For centuries some people have felt that they would rather be members of the opposite sex. Some have gone further and have lived full-time as members of the opposite sex. Since the early part of the 20th Century, people who feel that they possess the wrong body have used the medical world to help them to make their physical bodies match their minds.
The medical definition of a transsexual is someone who feels strongly that they should belong to the opposite sex and that they were born with the wrong body. The person will feel a sense of estrangement from their own body coupled with a sense of repugnance towards those parts of it that identify their gender. They will seek out surgical and medical treatment to change their sex and desire to live as a member of that sex in the community. However, not all transsexuals will have all of the indications above.
Typically, the first stage for any person in the UK who thinks that they may be a transsexual is their family doctor. The doctor will often refer the person to a psychiatrist. The psychiatrist will assess the patient and will find out whether or not the patient is suffering from a psychiatric disorder before beginning therapy, and will usually refer him or her onto a specialist clinic such as the one at Charing Cross Hospital in London. The specialist unit will make a decision about whether the patient may benefit from treatment. They will then ask the patient to live as a member of the opposite sex for three months before reversible hormone treatment can begin. A further two years of successful living in role is required before surgery is considered.
By the time hormones are administered it will have been some time since the initial visit to the GP, often as much as two years. Instead of waiting for this length of time, some transsexuals will find a psychiatrist who is willing to prescribe the hormones privately on a first visit.
For a male-born person the therapy will usually include hormone treatment, removal of unwanted hair by electrolysis and surgery of the genitals to create an realistic vagina and clitoris. For female-born patients, the treatment generally includes a mastectomy and hysterectomy, and treatment with male hormones. Few choose to undergo a phalloplasty, the creation of a penis, as this has many complications and is rarely successful. However, the person's original height and build cannot be changed by treatment. Hence a six foot two muscular man will become a six foot two muscular woman.
Transsexuality isn't the same thing as cross dressing, otherwise known as transvestism. Transvestites are men who feel the need to wear women's clothes. For some it creates sexual arousal, for others it could be part of a submission/dominance relationship, or it could be for entertainment purposes. The desire to cross dress will usually begin at puberty or later, along with the desire for sex. The transsexual will often recall feelings that they were in the wrong gender from childhood, though they may not choose to act on these or consult a medical professional until later in life.
The Beginnings of the Modern Transsexual
Einar Wegener was a Danish artist who longed to be a woman and persuaded a surgeon to make her physically a woman. As well as removing her penis, she had ovarian and uterine tissue implanted into her. This proved to be fatal and she died shortly afterwards.
By 1952, when American GI George Jorgensen decided to became Christine, she found surgeons in Scandinavia that were competent and familiar with the surgical procedure. When she wrote to her parents to tell them that she was now their daughter not their son, they replied that they still loved her. She returned to America as glamorous woman, hoping to begin a new life. Instead she found a media obsessed with her past.
She settled into her new life, becoming engaged twice. Yet she was only able to earn a living singing 'I Enjoy Being a Girl' in nightclubs, and giving interviews to newspapers and magazines.
Transsexualism in the 1970s and 1980s
In 1966 Dr Harry Benjamin, a personal friend of Christine Jorgensen, published The Transsexual Phenomenon. It outlined the nature of the condition, the differences between transsexuals and transvestites, and described the successful results of treatment with hormones and surgery.
Benjamin made it easier for thousands of transsexuals to obtain treatment. He outlined the standards of care for transsexuals and founded the Harry Benjamin International Gender Dysphoria Association, which still sets the standards for treatment.
Criticism of Medical Treatment
From 1966 many more patients began to seek sex reassignment treatment, and many more doctors began to provide it. However, many members of the medical community were uneasy with what they saw as supporting the delusion of psychotic people who wanted to mutilate their otherwise healthy bodies. In 1979 Meyer and Reter1 published a paper in a reputable scientific journal in which they concluded that the transsexuals who were treated by hormones and surgery were no better off than those treated by psychotherapy to help them accept their original birth gender.
However many researchers have attempted to follow up transsexuals after treatment and only Meyer and Reter came to this conclusion. Many researchers2 have pointed out a large number of flaws and prejudices in Meyer and Reter's study. For example he allocated positive and negative points to various aspects of transsexuals' lives to assess them, but a relationship with someone of the same sex was considered to be a negative point. And people who had middle class jobs were allocated more points than people in manual jobs. Most members of the medical profession would consider these views unbalanced and homophobic, and prejudices of this nature have no place in modern medicine.
Criticism from Feminists
In 1979 Janice Raymond published The Transsexual Empire. In this book she stated that the entry of male-to-female transsexuals to women-only spaces made women feel violated. She also argued that effeminate men should remain men and challenge society's conception of what it means to be male, rather than becoming feminine women and reinforcing society's perceptions of what it means to be female. She claimed female-to-male transsexuals were victims of a misogynistic society.
The vast majority of transsexuals that transitioned in the 1960s and '70s were previously living as gay men who then became heterosexual women. April Ashley, one of the first British transsexuals who came to the attention of the media, was able to work as a underwear model. However, once a friend sold her story to the press, she couldn't get a job in a shop.
Transsexualism in the 1980s and 1990s
In the early 1990s, the medical profession began to realise that not every man who was born male was attracted to women and neither did every man who was born female, and so at that time the gay and lesbian transsexual began to emerge. More and more people who felt that they did not fit into either of the two genders felt that they did not need to and began to identify themselves as transgender3.
Legal progress was made in the UK when a landmark case in the European Court in 1999 made it illegal to discriminate against someone on the basis of their transsexuality. By this time, the majority of transsexuals were able to remain in their jobs while transitioning from one gender to another. By now, gender on passports and driving licenses could be changed. The only documentation that could not be altered was the birth certificate, with that came the right to marry and to adopt a child with a partner of the opposite sex.
After a recent European Court ruling that the refusal to change birth certificates is unlawful, it should soon be possible to achieve full legal equality.
Recently, researcher have looked into the possible causes of transsexualism. One study has found that on examination of the brains of deceased transsexuals, the brains resemble the sex that they always insisted they were. This would indicate that one's feelings of being male or female are set in the brain from birth and cannot be altered. It is hypothesised that these feelings could be due to abnormalities in hormones before birth.
The research is not conclusive, though. Only a very small number of brains have been examined. Also the differences could be from the way that a brain is used, or from the administration of hormones to transsexuals during therapy. Other researchers hypothesise that transsexualism may be caused by an upbringing: which was either dysfunctional or where gender was not emphasised enough. Neither of these theories have been proved conclusively.
Criticism and hostility to transsexuality has reduced greatly in recent years, but suspicion is still present. Women sometimes feel threatened by male-to-female transsexuals who wish to enter a women-only space. Some are also disappointed that there are less 'butch' lesbians than there used to be as many of them have transitioned and are now living as male. Some Christians feel that if a person was made one gender by God then they ought to remain that way and changing healthy organs is a violation of God's will.
Nowadays a person transitioning from one gender to another does not face the challenges that a person would have done ten or 20 years ago. Most doctors are interested and supportive, if not knowledgeable of the condition. Most friends supportive and people's families come to be supportive with time. Most large organisations such as banks are friendly and sympathetic when it comes to changing paperwork.
It is currently illegal in the UK to discriminate against or to harass a transsexual at work. As a result most employers are supportive when a employee announces that they are going to transition. As a result most people stay in the jobs that they were previously in and continue to earn a living. Many transsexuals will eventually tire of being the office gossip and will chose to move to a work place where no one knows.