UNDERSTANDING TRANSSEXUAL PHENOMENA
AYESHA BINTI ABDUL MANNAN
Master student
Faculty of Management and Human Resource Development
Universiti Teknologi Malaysia
ABSTRACT.
This paper aims to present an introduction on transsexual phenomena. In addition to that, a discussion on causes of transsexual is also presented. Supplementary to that, this paper also describes four main methods to prevent transsexual. The methods to prevent transsexual phenomena is psychological treatment, diagnosing transsexualism, sexreassignment theraphy and the last one is legal and social aspects.
1.0 INTRODUCTION ON TRANSSEXUAL
Transsexuals can be define as who want to belong to the opposite sex, and transvestites, who only "cross-dress" in their clothes, sometimes live, quite unrecognized, as members of the sex or gender that is not theirs organically. In these cases, the psychological sex determines the social sex, which otherwise follows the sex of assignment at birth, and the sex of rearing in childhood, both based on the anatomical (and legal) sex. These are normally the kinds of sex in which a person dresses and finds his or her place in the world.
The transsexual male or female is deeply unhappy as a member of the sex (or gender) to which he or she was assigned by the anatomical structure of the body, particularly the genitals. To avoid misunderstanding: this has nothing to do with hermaphroditism. The transsexual is physically normal (although occasionally underdeveloped). These persons can somewhat appease their unhappiness by dressing in the clothes of the opposite sex, that is to say, by cross-dressing, and they are, therefore, transvestites too. But while "dressing" would satisfy the true transvestite, it is only incidental and not more than a partial or temporary help to the transsexual. True transsexuals feel that they belong to the other sex, they want to be and function as members of the opposite sex, not only to appear as such. For them, their sex organs, the primary (testes) as well as the secondary (penis and others) are disgusting deformities that must be changed by the surgeon’s knife. This attitude appears to be the chief differential diagnostic point between the two syndromes (sets of symptoms) - that is, those of transvestism and transsexualism.
Transsexualism is a condition in which an individual identifies with a physical sex different from the one with which he or she was born. A medical diagnosis can be made if a person experiences discomfort as a result of a desire to be a member of the opposite sex, or if a person experiences impaired functioning or distress as a result of that gender identification. Transsexualism is stigmatized in many parts of the world but has become more widely known in Western culture in the mid to late 20th century, concurrently with the sexual revolution and the development of sexual reassignment surgeries. It remains controversial, however. Discrimination and negative attitudes towards transsexualism often accompany certain religious beliefs or cultural values. There are other cultures, however, those have not only held a place for transsexuals but even sanction them. Some Native American tribes accept them as two-spirit people.
"Gender Identity Disorder" and "Transsexualism" both appear in the two major diagnostic manuals used by psychologist’s worldwide. They are the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) and the "International Statistical Classification of Diseases and Related Health Problems (10th Revision)" (ICD10). Both terms are used in subtly different ways in the ICD10 and the DSM. In the ICD 10 gender identity disorders are a category under which falls "transsexualism", "Dual Role transvestitistm" and "Gender identity disorder of childhood". Transsexualism is defined in the ICD10 as "A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex." The DSM on the other hand uses "Gender Identity Disorder" as a synonym for transsexualism and defines what it calls "transvestic fetishism" as a separate phenomenon which it says can be present in conjunction with Gender Identity disorder. The DSM specifically defines GID the following way.
From scientific, Transsexual man is who wants not only to appear as a woman by dressing as one, but who actually wants to be a woman in appearance as well as function and wants medical science to make him such as far as that is possible. In other words, it is the man who suffers from a reversed gender role and false gender orientation. He wants to change sex.
As we have seen, these persons, in a strictly scientific sense, fool themselves. No actual change of sex is ever possible. Sex and gender (to repeat for the sake of clarity) are decided at the moment of conception, when either two X chromosomes, one from the father and one from the mother, lay the foundation for a future girl, when one Y chromosome (from the father) and one X chromosome (from the mother) insure the birth of a boy. Nevertheless, the wish to change sex persists, and for all practica1 purposes such can and has been accomplished as far as the individual's future life and position in society are concerned. This alteration, from male to female, concerns only the visible genitalia and secondary sex characters. To the extent of external apearance it can be successful and convincing. If a chromosomal study should be made, however, the true (chromosomal) sex would be discovered and this remains true no matter how long the person may have lived as a member of the opposite sex or what operations or hormone treatments may have been applied.
Many transsexuals have no overt sex life at all. As Burchard has said, the sex drive in some of them is turned inward toward their own ego. Masturbation is then occasionally practiced, but the urge for it is low and under estrogen treatment gets even lower, to the point of zero.
Other transsexuals, however, have a sex life. There are those who still preserve a normal married life, that is to say, with a woman. They say they are able to have sex relations with the help of fantasies, by taking a succubus (under) position in intercourse, or by wearing a female nightgown. Some of these married transsexuals described to me a mental state during intercourse in which the penis seems to lose its identity of ownership. "The penis may just as well be my wife's being inserted into me as vice versa," one patient expressed it. Another one said bluntly, "I don't know whether I screw or am being screwed." Psychoanalysts may find ingenious explanations for such a phenomenon.
Other transsexuals again have normal boyfriends who treat them as girls whether they live as such or not. They hope, work, and save money for the conversion operation so that they can marry legally. Occasionally, the two persons live beforehand as a married couple, nobody but a few intimates knowing that they are actually two genetic males. Of course, there is always the fear of discovery, arrest, scandal, and the like, which keeps their emotional state in a precarious balance.
"Gender Identity Disorder" and "Transsexualism" both appear in the two major diagnostic manuals used by psychologists worldwide. They are the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) and the "International Statistical Classification of Diseases and Related Health Problems (10th Revision)" (ICD10). Both terms are used in subtly different ways in the ICD10 and the DSM. In the ICD 10 gender identity disorders are a category under which falls "transsexualism", "Dual Role transvestitistm" and "Gender identity disorder of childhood". Transsexualism is defiened in the ICD10 as "A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex." The DSM on the other hand uses "Gender Identity Disorder" as a synonym for transsexualism and defines what it calls "transvestic fetishism" as a separate phenomenon which it says can be present in conjunction with Gender Identity disorder. The DSM specifically defines GID the following way.
There are two components of Gender Identity Disorder, both of which must be present to make the diagnosis. There must be evidence of a strong and persistent cross-gender identification, which is the desire to be, or the insistence that one is of the other sex (Criteria A). This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex. there must also be evidence of persistent discomfort about one’s assigned sex or a sense of inappropriateness in the gender role of that sex (Criteria B). The diagnosis is not made if the individual has a concurrent physical intersex condition (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia) (Criteria C). To make the diagnosis, there must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criteria D).
Transsexual men and women desire to establish a permanent social role as a member of the gender with which they identify. Many transsexual people also desire various types of medical alterations to their bodies. These physical alterations are collectively referred to as sex reassignment therapy and often include hormone replacement therapy and surgery. The entire process of switching from one physical sex and social gender presentation to the other is often referred to as transition, and usually takes several years.
The word transsexual has a precise medical definition. It was defined by Harry Benjamin in his seminal book The Transsexual Phenomenon. In particular he defined transsexuals on a scale called the "Benjamin Scale", which defines a few different levels of intensity of transsexualism: "Transsexual (Nonsurgical)", "True Transsexual (moderate intensity)", and "True Transsexual (high intensity)". Many transsexuals believe that to be a true transsexual one needs to have a desire for surgery. However it is notable that Benjamin's moderate intensity "true transsexual" needs estrogen medication as a "substitute for or preliminary to operation." There also exist people who have had SRS but who do not meet the definition of a transsexual such as Gregory Hemmingway. While other people do not desire SRS yet they clearly meet Dr. Benjamin's definition of a "true transsexual". Beyond Benjamin's work, which focused on male-to-female transsexuals, there is the case of the Female to male transsexual for whom surgery is not practical.
The two terms of sex and gender have become popularly used as one concept, which blurs distinction, but they have different meanings. Physical sex refers more to one's biology and anatomy (that is, male or female), where gender is a more socio-cultural term of how a person presents or is taken (that is more at man or woman, or "like" a male or female" (see Milton Diamond, Ph.D. 2001 or U.S.S.C. Justice Antonin Scalia saying, "The word gender has acquired the new and useful connotation of cultural or attitudinal characteristics (as opposed to physical characteristics) distinctive to the sexes. That is to say, gender is to sex as feminine is to female and masculine is to male.”)
When genital surgery is undertaken it is commonly referred to as "sex reassignment surgery" or genital reconstructive surgery or even gender reassignment surgery by some health care providers and community members. An older term, sex change surgery, may be seen as disrespectful.
The Diagnostic and Statistical Manual of Mental Disorders accepts the expression of desire to be of the opposite sex, or assertion that one is of the sex opposite from the one with which one was assigned at birth, as sufficient for being transsexual. The ICD-10 states in a similar way that transsexualism is defined by "the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment." In contrast, transgenderists do not identify as being of, or desiring to be the opposite sex, but as being of or wanting to be another gender.
Transsexualism has been variously described as a physical disability, a condition, trait, disease, behaviour, desire, mental illness, perversion, paraphilia, political identity, and lifestyle. The term perversion is often used in a derogatory manner (especially by Western religions). People may consider the use of such labels offensive whether they are or are not transsexual, or involved with Western religions, themselves.
Transsexualism is often included within the broader term transgender, which is generally considered an umbrella term for people who do not conform to typical accepted gender roles, for example cross-dressers, drag queens, and people who identify as genderqueer. However, some transsexuals object to this inclusion. Historically the reason that transsexuals rejected associations with the transgender or broader LGBT community is largely that the medical community in the 1950s through the late 1980s encouraged (and in many ways required) this rejection of such a grouping in order to be a 'good transsexual' who would thus be allowed to access medical and surgical care. The animosity that is present today is no longer fed by this same kind of pressure from the medical community (indeed, today many gender therapists actively encourage their clients to explore support within the broader community.)
However, where some of the beliefs of modern day transsexual people that they are not transgender, is reflective of this historical division, other transsexual people state that someone choosing to retain their former physical sex (no SRS) is very different from someone who needs to be of "the other sex", that the groups have different issues and concerns and are not doing the same things. The latter view is rather contested, with opponents pointing out that merely having or not having some medical procedures hardly can have such far-reaching consequences as to put those who have them and those who have not into such distinctive categories. Notably Harry Benjamin's original definition of Transsexual does not require that they need to have had SRS.
2.0 CAUSES OF TRANSSEXUAL
Many psychological causes for transsexualism have been proposed, while research has also been presented to suggest that the cause of transsexualism has its roots in biology. There remains no agreement, however, as to the cause of transsexualism.
Some transsexual people and professionals feel that research into causes of transsexualism assumes at face value the legitimacy of a normative gender identity, and/or that transsexualism is contrary to normal development, and could be considered a disease, or syndrome, which transsexual people may find stigmatizing. This subset usually considers such research to be unnecessary, and wonder if such studies might possibly be causing more harm than good for transsexual people.
Meanwhile, other transsexual individuals and professionals believe that transsexualism is, in fact, a syndrome with a physiological basis as a form of intersexuality. Those with this viewpoint generally support research as to the cause, believing that it will verify the theory of a biological origin and thereby reduce social stigma by demonstrating that it is not a delusion, a political statement, or a paraphilia. Note stigma has a role to play in the development of and adherence to both viewpoints. See the trans-feminism article's section on GID for an insight to this.
Harry Benjamin wrote, "Summarizing my impression, I would like to repeat here what I said in my first lecture on the subject more than 10 years ago: Our genetic and endocrine equipment constitutes either an unresponsive [or] fertile soil on which the wrong conditional and a psychic trauma can grow and develop into such a basic conflict that subsequently a deviation like transsexualism can result."
Studies indicate that transsexualism is connected with a difference in the human brain called the bed nucleus of the stria terminalis. In one study, male-to-female transsexuals and cisgendered women were shown to have brains that were similar to each other in the BSTc area of the brain. Both heterosexual and homosexual men showed male brain structuring in this area. Research published in 2008 suggests that transsexuality may have a genetic component.
3.0 METODS TO PREVENTING TRANSSEXUAL
There are four main methods to prevent transsexual from being more free and easy. Transsexual can be reduced if this technique be applied.
3.1 PSYCHOLOGICAL TREATMENT
Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex have typically been shown to be ineffective. The internationally accepted and followed Standards of Care note that sometimes the only reasonable and effective course of treatment for transsexual people is to go through sex reassignment therapy.
The need for treatment is emphasized by the high rate of mental health problems, including depression, anxiety, and various addictions, as well as a higher suicide rate among untreated transsexual people than in the general population. Many of these problems, in the majority of cases, disappear or decrease significantly after a change of gender role and/or physical characteristics.
Many transgender and transsexual activists, and many caregivers, point out that these problems usually are not related to the gender identity issues themselves, but to problems that arise from dealing with those issues and social problems related to them. Also, many feel that those problems are much more likely to be diagnosed in transsexual people than in the general population, because transsexual people are usually required to visit a mental health professional to obtain approval for hormones and sex reassignment surgery. This exposes the transsexual community to a higher level of evaluation for mental health issues than the general populace.
A growing number of transsexual people are resenting or even refusing psychological treatment which is mandated by the Harry Benjamin Standards of Care, because they believe that gender dysphoria itself is untreatable by psychological means, and that they have no other problems that need treatment. Unfortunately, this can often cause them significant problems when they attempt to obtain physical treatment as health professionals expect such therapy to be occurring concurrently with physical treatment.
Therapists' records reveal that many transsexual people do not believe they need psychological counselling, but rather they will acquiesce to legal and medical expectations in order to gain rights which are thus granted through the medical/psychological hierarchy. Legal needs such as a change of sex on legal documents, and medical needs, such as sex reassignment surgery, are usually impossible to obtain without a doctor and/or therapist's approval. Because of this, many transsexual people feel coerced into affirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference, in order to overcome simple legal and medical hurdles. Transsexual people who do not submit to this medical hierarchy typically face the option of remaining invisible, with no legal rights and possibly with identification documents incongruent with gender presentation.
3.2 DIAGNOSING TRANSSEXUALISM
The current diagnosis for transsexual people who present themselves for psychological treatment is "gender identity disorder" (leaving out those who have sexual identity disorders without gender concerns). As the DSM has changed its terminology, the diagnosis of "transsexualism" has become unused in recent years. This diagnostic label is often necessary to obtain sex reassignment therapy. However, some people diagnosed with gender identity disorder have no desire for sex reassignment therapy at all, particularly not genital reassignment surgery, and/or are not appropriate candidates for such treatment. While some feel that formal diagnosis helps to destigmatize transsexualism, others feel that it only adds stigma, essentially feeling that such a diagnosis is equivalent to saying something really is wrong with them.
Some people who desire sex reassignment therapy does not have gender identity disorder, as the term is usually defined and desire to transition for other reasons. This can include homosexual people who are unable to accept their homosexuality (or who were, up until the 1970s, encouraged by caretakers to change their gender role, including SRS), cross-dressers who feel more comfortable dressed as members of the opposite gender and may become confused (although it may be important to realize that many transsexual women go through a period where they self-identify as cross-dressers), and people with certain psychiatric disorders, such as schizophrenia, borderline personality disorder, dissociative identity disorder, and Munchausen syndrome. Most professionals believe that sex reassignment therapy is not appropriate for such individuals. If SRS is performed in such cases, the result is usually expected to be very negative for the individual, since it, unlike with patients with GID, typically does not alleviate issues for them, but rather leaves them with an intolerable body.
However, some transsexual people may suffer from co-morbid psychiatric conditions unrelated to their gender dysphoria. The DSM-IV itself states that in rare instances, gender identity disorder may co-exist with schizophrenia, and that psychiatric disorders are generally not considered contraindications to sex reassignment therapy, that is unless they are the primary cause of the patient's gender dysphoria. Despite this permissiveness, the process of psychological treatment is usually much more complicated for transsexual people with co-morbid psychiatric conditions.
Some transsexual people have pressured the American Psychiatric Association to remove Gender Identity Disorder from the DSM. Many of these people feel that at least some mental health professionals are being insensitive by labeling transsexualism as "a disease", rather than as an inborn trait. Furthermore, many people express that some psychologists and psychiatrists in viewing transsexualism as "a disease" have sought to develop specific models of transsexualism, which they feel exclude many transsexual people, such as Ray Blanchard's model.
Andrea James in an article rejecting terminology and disease-models of transsexuality, has proposed the terms "interest in feminization" and "interest in masculinization" to refer to a desire for sex reassignment therapy, regardless of whether the person with the desire is transsexual. Although she herself admitted that there are numerous difficulties and issues with this terminology that she herself could easily list, she hasn't advanced this terminology as a finalized terminology, but rather a start towards finding terminology that avoids the traditional issues surrounding transsexuality which describe it as a "disease" or a "deviant" condition. Critics of her terminology would point out that she has swung the pendulum too far in the other direction, now equating transsexuality to a "life-style choice", which often offends those transsexuals who feel that their condition has a biological origin. Andrea herself agreed with this position that transsexuality is not a choice, but she was rather strong in rejecting any assertion that it should be classified as a disease rather than a part of typical human variance. This strident desire to divorce transsexual people from medical diagnoses or use such diagnoses to deflect fault from the transsexual person for various undesired side effects of coming out or transitioning as a transsexual person is best explained through sympathetic reasoning, such as in the article on trans-feminism.
Other people, under the position that transsexualism is a physical condition and not a psychological issue, assert that sex reassignment therapy should be given if requested, and may even align with those who feel that all body modification should be offered on demand.
Sex reassignment therapy (SRT) is an umbrella term for all medical procedures regarding sex reassignment of both trans-gender and inter-sexual people. Sometimes SRT is also called gender reassignment, even though many people consider this term inaccurate as SRT alters physical sexual characteristics to more accurately reflect the individual's psychological/social gender identity, rather than vice versa as is implied by the term "gender reassignment."
Sex reassignment therapy can consist of hormone replacement therapy (HRT) to modify secondary sex characteristics, sex reassignment surgery to alter primary sex characteristics, and permanent hair removal for trans-women.
In addition to undergoing medical procedures, transsexual people who go through sex reassignment therapy usually change their social gender roles, legal names and legal sex designation. The entire process of change from one gender presentation to another is known as transition.
Many Western societies have procedures whereby an individual can change their name, and sometimes, their legal gender, to reflect their gender identity. Laws regarding changes to the legal status of transsexuals are different from country to country. Within the US, some state jurisdictions do allow amendments or complete replacement of the original birth certificates. Some jurisdictions may even seal earlier records against all but court orders in order to protect the transsexual's privacy.
In many other countries, it is still not possible to change birth records or other legal documents relating to ones gender status. Since many governments are revising the legal status of post-operative transsexuals, there are many individuals pioneering changes to these laws, such as Estelle Asmodelle whose book documents her struggle to change the Australian birth certificate and passport laws, although there are other individuals who have been instrumental in changing laws and thus attaining more acceptance for transsexual people in general.
Medical treatment for transsexual and transgender people is also available in most Western countries. However, transsexual and transgender people challenge the "normative" gender roles of many cultures and often face considerable hatred and prejudice. The film Boys Don't Cry chronicles the case of Brandon Teena, a transsexual man who was raped and murdered after his status was discovered. The project Remembering Our Dead, founded by Gwendolyn Ann Smith, archives numerous cases of transsexual and transgender people being murdered. In the United States, November 20 has been set aside as the "Day of Remembrance" for all murdered transgender people.
Some people who have switched their gender role enter into traditional social institutions such as marriage and the role of parenting. They sometimes adopt or provide foster care for children, as complete sex reassignment therapy inevitably results in infertility. Sometimes, they adopt children who are also transsexual or trans-gender and help them live according to their gender identity. Some transsexual people have children from before transition. Some of these children continue living with their transitioning/transitioned parent, or retain close contact with them. A recent study shows that this does not harm the development of these children in any way.
The style guides of many media outlets prescribe that a journalist who writes about a transsexual person should use the name and pronouns used by that person. Family members and friends, who are often confused about pronoun usage or the definitions of sex, are frequently instructed in proper pronoun usage, either by the transsexual person or by professionals or other persons familiar with pronoun usage as it relates to transsexual people. Sometimes, transsexual people have to correct their friends and family members many times before they begin to use the proper pronouns consistently.
4.0 CONCLUSION
From this article, we already understand about transsexual phenomena. There is many matter or affair that will influence people into this situation. Transsexual phenomena hesitation all people if this symptom didn’t dike from beginning. The life style of transsexual is irrelevant from the real life style of the normal human. The sense of love and like the same gender gives negative response and hesitating if the symptom going on. This disavowal must be dike as soon as possible before it spread to other social disease. Society must rally and co-operate to help transsexual man return to normal life.
Nowadays, linkage between transsexual man and society is very limited. For them, the society only contemplates them by negative view without try to approach them more closely. This situation motivates them to give more attention in interaction and communication with their group only to fulfil their socialist claim. Thus, it’s not surprised if they can incorporate organize their own unity to tighten linkage and facilitate them for draft along with actualise their activities. They also have one place for do any discussion about academic, life and any problem that they are facing.
There are some methods that can be used to prevent these phenomena from being more serious. All people must play their role to make sure this problem can be prevented.
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