Put at it's most simple, it's where the gender of your mind does not correspond to the gender of your body. In fact, despite the name, it has nothing to do with sexual orientation at all. Nor is it anything to do with cross-dressing (also known by many as transvestitism). There is a formal definition of transsexuality "the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex" (American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders). Despite the interest of this august group of practitioners, the condition is not a mental disorder, either.
Although in the overwhelming majority of cases, it is self- diagnosed, this is a condition that is recognised and is treated (in the main, rather amateurishly, in my opinion) within the National Health Service. It is a condition that affects both genders. Male-to-female transsexual people are believed to be three times more common that female-to-male. The amount of research into the subject is painfully small - it is known with certainty how many people in the UK have Gender Identity Dysphoria. The preamble to the Gender Recognition Bill 2003 (one of the most enlightened pieces of legislation to see the light of day in the UK) talks of some 5,000 transsexual individuals. However, this is the number of people known to have ha Genital Reconstruction Surgery provided by the NHS as a consequence of transsexuality. The number that have the operation privately is "unknown" but is certain (given the restrictions on the availability of treatment with the NHS) likely to to be many times this number, perhaps as high as ten times (from my own observations). There will also be a number, possibly as large again who have decided not to undergo any surgery for various reasons. This means that the incidence in the UK may, at the top end of the scale be as high as one person in about 600, though I feel that the figure is probably nearer to one in 5,000. This makes it rather more common than many conditions that attract an enormous amount of public sympathy.
A friend of mine (not a transsexual person) once described this group as the "most anguished souls you could find". The statistics bear this out - I count amongst my close friends four other transsexual women. According to the statistics, one of us will commit suicide before completing our treatment. After completion of treatment, the rate falls to the national average. This must make it one of the most successfully treatable causes for suicide and the costs to the public purse associated with its treatment must make this worthwhile.
No-one really understands what causes this mismatch between mind and body. A theory that appeals to me is related to hormonal changes in the foetus. During the development of a male foetus, there are two surges of testosterone a few weeks apart. (In the absence of testosterone, the foetus develops as a female.) It is believed that one of these surges will determine the gender of the body, the other the gender of the mind. If one or is other disrupted, so the theory goes, the result will be an individual who may experience a degree of gender dysphoria. A study in Holland about ten years ago on a very small number of transsexual women, post mortem, appeared show that all their brains shared more characteristics with typically female brains than with typically male brains. It is unclear whether these effects were merely artefacts of the study procedure, artefacts of the hormone therapy the individuals had undertaken, or were indeed intrinsic properties of the brains of the subjects. In any case the sample size was extremely small. However, one of the individuals in the study had never taken any hormone therapy. There is also evidence that it is genetic - anecdotally, I know of several instances where transsexuality affects successive generations in the same family. Some of the best surgeons in the world for this work are to be found in Thailand.
My comments from here on are oriented toward male-to-female transsexuality.
Not every transsexual decides to transition from one gender presentation to the other. In many cases these people still suffer the same anguish as those who transition, but have developed sufficient mechanisms to cope - often by immersing themselves in their work. For those that decide that to take the plunge, the treatment may involve some or all of the following: taking hormones to alter secondary physical characteristics (e.g. development of breasts, improvements in skin quality), hair removal and hair transplants, facial feminisation surgery and eventually Genital Reconstruction Surgery. (I hate the expressions Gender Reassignment Surgery and Sex Reassignment Surgery - this has nothing to do with sex and has nothing to do with reassignment - it has everything to do with reconstructing the genitalia to match the gender of the mind.) The surgery nowadays is extremely sophisticated and barring serious post-operative complications, the individual is orgasmic and has perfectly formed, functional, female genitalia.
In general, the gatekeepers for access to this treatment are psychiatrists. I'm in two minds about this. On the one hand this transition probably the most major change that one could contemplate in a person's life and the possibilities for depression and mistakes are legion. On the other hand, transsexual people are not intrinsically mentally ill and are not in need of psychiatric support. The need for psychiatric support may appear as a consequence of their treatment at the hands of health professionals.
How should you react to a transsexual person? Treat them like every other person you meet. Staring is definitely a no-no. On the other hand, a overly warm greeting can be just as hurtful. This might be be meant well, but most transsexual women want to be able to get on with our lives as unremarkably as possible.
Finally, a word or two about terminology. Those assigned male gender at birth but feel themself to be female is known as a transsexual woman. Similarly, those assigned female gender, but feel themselves to be male as known as transsexual men. Notice that throughout this article, I've talked about transsexual people. It as unacceptable to talk of transsexuals as it is to talk of blacks - we are not identified purely by an adjective. Even worse, certainly in the UK (though in other countries these expressions may be acceptable - possibly due to the social conditions in which the individuals find themselves), is talk of "chicks with dicks" or "shemales". Both these expressions are highly offensive - tabloid newspapers take note! It has been recently pointed out to me that there is group of individuals in the UK that apply these terms to themselves, not wishing to undergo GRS. The combination of this terminology and the lack of desire to be taken as women means that, in my opinion, they fail the definition of Gender Identity Dysphoria and should not be taken as transsexual.
Page last edited: 24 January 2004