains most often resemble those of their identified gender), and
• endocrine disrupting chemicals (synthetic chemicals which might affect the development of physical and psychological gender, which are determined at different times in utero.

While these studies are not yet conclusive, they cumulatively and repeatedly demonstrate a likelihood of a biological component to transsexuality and perhaps transgender by extension.

Treatment & Surgery

Treatment of Gender Dysphoria is directed by the World Professional Association for Transgender Health (WPATH) and encorporates surgical and endocrine intervention. Historically, analytical and aversion therapies have proven damaging.

As much as mainstream society would like to believe that aversion therapy would help transsexuals "just get over it," modern medicine has realized that this approach simply does not work, and usually results in suicide, self-destruction or extreme anti-social behaviour. Aligning body to mind, however, has enabled transsexuals to become valued and successful people in society.

For this reason, medical bodies including the American Medical Association and the American Psychiatric Association assert that Gender Reassignment Surgery (GRS) is a medically necessary procedure. Additionally, because many jurisdictions will not allow changing identification until surgery is performed, issues of citizenship and safety can come into play.

In fact, some transsexuals feel that they can live without having GRS, but they are the exception and not the rule.