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Basic TG/TS/IS Information   by Lynn Conway http://www.lynnconway.com/ Copyright @ 2000-2006, Lynn Conway. All Rights Reserved.     Part I: Gender Basics & Transgenderism Deutsch Español Français Italiano Русский	Photo of Lynn and her boyfriend (now husband) Charlie, in late summer 2000.

 

We learned in Lynn's story that she was born and raised as a boy, and later in life was changed into a girl by female sex hormone treatments and major surgical procedures. Because of this past, Lynn is sometimes called a "transsexual" woman. Why did this happen to Lynn, and what is transsexualism anyway?

 

In order to understand transsexualism, we must first answer some basic questions about gender. What is Gender Identity? Where does it come from? What events occur in nature that interfere with correct assignments of gender? These pages aim at answering these questions. Links are then provided to further information on gender identity, transgenderism, transsexualism and intersexuality, and to information about methods and technology for physical gender modification.

 

Knowledge in this area is under rapid development. There are challenges in defining, separating and "labeling" the different phenomena, and in making estimates of frequencies of occurrence. There are also differing interpretations of the underlying science, and differing points of view about the evolving social and medical protocols for resolving these conditions.

 

However, much more is known about gender identity than just a few short years ago, and those new understandings are very much worth sharing and building upon. The taboo on this area has also been broken, so that we can openly discuss these important issues without fear, shame or embarrassment.

 

As we'll see, far more people suffer from gender-identity conditions than previously suspected, and the lives of millions of people are impacted by gender-identity issues. The key to improving the quality of those lives is better knowledge and more widespread understanding of that knowledge.

 

 

Part I: Gender Basics & Trangenderism

Part Ia: (TG continued)

Part II: Transsexualism (MtF)

Part III: Life as a Woman After TS Transition

 

 

ADDITIONAL REFERENCE WEBPAGES:

 

TS Womens' Resources	TS Women's Successes (es)	Facial Feminization Surgery (FFS) (es)
TG/TS/IS Info Links	Successful TransMen (es)	Sex Reassignment Surgery (SRS) (es)

 

 

 

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Part I - Contents:

 

GENDER BASICS:

What makes us a boy or a girl? What determines our gender identity?

Intersex conditions - including intersex babies whose gender is ambiguous at birth.

The practice of "surgically correcting" the genitals of intersex infants to make them "normal".

How these attempted "corrections" reveal that old theories of gender identify formation were wrong.

More lessons from intersex people about gender identity.

The theory that gender identity is socially constructed is finally shattered

The theory that prenatally established brain and CNS structures determine innate gender feelings.

TRANSGENDERISM:

Introduction

Counseling and medical treatment of transgender and transsexual women.

Other conditions overlapping with or often conflated with transgenderism and transsexualism:

Ex: Being gay, drag queens, female impersonators, transvestites and crossdressers, travestis, fetishists, others.

Why do some react to transgender and transsexual people with such hostility?

Shades of gray: Combinations and intergradations of gender and partner-preference.

Getting beyond "labels", and thinking of gender feelings, gendered behaviors and gender trajectories instead.

Part I continued - in Part Ia:

ContrastingTransgender (TG) transitions and Transsexual (TS) transitions.

Rethinking discrimination and hate crimes against gay and transgender people.

Sadly, transphobia is also often projected by gays, lesbians and feminists (and how that is changing now).

The transgender kids who are run away or are"thrown away".

The transgender kids who are helped by their families.

However, even those transgendered kids who are accepted by their families face many dangers right now.

Efforts at extending full human rights protections to transgender people.

Sketch of the differences in the situations of TG and TS people in different countries around the world.

The powerful role of the internet is now playing in helping transgender and transsexual people.

Hopes for the future.

 

 

 

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GENDER BASICS:

 

 

Gender is the most fundamental part of one's identity as a human being. The very first question everyone asks about us is "Is it a boy or a girl?"

 

Important though it is, most people never think much about gender. They have no idea what causes their sense of being a boy or a girl, a man or a woman. Having never suffered mis-gendering, they take their gender for granted like the air that they breathe, never giving it a second thought. It is an unquestioned birth privilege to have a gender.

 

Conventional wisdom says that people are either boys who grow up to become men, or they are girls who grow up to become women. There are only two possibilities, and you are either one or the other. It's obvious at birth from your "genital sex", and that's all there is to it! However, as we will see, reality is not that simple.

 

 

What makes us a boy or a girl? What determines our gender identity?

 

During early pregnancy, a fetus that has male genes (XY chromosomes) usually develops into a boy with male genitals. It develops into a girl with female genitals if it has female genes (XX chromosomes). This happens well over 99% of the time. Doctors and parents look at an infant's genitals at birth, and simply declare it to be a boy or a girl.

 

Those declared to be boys usually grow up into men having a male gender identity, and those declared to be girls usually grow up into women having a female gender identity. Again, it all seems pretty straightforward.

 

Although more than 5% of all men and women will grow up to be gay, and will seek love partners of the same sex and/or gender as themselves, they too usually have normal male and female gender identities as men and women, respectively.

 

Intersex conditions - including intersex babies whose gender is ambiguous at birth:

 

Although most infants appear to be either normal boys or normal girls, various genetic and developmental effects can lead in some cases to infants having ambiguous genitalia, so that even the doctors can't be sure whether it's a boy or a girl. In other cases, the genitals look correct for one gender, but aren't consistent with the infant's genes. In yet other cases the child's genes are something more complex than just XX or XY, and the child's gender identity and physical gender trajectory as they mature may be difficult to predict in advance. Children having these genital and/or genetic variations are called "intersex".  Intersex babies are produced in about one in every 1000 births.

 

For example, in about one in 13,000 births an XY (genetic male) fetus is unresponsive to fetal male hormones, and develops genitals that look like a girl's, except for a lack of internal reproductive organs. These XY "complete androgen insensitivity syndrome" (cAIS) infants are simply declared to be girls and are raised as girls. Although they cannot bear children, they often develop into slender, attractive women who have a female gender identity. It's rumored that a number of beautiful models have been cAIS girls.

 

In other births, a "partial androgen insensitivity syndrome" (pAIS) results in the external genital appearance may lie anywhere along the spectrum from male to female. (See the Androgen Insensitivity Syndrome Support Group (AISSG) website for more information about AIS conditions). Incredibly, many of these girls are never told about the true nature of their conditions, because their doctors and families feel such shame and embarrassment about thes "terrible secret" that these girls have male genes. Instead they are usually told things like "you didn't develop any female internal organs, and thus can't have babies", and often discover the truth about themselves by accident later in life (for example, read Sherri's Story on the AISSG website).

 

Our society is almost completely unaware of the existence of cAIS girls, and this had led to many problems for them. For example, for more than thirty years the International Olympic Committee (IOC) has conducted genetic "gender-testing" on all women athletes to make sure that they were "really female" (this was done to prevent "sex changes" from competing). In quite a number of cases these tests turned up cAIS girls, identified them as "males", and disqualified them from competition. These were truly tragic mis-identifications, since the presence of the Y chromosome in AIS girls does not make them males either genitally or in gender identity, nor does it confer any strength advantage to them. These mis-genderings were often made public, resulting in total humiliation for the women involved.

For an overview of the many categories and prevalence of intersex conditions, see the Intersex Society of North America's page entitled "How Common Are Intersex Conditions?". For extensive historical and medical information about intersex conditions and about social and medical reactions to those conditions, see the excellent textbooks Intersex in the Age of Ethics and Hermaphrodites and the Medical Invention of Sex, by Prof. Alice Dreger, Ph.D., of Michigan State University:

 

 

 

 

The existence of XY (genetic male) intersex infants who have female genitals and who grow up to have female gender identity (the cAIS girls), was one of many early-known facts of intersexuality that led scientists years ago to recognize that gender identity IS NOT determined directly by having XY vs XX genes. Instead, they theorized that gender identity must be neutral at birth, and is determined later in early childhood by one's genitalia and upbringing. The leading proponent of this theory was John Money of Johns Hopkins University.

 

According to this theory, a child having a vagina and raised as a girl will grow up to have a female gender identity, independent of her genes. Similarly, it predicted that a child having a penis and raised as a boy would grow up to have a normal male gender identity, independent of his genes. If the child's gender identity didn't turn out according to this scheme, psychologists and psychiatrists assumed that something "went wrong" in the child's upbringing, or that the child was mentally disturbed or delusional in some way (i.e., "mentally ill"). Corrections to any gender identity problems were sought through psychiatry, on the assumption that this "mental disturbance" could be reversed.

 

The practice of "surgically correcting" the genitals of intersex infants to make them "normal":

 

By the 1960's, advances in plastic surgery combined with the "Genitals + Upbringing" theory of gender identity led physicians to recommend "corrective" surgeries on many types of intersexed infants. The idea was to make the genitals look cosmetically correct for a boy or girl, and then raise the child in the corresponding gender, believing that the child would grow up to have a correspondingly normal gender identity.

 

John Money of Johns Hopkins University, who gradually became the medical community's dominant authority-figure in "gender-identity studies", was the leading advocate of such treatments. A believer in behaviorist psychology, in which the mind of the infant is thought to be a blank slate having no inherent personality characteristics, John Money theorized that gender identity was solely the product of upbringing and socialization.

 

The motive for doing "corrective" surgeries on infants was to solve the "social emergency" caused by an intersex birth. The very existence in nature of many intersex babies, with their many variations of genitalia, breaks down the strict male-female gender dichotomy of our culture. Thus the existence of intersex babies brings into question many deep religious and legal strictures. Parents and doctors are under incredible social pressure to eliminate these variations. John Money provided a theoretical rationale which validated intersex infant "corrective" surgeries, and made them appear to be "scientifically sound".

 

Since it was easier to surgically "make a girl" than to "make a boy", it frequently happened that XY intersex boys having small or missing penises were turned into girls. The fact that sensitive genital tissue was lost in the process didn't deter the surgeons, because for many years our society did not openly recognize that most women have strong sexual feelings and a capacity for orgasm. If the infant was turned into a girl, doctors didn't worry about whether she would later have strong erotic genital sexual feelings and enjoy lovemaking; they only worried about whether she would function sexually for her male partner's pleasure.

 

Surgeries on intersex infants have been done for many years now, with a frequency of about 1 in every 2000 births. In most cases the surgeries create girls. Amazingly, there was never any organized scientific follow-up to see how these cases turned out!

 

Even in the early years of these surgeries, there were people urging caution, most notably a young researcher named Milton Diamond, now a Professor at the University of Hawaii. While still a graduate student, Diamond made an audacious challenge to Money's theories in a 1959 paper entitled "A Critical Evaluation of the Ontogeny of Human Sexual Behavior". Diamond's insights were based on his own observations in animal experimentation. He further marshaled "evidence from biology, psychology, psychiatry, anthropology, and endocrinology to argue that gender identity is hardwired into the brain virtually from conception" (see As Nature Made Him, p.44).

 

However, the notions that human beings had "advanced beyond the influences of biological evolution in matters of sexuality", and that one's sexuality and gender were socially constructed, had already been deeply imprinted in the medical community. Under the influence of the "gender prophet" John Money, this view dominated medical and psychological thinking for the remaining decades of the 20th century. Infant intersex surgeries were performed by the thousands during those decades, and again without any follow-ups. Only as the century was closing did awful questions begin to arise, as occasional rare follow-ups revealed things hadn't turned out as Money predicted.

 

How these attempted "corrections" reveal that old theories of gender identify formation were wrong:

 

In recent years, many intersex people have "found each other" via the internet and begun to compare notes about their situations. As a result, it's become clear to intersex people themselves that many of the "corrective" surgeries didn't work out according to their doctors' theories. Instead, many intersex people were left genitally maimed by those infant genital surgeries. Many were also suffering from gender identity crises, because of having undergone arbitrary gender reassignments based on what it was "easiest for the surgeons to do".

 

Under pressure from intersex activists, especially the newly formed ISNA, follow-up studies have finally begun on infants who were "surgically corrected" over the years. The first such study, of 25 genetically XY boys who had missing penises as infants (cloacal exstrophy syndrome) and who had been surgically turned into girls and raised as girls, revealed that all 25 developed MALE gender identities.

 

Those kids, although raised as girls, had all exhibited the rough and tumble play of boys when young. By their teens, each of these kids insisted against all evidence of their female genitalia and upbringing that they were boys, and wanted to be changed into boys. Many of them desperately sought girlfriends, just as might any other teenage boys.

 

Instead of reversing their innate gender identities and turning these intersex boys into girls, the infant surgeries effectively turned them into the equivalent of female to male transsexuals! Many of these boys have since undertaken hormonal and social gender reassignment from female to male. Tragically, the effects of their infant genital surgeries preclude the surgical reconstruction of male genitalia and in many cases even preclude them from experiencing sexual pleasure and orgasm.

 

More lessons from intersex people about gender identity:

 

These recent studies call into question the entire existing practice of genital surgery on intersex infants.

 

The studies then do something even more awesome: They turn on its head the theory that genitals and upbringing determine gender identity, triggering a paradigm shift in the medical community's overall thinking about the underlying nature of gender identity. The personal experiences of intersex people who have traveled different gender trajectories (some "corrected" as infants, and some not) are now becoming more widely known about, and are helping build a deeper understanding of the many variations in gender identity that are independent of one's physicality.

 

For example, in intersex conditions such as XY-Turner mosaic (mixed gonadal dysgenesis) a child may appear to have normal male genitalia at birth and be raised as a boy, but then not masculinize at puberty and instead remain slight and feminine appearing. These teens can face great difficulties if their condition goes undiagnosed and/or if they do not become aware of good options for treatment. If they do not have a well-established male gender identity, they may face a difficult choice of whether to undertake testosterone treatments to masculinize and become men, or undertake estrogen treatments and genital surgeries to become women. In some cases, XY-Turner teens have female gender identities and if given a choice in the matter will chose reassignment as females.

 

The article "What do children know?", by Jane Spalding tells the compelling story of such a child who was raised as a boy, but who had a female gender identity and who sought hormonal and surgical reassignment as a female during her twenties. The existence of such cases further refutes John Money's proclamation that genitalia and upbringing establish gender identity:

 

Jane Spalding

 

Misguided by Money's theories for many decades, the medical profession has caused the irreversible physical maiming of thousands upon thousands of intersex babies. For compelling insights into the traumatic life experiences of an intersex person who was surgically "corrected" at birth, and who grew up without ever being told what had been done, see the recent interview of Cheryl Chase in Between the Lines: coming to terms with children born "intersexed", by Victoria Tilney McDonough.

 

Cheryl was the founding Director of the Intersex Society of North America (ISNA), and the early leader of the movement to end shame, secrecy and unwanted genital surgeries for people born with atypical reproductive anatomies. ISNA is working to end the idea that intersexuality is shameful or freakish. In the U.S. alone, five children are subjected to harmful, medically unnecessary sexual surgeries every day. ISNA urges physicians to use a model of care that is patient-centered, rather than concealment-centered. For more insight into these issues, see the Discovery Channel documentary "Is it a Boy or a Girl?", which was produced with ISNA participation.

 

Cheryl Chase, Founding Director of ISNA

"When an intersex baby is born, the default is usually to

perform surgery," says Cheryl Chase, who was surgically

"reassigned" female when she was 18 months old.

"Doctors want to 'fix' what is not right, then slap a diaper

on the baby, close the file, and send it off into it's life."

 

 

The theory that gender identity is socially constructed is finally shattered:

 

The breakaway from John Money's paradigm escalated rapidly after the scientific community learned that Money had suppressed for many years clear evidence that his theories were wrong. The final straw was the highly publicized case of "John/Joan", presented in the book As Nature Made Him: The Boy Who Was Raised as a Girl, by John Colapinto.

 

Decades ago, John Money had advised the parents of an infant boy who had lost most of his penis in a medical accident to have the boy surgically changed into a girl - under the theory that "she" would then grow up to be a normal girl instead of an "abnormal boy". This was a very noteworthy case for scientific researchers because the child was born with an identical twin who could serve as a basis of comparison in the study of gender development. As a first step, the child was castrated and the rest of his penis removed. He was then raised as a girl. However, clearly exhibiting an innate gender identity as a little boy, "she" began to declare that "she" was "really a boy" and rebelled against efforts to make "her" behave like a girl. At puberty, still unaware of "her" childhood surgery, she resisted her parent's and physician's efforts to feminize her with estrogen and further surgeries. Eventually, she underwent gender transition to become male, much as would an FtM transsexual. In this case, raising a boy-child with female genitals as a girl clearly did NOT alter the child's inborn sense of his own true gender.

 

Over many decades, John Money continually referred to the John/Joan case as a victory, fabricating facts to indicate that this case had been a "complete success". Money never "allowed" anyone to get close to "Joan" to learn more details about her life, begging off any contact in the name of "privacy". The case gradually became so legendary that it became the cornerstone of support for Money's entire theory of gender.

 

And then the shattering news came down, in the revelations that John Money knew full well that the infant's reassignment had not worked at all. And worse yet, he had deliberately concealed this counter-evidence to his theories for decades - decades during which thousands more infants had been subjected to infant intersex surgical maimings. Fittingly, it was Professor Milton Diamond, the scientist who'd bravely challenged Money as a young graduate students decades earlier, who uncovered the deception.

 

Professor Diamond had always been suspicious of Money's results. Over the years he had tried in numerous research studies and papers to persuade others to at least consider the possibility that gender identity was inborn. However, his efforts were to no avail, given Money's intellectual dominance of the field.

 

Finally, in the early 1990's, Diamond managed to track down the child "Joan", now presumably a grown woman, whose case had been the foundation of Money's entire viewpoint. Wanting to simply confirm what had or had not happened to her, Diamond had stumbled into the incredible fact that "she" had never felt like a girl at all, and was now a married man!*

[*The story later came to a very tragic end.  Although "John" had been able to socially and surgically reverse his childhood reassignment and become a male, "he acknowledged a deep well of wrenching anger that would never go away. "You can never escape the past," he told the Seattle Post-Intelligencer in 2000. "I had parts of my body cut away and thrown in a wastepaper basket. I've had my mind ripped away.""  "John" committed suicide on May 4 2004.]

Diamond and a colleague, Sigmundson, then worked tirelessly to document what had happened in this case, and they wrote a journal paper to reveal the results. The paper was so controversial that many research journals simply turned it down! So great was the influence of Money and the knee-jerk buy-in into his now established paradigm of thought about gender identity. The various journals simply could not believe the evidence that was staring them in the face!

 

The paper, "Sex Reassignment at Birth: Long Term Review and Clinical Implications" by Milton Diamond & H. Keith Sigmundson, was finally published in 1997 in the Archives of Pediatric and Adolescent Medicine. There was a firestorm of reaction in the media and the research community to its astonishing news. John Money was publicly revealed to have falsified evidence and suppressed counter-evidence in the case that was the cornerstone of his entire theory of gender identity. Within two years the writer John Calapinto's published a detailed account of the overall story, bringing it to the public at large.

  

 

 

 

The story of John/Joan obtained early public notice in an article by John Colapinto in The Rolling Stone on Dec. 11, 1997 entitled "The True Story of John/Joan". Here's an excerpt from the last page of that article:   " - - - His story has shaken to its foundations the edifice constructed on John Money’s theories from the 1950s. And it has exposed a central flaw in a theory that has held sway for most of the 20th century. It was Sigmund Freud who first stated that a child’s healthy psychological development as a boy or a girl rests largely on the presence, or absence, of the penis – the notion central to Money’s theory of sexual development and the ultimate reason that John Thiessen was converted to girlhood in the first place. It is a notion that, today, has also been called into question by neurobiological research that, in the sexual realm, is leading scientists toward the conclusion that, as Dr. Reiner puts it, "the most important sex organ is not the genitals; it’s the brain - - - "

 

 

 

John Money, Ph.D. Gender "theorist" who claimed that gender identity is socially constructed. Purveyed his views by personal dominance of his field and by falsification and suppression of research data contrary to his views.

Milton Diamond, Ph.D. Professor of anatomy and reproductive biology who shattered Money's long-held theory that gender identity is socially constructed. His work instead strongly suggests that gender identity is biologically innate.

 

Professor Diamond has since won important awards for his work. Director of the Pacific Center for Sex and Society at the University of Hawaii, he has written widely on issues of gender identity and intersex surgical interventions. I highly recommend his papers to you (see for example Sex and Gender are Different: Sexual Identity and Gender Identity are Different and An Emerging Ethical and Medical Dilemma: Should Physicians Perform Sex Assignment on Infants with Ambiguous Genitalia? ).

 

The refutation of John Money's theories is finally leading to a paradigm shift not just in the scientific community, but also in the medical community - although progress there will be slower, given the lingering influence of Money's views among medical "elders". It is also leading to legal assaults on the continuation of infant genital surgery by "traditional surgeons". See in particular the recent article in the Yale Law Review which outlines the emerging understandings of the medico-legal issues in this area.

 

 

 

The theory that prenatally established brain and CNS structures determine innate gender feelings and gender identity:

 

Well now, if it isn't the genes that determine gender identity (cAIS girls disprove that), and if it isn't the genitals and upbringing that determine it (cloacal exstrophy boys disprove that), then what the heck does determine a person's gender identity?

 

Scientific evidence has been growing that somehow certain brain-structures in the hypothalamus (the BSTc region) determine each person's core gender feelings and innate gender identity. These structures are "hard-wired" prenatally in the lower brain centers and central nervous system (CNS) during the early stages of pregnancy, during a hormonally-modulated imprinting process in the central nervous system (CNS).

 

It appears that if those brain and CNS structures are masculinized in early pregnancy by hormones in the fetus, then the child will have male percepts and a male gender identity, independent of whether the genes or genitalia are male. If those structures are not masculinized in early pregnancy, the child will have a female percepts and a female gender identity, again independent of the genes or genitalia. As in the case of intersex infants having ambiguous genitalia, there are undoubtedly many degrees of cross-gendering of brain and CNS structures, so that while some infants are completely cross-gendered others are only partially cross-gendered. 

 

More recent research indicates that the brain begins to differentiate in embryonic males and females even earlier, possibly before embryonic sex hormones come into play, and under mechanisms still not yet understood - with gender identity then becoming a complex effect of the interaction between earlier brain differentiation and later embryonic hormones. For more on this emerging research, see: "Brain development: The most important sexual organ", in Nature magazine, January 29, 2004  (Nature 427, 390 - 392)

 

That is why it is possible for some children to have gender identities inconsistent with their genes. In cAIS cases, for example, those girls’ brain structures are likely insensitive to the masculinization effects of fetal testosterone, as were their genitals. Therefore, they develop the brain structures and gender identity of females, even though they are XY genetically.

 

That is also why it is possible for some children to have gender identities inconsistent with their genitalia and upbringing. In the case of the boys with cloacal exstrophy ("micropenises"), their brain-structures and CNS presumably did masculinize under the influence of fetal testosterone, leading to later male gender identities even though they had been surgically "turned into girls" as infants and raised as girls.

 

Those recent cloacal exstrophy observations are already having a profound impact in the medical research community. They are to the science of gender much like the Galileo's observations of the moons of Jupiter.

 

These are dramatic, unprecedented, undeniable observations that shift the previous paradigm of thought, and do so in an area of science that had been subject to much misinformation and taboo. In Galileo's case, the shift was from an 'earth-centered universe' to a 'sun-centered universe'. In the cases here, the shift is away from a 'genitals + upbringing' theory of gender identity to a 'CNS neurobiological developmental' theory of gender identity.

 

The implications of this paradigm shift are far reaching, especially for those who suffer from cross-gender identities. Instead of those gender feelings being considered to be "psychological", they can now be understood as being "neurological" in nature.

 

Listen carefully to the conclusions of William Reiner, M.D., a pediatric clinician and researcher at The Johns Hopkins Hospital, based on his work with intersex children (Reiner is now an investigator in the Cloacal Exstrophy follow-up study, which now confirms these conclusions):

 

 

"In the end it is only the children themselves who can and must identify who and what they are. It is for us as clinicians and researchers to listen and to learn. Clinical decisions must ultimately be based not on anatomical predictions, nor on the 'correctness' of sexual function, for this is neither a question of morality nor of social consequence, but on that path most appropriate to the likeliest psychosexual developmental pattern of the child. In other words, the organ that appears to be critical to psychosexual development and adaptation is not the external genitalia, but the brain." William Reiner, M.D., To Be Male or Female--That is the Question, 151 Arch Pediatr. Adolesc. Med. 225 (1997)].

 

  

It is amazing that psychiatrists completely missed all of this in the past, and so long assumed that gender identity was neutral at birth and later established by social interactions. Mis-gendered people themselves have long reported their problem not as one of THOUGHTS, but of cross-gendered percepts and BODY FEELINGS - as a little child the gendered feelings of how your body wants to move, how you respond to being touched, how aggressive or cuddly you are, how you interact with other little children. Then, after puberty, one's feelings upon being sexually aroused, and whether those deep urges are male (mounting urges) or female (urges of being manipulated and penetrated).

 

One doesn't "think up" these CNS-produced male/female gender and sexual feelings, one simply perceives them! The basic perceptual mechanisms involved are hard-wired, and cannot be changed by psychiatric means any more than one could permanently change one's sense of feeling hot into that of feeling cold and vice-versa.

 

Whatever in-utero process produces it, a person's gender feelings and gender identity are at the very core of their being. Gender identity is fixed, immutable and irreversible by any known medical or psychological means. We also now know that there is only one method for determining your gender identity. We have to ask YOU! Your gender is a percept: You are the only one who knows for sure what it is, and no one else can tell you what it is.

 

 

 

 

TRANSGENDERISM:

 

 

Now that we know some basics about gender and gender identity and have some insights into the difficulties faced by intersex people, we're prepared to learn about and understand transgenderism and transsexualism.

 

In this webpage we focus on male to female [MtF] conditions, since those are within Lynn's direct experience. However, there is a completely symmetrical set of female to male [FtM] gender conditions that are almost as common as MtF conditions. For more information about FtM transgenderism and transsexualism, see the websites of FtM International and The American Boyz. The article "Girls will be Boys", by T. Eve Greenaway discusses the sudden emergence of FtM trangenderism out of the shadows and into the open in many U.S. colleges and universities. For in-depth background on FtM transgenderism and transsexualism, see the recent book by Jason Cronwell, Transmen & FtMs, and also Jamison Green's book "Becoming a Visible Man". See also Lynn's new webpage listing weblinks and photos of Successful TransMen (es).

 

 

Introduction:

 

Hidden away and seldom talked about is the fact that some apparently normal boys aren't boys at all, but should have been girls. Although they have normal XY genes, normal male genitalia, and are raised as boys, they nevertheless have the gender feelings, body feelings and gender identity of girls. Similarly, some girls aren't girls at all, but should have been boys. It doesn't happen very often, but it does happen. And it's always been that way.

 

Perhaps once in every 200 to 400 births something must go amiss in the early stages of pregnancy so that sex hormones do not have the usual action on the integration of the fetus's brain. In these cases, children are born having a brain-sex (neurological sex) and innate gender identity opposite to that indicated both by their genes and their genitalia. Since these infants look normal, they will be raised in the wrong gender for their brain-sex (neurological sex). Being raised in the wrong gender causes them profound gender dysphoria and mental anguish as they grow up. These are the "transsexuals" (TS), the most intensely affected of the "transgendered" (TG).

 

In many more cases, perhaps as many as one out of every 50 children, it appears that the "transgendering effect" is less pronounced but still present to some degree - and this occurs in both boys and girls. We can estimate these numbers from the numbers of gender-variant people who have always coalesced in and around the gay community. Although a small fraction of that community, they are perhaps as much 1% to 2% of the overall population. This group of children presents a wide range of variations in cross-gender feelings (just as the group of intersex children present a wide range of genital configurations). Many of these transgender children will have major adjustment problems if forced into too strict a gender role.

 

Women notice these cases, especially the very feminine little boys who really should have been girls. They'll often even say among themselves "he should have been a girl". These common-sense reactions to feminine boys are seldom discussed outside the closed company of women. Fathers especially will make every effort to "straighten out" such boys. The feminine boy is mistakenly thought of as "pre-homosexual". Every effort is then made to "save the boy from that fate". On the other hand, the girl who feels like a boy can often become a "tomboy" and not get criticized for that - in fact she may even gain approval for being outgoing and aggressive and tomboyish in our male-dominated society. However, she may still feel the same degree of gender angst about her assigned gender role as does the MtF transgender boy.

 

There is no social script for such a boy to tell someone "I feel like I'm a girl", and to get active assistance with their gender problem. Instead, transgender youngsters often pick up the idea from parents and school-mates that they are "going to be gay men". Some may later even try to "become gay" and be accepted in the gay male community, when in fact that very seldom works. Gay men seek men as partners, not people whose gender identity is female. The last thing in the world that an MtF youngster could ever become is a gay male who is into his masculinity and his male parts even more than the average guy!

 

Many other transgender youngsters will secretly find ways to cross-dress in girls' and women's clothes as a way of exploring and enjoying their feminine gender feelings, often starting to do this well before puberty. The denial of opportunities for openly expressing their gender longings and the need to maintain complete secrecy about their crossdressing are often the source of tremendous angst, anxiety and depression among these kids.

 

A few MtF transgender and transsexual teenagers will try to appear openly as pretty girls, and may attract straight boys as love partners (i.e., boys who will love them as girls). Other MtF teens will seek the company of girls, and will become attracted to them and love them as if they themselves were lesbian. In such cases, if their girl friends are accepting of them, they can be wonderful and attentive lovers and partners. However, many transgender youngsters will become so ashamed and humiliated by their female tendencies that they will hide their "terrible secret longings" from everyone, sometimes even from themselves, for a long, long time.

 

For those who are strongly transgender or transsexual, living without having a properly assigned gender produces a nightmarish separation from the dance of life. Whether it's dating, finding love, courting, marrying, raising children, and generally doing all the little everyday things that continually celebrate one's own gender, the transgendered are often left stranded on the sidelines, to watch as spectators. Or worse yet, while feeling ugly and ludicrous in their male social appearance, they are forced to "act out" empty of all feeling a role that is alien to their inner female nature.

 

The overall name for the intense form of these cross-gender feelings is "gender dysphoria". (This condition is often called "gender identity disorder" (GID). However, we refrain from using the word "disorder", because we consider this condition to be a natural variation in human gendering. Instead we use the phrase "gender dysphoria", referring to the angst felt at being forced to live in the wrong gender).  For a more formal description of "GID" and background on exploratory research in this areas, see the following links at the Gender Identity Research and Education Society (GIRES) website:

 

 

GIRES Main Page Gender Dysphoria [2004] Definition and Synopsis of the Etiology of Adult Gender Identity Disorder and Transsexualism.   "In conclusion, transsexualism is strongly associated with the neurodevelopment of the brain...The condition has not been found to be overcome by contrary socialisation, nor by psychological or psychiatric treatments . . . Individuals may benefit from an approach that includes a programme of hormones and corrective surgery to achieve realignment of the phenotype with the gender identity, accompanied by well-integrated psychosocial interventions to support the individual and to assist in the adaptation to the appropriate social role . . . Treatments may vary, and should be commensurate with each individual's particular needs and circumstances."    - Quote from the GIRES synopsis of current research on the etiology of GID; this document was signed by the world's leading researchers in the field.

 

 

Counseling and medical treatment of transgender and transsexual women:

 

Gender counseling services and support groups now exist in many major cities to help the transgendered diagnose their conditions and become aware of options for social gender-change and for medical help. The web now offers a large number of transgender and transsexual support sites that provide a wide range of practical information regarding counseling and transitions. Many of those sites keep up-to-date lists of service providers for TG/TS people (counselors, electrologists, endocrinologists, surgeons). Some of these websites (such as the TG Forum) also list clubs, support groups and important national-level events where TG people can congregate for mutual support.

 

In many cases, relaxed gender constraints and flexibility of dress, mannerisms and presentation can ease the discomfort of the transgendered and greatly improve their opportunities for honest self-expression and for a sense of well-being and happiness. In many cases where the individual finds some degree of inner peace and self-acceptance that way, they can go on to find love and enjoy life fully without further gender modification efforts.

 

However, people having very strong transgender feelings may consider making physical changes by taking sex hormones and social changes by permanent cross-dressing, and thus undergoing a "transgender transition", usually with the advice and guidance of a practical-minded gender counselor. Many people now pass through transgender transition each year, and then live out their lives in the social gender they feel most comfortable in, while remaining somewhere in the middle of the physical gender spectrum (i.e., without undergoing sex reassignment surgery to modify their original genitalia).

 

The gender trajectories of TG women vary considerably from person to person, depending upon many factors including the intensity of their condition and the initial timing and method of openly expressing their condition.

 

For example, in past decades it was very common for intense young TG girls to migrate towards the gay "drag scene" (see below), where they had opportunities to openly cross-dress and perform in public, and to experience being attractive to men and in gaining the favors of men (albeit gay men, who thought of them as boys). It was no secret that there was always a minority of the gay "drag queens" who were not gay boys at all, but who were actually transgender (or even transsexual) girls.

 

With the recent proliferation of heterosexual male crossdressing clubs and groups (see below), and the many opportunities these days for safe crossdressing in such environments, it has nowadays become even more common for young TG people to initially think of themselves as being male crossdressers and to be attracted to the crossdressing scene. Only over time do they realize that they are not solely interested in crossdressing for the autosexual sensual buzz. Sensing that they are not really like the majority of male crossdressers (who usually have wives and girlfriends at home), they begin to confront their underlying gender dysphoria. Once this awareness of difference develops, the TG person usually migrates away from the CD scene, and on into interactions with gender counselors and TG support groups.

 

National-level gender conferences also now enable people who are just beginning to explore their gender issues to anonymously attend one big event and get an introduction to the entire range of transition options. Conferences such as Southern Comfort and the Colorado Gold Rush, although mainly being big gatherings for heterosexual crossdressers, also include excellent clinics and workshops to help people get started on gender transition. Anyone questioning their gender identity can attend one of those conferences (in boy or girl mode), meet and talk with people in all stages of transition, and quickly gain a lot of information into the how-to's, challenges and possibilities of transition.

 

The web has had a profound effect on the TG world by stimulating very rapid propagation of knowledge about transition, and by helping people network and share information. With the emergence of the web and the widespread availability of electronic information of transgenderism and transsexualism, many TG people now bypass the gay drag clubs and heterosexual male crossdressing scenes for their first gender explorations. Instead they go directly to the big gender conferences, to gender counselors and to TG support groups for assistance, and quietly and rather anonymously explore their options for gender modification and possible transgender transition. Intensely transsexual (TS) girls also sometimes undertake TG transition and live as TG women for extended periods of time before undergoing sex reassignment surgery (see Part II: Transsexualism).

 

Transgender transition doesn't require anyone's or any authority's "permission", although it is usually done with the coaching of a gender counselor. The MtF TG transitioner works hard to feminize their appearance and manners as much as possible by taking female hormones, removing facial hair via electrolysis, and making adjustments to the voice and many other behaviors. Some TG transitioners will also undergo cosmetic surgery to improve facial features and/or augment their breasts. Once these changes have proceeded far enough, the person then transitions socially by permanently dressing in their new gender, legally changing their name, and getting all their identification shifted into their new name and gender (which is now relatively easy to do in many states in the US). There are still many difficulties on this path, because society does not yet readily accommodate someone who is physically "in-between" the two standard genders. However, in some cases transgendered women who have transitioned have become very successful in life, have gone on to fine careers and have found wonderful love-partners too.

 

Some examples of TG women and their stories are found in the following photos and weblinks. These photos show the possibilities for successful transgender transitions without SRS (although some of these women have or will go on to complete transsexual transitions, by also undergoing SRS):

 

Calpernia Addams in 2000:

A beautiful transgender woman

who has been feminized by taking estrogen

For more about Calpernia, see Part Ia.

Since this photo was taken Calpernia has undergone SRS.

See Calpernia's new webpage and her new book Mark 947.

Her story is also told in the movie Soldier's Girl.

 

 

 

Chrysis, a stunning TG woman who was a cabaret

performer in New York City in the 70's and 80's.

Here we see Chrysis with Nick Nolte, on the set

of the movie Q&A (in which she appeared)

 

 

 

 

Carla Antonelli, a beautiful trans actress from Spain.

 

 

 

 

Miriam, a stunning transgender woman from the UK.

Miriam is very happy as she is, and is not planning to have SRS.

Miriam was the subject of a controversy recently

regarding her appearance in a "reality TV show" in the UK.

 

 

 

In the more intense cases of transsexualism, the TS girls' initial trajectories may appear similar to those for TG people. However, the ultimate resolution of their condition requires more than just a hormonal and social-gender change. The only way for them to resolve their condition is to also completely change the physical sex of the body to match their innate gender feelings. This means undergoing a "transsexual transition", which in the case of a male to female (MtF) transsexual involves completely changing the body from that of a boy to that of a woman. This is done by taking female sex hormones AND by undergoing sex reassignment surgery (SRS) to reconstruct the genitalia from male to female. Transsexual transition in the U.S. is conducted under formal medical protocols that require counseling, hormone therapy, and a "real life experience" of at least a year of living and working in the new gender before the patient is recommended for SRS (see Part II. Transsexualism)

.

 

Harisu, a pretty young Korean transsexual girl who transitioned in her teens with the help of her mother and had MtF sex reassignment surgery at age 19. Harisu thus underwent 'transsexual transition' and is now a postop TS woman.

 

 

 

Dana International, a pretty young Israeli girl who transitioned during her teens and had SRS at age 22 . Dana was a drag cabaret performer in her teens, and went on to become a world-renown singer as a postop TS woman.

 

 

There are at least 32,000 to 40,000 post-operative transsexual women in the U. S. (see TS Prevalence information, in Part II ). About 1500-2000 U. S. residents now undergo male to female sex reassignment surgery each year, so the overall number is expanding fairly rapidly. As we'll see, many of these women have gone on to very successful lives after TS transition.

 

The numbers of transgender women and the numbers undergoing transgender transition are many times those numbers for transsexuals. Therefore, it is likely that many hundreds of thousands and perhaps several millions of people in the U.S. are transgendered.

 

 

Other conditions that overlap with or are often conflated with transgenderism and transsexualism:

(i) being Gay (ii) Drag Queens, (iii) "Female Impersonators", (iv) Crossdressers ("Transvestites"), (v) Travestis ("She-males"), (vi) Fetishists and (vii) Others

 

Transgenderism and transsexualism are often mixed up with other common conditions involving cross-gender behaviors or appearances. We can learn more about transgenderism and transsexualism by contrasting them with these other conditions, and by visualizing the sometimes blurred boundaries that exist among these conditions.

 

As we discuss these conditions, remember that "labeling" is very imprecise in this field. Different people label things differently. Some people consider ALL situations involving cross-dressing as being under the "overall transgender umbrella". However, there are fundamental differences between those people who have cross-gender identities significant enough to lead them to transition (TG and TS people), as compared to those transvestites or gay male drag queens who are male-gendered. Unless those differences are well understood, lumping these situations together under one label can cause major confusion.

 

These confusions can also affect young TG/TS kids themselves as they struggle with their gender issues early in life. As we'll see, many TG/TS kids initially think that they must "be gay", or that they are "drag queens" or "crossdressers", as they try to pattern on something that seems to speak to their issues. As a result, many young TG/TS people migrate through the gay club scene and the crossdressers' clubs, on the route to working out their gender issues.

Also note that the emotions and feelings of gender variance are expressed in different ways in different cultures, depending on available social roles in which transgender people can exist in each culture.  Different words may be used to describe of gender-variant people in a particular culture.  These “types” vary widely from culture to culture, and evolve over time within each culture. See Lynn's page regarding the situations of TG/TS people in different countries and also the TransgenderAsia website, for examples of widely varying transgender typing in many different cultures.

See also the following page concerning the difficulties in cross-cultural communications and language translations regarding gender variance. As one example, that page discusses how the word “travesti” in Romance languages (such as Spanish, Portuguese, Italian, etc.) is very often confused with the word “transvestite” in English (a word that has a very different meaning). As we will learn, gender-variation typing and labeling are highly culture-dependent and language-dependent, and are very inexact practices.

 

 

 

(i) confusion of TG'ism and TS'ism with being Gay:

 

Over 5% of all men and women are gay, and prefer to mate with love-partners of the same sex and/or gender. This innate feeling of same-sex attraction in many people is a part of human nature. It has always been so, in spite of ongoing efforts by various religions and societies to stamp it out. It seems that love always finds a way to thrive, in spite of all obstacles.

 

Because being gay is so common, transgenderism and transsexualism are most often confused with simply being gay, and in fact confused with being "really, really gay". The first thing that pops into the people's heads when they hear that someone is transsexual is, "wow, I didn't know 'he' was gay".

 

It's easy to see how people might jump to this conclusion. Seeing an MtF TS woman with a straight man as her partner, they simply think that she is (or was) a "gay man". They jump to the conclusion that "he" changed sex simply in order to attract men as partners. However, this is a totally mistaken idea rooted in ignorance about gender identity. And as we'll see, this idea totally mixes up and conflates two totally different kinds of people: transsexual women and gay men.

 

How did the confusions get started? One possibility is that years ago many gay people got into "role-playing". For decades and decades there have been gay men who act "effeminate", and who emulate the "woman's" role in a relationship, even though they are strongly male-gendered and don't feel like women at all.

 

Gays and lesbians have also often allowed themselves more freedom than heterosexuals to break the rules of gender behavior as well—especially within closed or “friendly” social environments. Even so, the majority of gay and lesbian people have gender expressions difficult or impossible to distinguish from that of heterosexuals. 

 

However, effeminate gay men as a minority of the gay male community have been far more publicly visible than TG/TS women, because the gay male community is so large to begin with. After all, over 5% of all men and women are gay, and prefer to mate with love-partners of the same sex and/or gender. Meantime, TG/TS women have mostly had to live in stealth in the past, staying as "invisible" as possible just to survive, and they were much smaller in number than gay men to begin with. All this led many straight folks to confuse "role-players" and feminine-acting gays as being gay men who "really wanted to be women."

 

Such gay role-playing is now mostly a thing of the past, and most gay people nowadays appear to be normally gendered. They "pass" as just plain regular folks in the everyday world. Sure, some gay people still display cross-gender appearances and mannerisms in order to signal their partner preferences, but these people are usually normatively-gendered as men and women. Their "role-playing" displays are about where they fit into the gay world, and aren't usually a gender issue.

 

Now, here's the deal: A gay man has a male gender identity. He is attracted to males who also have a male gender identity, and who are attracted to him because he is a male. The last thing on earth that a gay man would want to do is change sex and become a woman. To do so would be a catastrophically self-destructive act, because of his male gender identity and his love of masculinity both in himself and in his partners.

 

In contrast, an MtF TG or TS woman has a female gender identity. She may be either straight or gay after she transitions. She is either attracted to males who have a male gender identity or to females who have a female gender identity, and who are attracted to her because she is a female. She is desperate to change her body so that she can fully feel like and be perceived to be a woman - both by herself and her lovers. If it turns out that she is "gay" after her transition, it is because she is a lesbian in her new role, not because she is a "gay man".

 

 

 

(ii) Drag Queens:

 

Some gay men occasionally dress in "drag" for fun and as a kind of caricature of women (DRAG = "DRessed As a Girl"). They'll sometimes they "go in drag" to bars and clubs, and sometimes on special occasions and for various fun events. Gay men who are particularly skillful female impersonators perform in drag in various gay nightclubs (such as the club "Oz" in New Orleans). Some of these gay men, such as Ru Paul, have great skills as "illusionists" and have become famous mainstream drag performers.

 

RuPaul - a famous drag performer

 

 

The origins of this fairly common practice go way back in gay culture. These men are called "drag-queens" (DQ) and are usually completely male-gendered gay men. Many of them started in drag as gay teenagers when they discovered it was a way to attract lots of attention from men in gay clubs. They make no permanent body modifications by hormones and rely on great performance skills and skill with clothing, prosthetic props and makeup to create their female bodily images. As gay men they tremendously value their masculine genitals. They are totally turned off by the concept of "sex changes", and would never consider such a thing themselves, any more that any other gay man would.

 

There is a rather large gay-male subculture of drag performers and drag contests all across the U.S., and there is always some small fraction of young gay men who are attracted to the "lifestyle" as it is sometimes called. For many of these young men, even those who aren't particularly attractive as boys, performing in drag in a gay club is a sure-fire way to attract gay male lovers and attention, at least while they are still young. However, outside the clubs these gay boys are almost always boys again, and since they do not take hormones or make major body-feminization modifications very few could pass as women in the light of day.

 

Many transgender and transsexual youths, on learning that they could dress and perform as "girls" in local gay clubs, feel a strong tug to join that scene and initially may even self-identify as drag queens. This has always been a common path for TG/TS kids who are beginning to explore their gender issues. After going to these clubs for a while, these TG/TS girls usually realize that they aren't gay male "queens" after all. Many tire of the attention of gay men who want them precisely because they "are boys", instead of wanting them to love them as women. They gradually learn about other girls who've taken hormones and had electrolysis and breast implants, and who can "pass" as women outside the clubs. Better yet, they hear that some of those girls are finding straight boyfriends who love them as girls. As they learn about the possibilities of "going full-time" by undertaking a TG or TS transition, they may begin to plan their own transition too - and work to move on beyond the part-time gay drag scene and out into heterosexual society as a transitioned woman.

 

Thus there has long been a mixture of DQ, TG, and TS girls in the gay drag scene, because so many TG and TS girls continually migrate through that scene and on out into the world beyond it. Although the majority of girls performing at the gay clubs are gay queens, there are always a few TS's in among them. This isn't a bad way for some TS girls to get started, because drag clubs are often a fun-loving, uninhibited, non-judgmental environments where they can feel very liberated and able to explore their gender issues. For an inside look into "the lifestyle" by a transsexual girl who passed through the gay club scene, see Calpernia Addams' wonderful book Mark 947.

 

For more insight into the world of drag queens, drag performances and drag contests, you can explore the links to drag clubs from many gay male community websites. Of special interest are the major beauty and performance contests, such as the famous Miss Continental pageant (more), which provide opportunities for the expression of feminine beauty by large numbers of DQ's and TG girls. QUEENMOTHER.TV , the online outpost of New York City's thriving drag performance community, is another good window into the drag community.

 

Drag queens (DQ's) themselves are often confused by the public as being "transsexuals", and vice-versa. The extravagant caricatures of femininity presented by many drag queens tends to propagate a misleading image of transgender people as being male-gendered people who like to caricature women in flamboyant ways. Then too, people familiar only with MtF transsexualism may mistakenly assume that a drag queen has a female gender identity, which he generally does not.

 

Some gender theorists consider drag queens to fall under the "transgender umbrella", a term that lumps all gender-variant people together. Lynn finds this over-inclusive terminology very confusing, since the majority of drag queens unquestionably self-identify as male-gendered, do their crossdressing just for fun, and seldom self-identify as "transgender" since they do not have any issues with gender identity. The best way to learn whether a drag queen considers themself to be "transgender" is to ask them, rather than automatically label them that way just because they do drag.

(iii) Female impersonators (FI's), and the historical role of FI clubs in disseminating knowledge about gender transition: