3 Transsexual

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Transsexual people experience a gender identity that is inconsistent with their assigned sex and desire to permanently transition to the sex or gender with which they identify, usually seeking medical assistance (including sex reassignment therapies, such as hormone replacement therapy and sex reassignment surgery) to help them align their body with their identified sex or gender.
Transsexual is a subset of transgender,[2][3][4] but some transsexual people reject the label of transgender.[5][6][7][8] A medical diagnosis of gender dysphoria can be made if a person expresses a desire to live and be accepted as a member of their identified gender[9] and if a person experiences impaired functioning or distress as a result of their gender identity.[10][page needed]
Norman Haire reported that in 1921[11] Dora R of Germany began a surgical transition, under the care of Magnus Hirschfeld, which ended in 1930 with a successful genital reassignment surgery. In 1930, Hirschfeld supervised the second genital reassignment surgery to be reported in detail in a peer-reviewed journal, that of Lili Elbe of Denmark. In 1923, Hirschfeld introduced the (German) term "Transsexualismus",[12] after which David Oliver Cauldwell introduced "transsexualism" and "transsexual" to English in 1949 and 1950.[13][14]
Cauldwell appears to be the first to use the term to refer to those who desired a change of physiological sex.[15] In 1969, Harry Benjamin claimed to have been the first to use the term "transsexual" in a public lecture, which he gave in December 1953.[16] Benjamin went on to popularize the term in his 1966 book, The Transsexual Phenomenon, in which he described transsexual people on a scale (later called the "Benjamin scale") of three levels of intensity: "Transsexual (nonsurgical)", "Transsexual (moderate intensity)", and "Transsexual (high intensity)".[17][18][19] In his book, Benjamin described "true" transsexualism as the following:
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.[20]
Benjamin suggested that moderate intensity male to female transsexual people may benefit from estrogen medication as a "substitute for or preliminary to operation."[17] Some people have had sex reassignment surgery (SRS) but do not meet the above definition of transsexual.[citation needed] Other people do not desire SRS although they meet the other elements of Benjamin's definition of a "true transsexual".[citation needed] Transsexuality was included for the first time in the DSM-III in 1980 and again in the DSM-III-R in 1987, where it was located under Disorders Usually First Evident in Infancy, Childhood or Adolescence.
Beyond Benjamin's work, which focused on male-to-female (MTF) transsexual people, there are cases of the female to male transsexual, for whom genital surgery may not be practical. Benjamin gave certifying letters to his MTF transsexual patients that stated "Their anatomical sex, that is to say, the body, is male. Their psychological sex, that is to say, the mind, is female." After 1967[clarification needed], Benjamin abandoned his early terminology and adopted that of "gender identity."[21]
The term transgender was coined by John Oliven in 1965.[3] By the 1990s, transsexual had come to be considered a subset of the umbrella term transgender.[2][3][4] The term transgender is now more common, and many transgender people prefer the designation transgender and reject transsexual.[22][23][24] The term transsexual, however, continues to be used,[25] and some people who pursue medical assistance (for example, sex reassignment surgery) to change their sexual characteristics to match their gender identity prefer the designation transsexual and reject transgender.[22][23][24] One perspective offered by transsexual people who reject a transgender label for that of transsexed is that, for people who have gone through sexual reassignment surgery, their anatomical sex has been altered, whilst their gender remains constant.[26][27][28]
Historically, one reason some people preferred transsexual to transgender is that the medical community in the 1950s through the 1980s encouraged a distinction between the terms that would only allow the former access to medical treatment.[29] Other self-identified transsexual people state that those who do not seek sex reassignment surgery (SRS) are fundamentally different from those who do, and that the two have different concerns,[19] but this view is controversial, and others argue that merely having some medical procedures does not have such far-reaching consequences as to put those who have them and those who have not (e.g. because they cannot afford them) into such distinctive categories. Some have objected to the term transsexual on the basis that it describes a condition related to gender identity rather than sexuality.[30][better source needed] For example, Christine Jorgensen, the first person widely known to have sex reassignment surgery (in this case, male-to-female), rejected transsexual and instead identified herself in newsprint as trans-gender, on this basis.[31][32]
The word transsexual is most often used as an adjective rather than a noun – a "transsexual person" rather than simply "a transsexual".[citation needed] As of 2018, use of the noun form (e.g. referring to people as transsexuals) is often deprecated by those in the transsexual community.[33] Like other trans people, transsexual people prefer to be referred to by the gender pronouns and terms associated with their gender identity. For example, a trans man is a person who was assigned the female sex at birth on the basis of his genitals, but despite that assignment, identifies as a man and is transitioning or has transitioned to a male gender role; in the case of a transsexual man, he furthermore has or will have a masculine body. Transsexual people are sometimes referred to with directional terms, such as "female-to-male" for a transsexual man, abbreviated to "F2M", "FTM", and "F to M", or "male-to-female" for a transsexual woman, abbreviated "M2F", "MTF" and "M to F".
Individuals who have undergone and completed sex reassignment surgery are sometimes referred to as transsexed individuals;[34] however, the term transsexed is not to be confused with the term transsexual, which can also refer to individuals who have not yet undergone SRS, and whose anatomical sex (still) does not match their psychological sense of personal gender identity.
The terms gender dysphoria and gender identity disorder were not used until the 1970s,[25] when Laub and Fisk published several works on transsexualism using these terms.[35][36] "Transsexualism" was replaced in the DSM-IV by "gender identity disorder in adolescents and adults".
Male-to-female transsexualism has sometimes been called "Harry Benjamin's syndrome" after the endocrinologist who pioneered the study of dysphoria.[37] As the present-day medical study of gender variance is much broader than Benjamin's early description, there is greater understanding of its aspects,[21] and use of the term Harry Benjamin's syndrome has been criticized for delegitimizing gender-variant people with different experiences.[38][39]
Since the middle of the 20th century, homosexual transsexual and related terms were used to label individuals' sexual orientation based on their birth sex.[40] Many sources criticize this choice of wording as confusing, "heterosexist",[41] "archaic",[42] and demeaning because it labels people by sex assigned at birth instead of their gender identity.[43] Sexologist John Bancroft also recently expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women.[44] He says that he now tries to choose his words more sensitively.[44] Sexologist Charles Allen Moser is likewise critical of the terminology.[45] Sociomedical scientist Rebecca Jordan-Young challenges researchers like Simon LeVay, J. Michael Bailey, and Martin Lalumiere, who she says "have completely failed to appreciate the implications of alternative ways of framing sexual orientation."[46]
The terms androphilia and gynephilia to describe a person's sexual orientation without reference to their gender identity were proposed and popularized by psychologist Ron Langevin in the 1980s.[47] The similar specifiers attracted to men, attracted to women, attracted to both or attracted to neither were used in the DSM-IV.[48]
Many transsexual people choose the language of how they refer to their sexual orientation based on their gender identity, not their birth assigned sex.[21]
Several terms are in common use, especially within the community itself relating to the surgical or operative status of someone who is transsexual, depending on whether they have already had sex reassignment surgery (SRS), have not had SRS but still intend to, or do not intend to have SRS. They are, post-op, pre-op, and non-op, respectively.[49]
A pre-operative transsexual person, or simply pre-op for short, is someone who intends to have SRS at some point, but has not yet had it.[49][50]
A post-operative transsexual person, or post-op for short, is someone who has had SRS.[49]
A non-operative transsexual person, or non-op, is someone who has not had SRS, and does not intend to have it in the future. There can be various reasons for this, from personal to financial.[49]
Transsexualism no longer is classified as a mental disorder in the International Statistical Classification of Diseases and Related Health Problems (ICD). The World Professional Association for Transgender Health (WPATH) and many transsexual people had recommended this removal,[51] arguing that at least some mental health professionals are being insensitive by labelling transsexualism as a "disease" rather than as an inborn trait, as many transsexuals believe it to be.[52] Now, instead, it is classified as a sexual health condition; this classification continues to enable healthcare systems to provide healthcare needs related to gender.[53] The eleventh edition was released in June 2018. The previous version, ICD-10, had incorporated transsexualism, dual role transvestism, and gender identity disorder of childhood into its gender identity disorder category. It defined transsexualism 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."
Historically, transsexualism has also been included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). With the DSM-5, transsexualism was removed as a diagnosis, and a diagnosis of gender dysphoria was created in its place.[54] This change was made to reflect the consensus view by members of the APA that transsexuality is not in and of itself a disorder and that transsexual people should not be stigmatized unnecessarily.[55] By including a diagnosis for gender dysphoria, transsexual people are still able to access medical care through the process of transition.[citation needed]
The current diagnosis for transsexual people who present themselves for medical treatment is gender dysphoria (leaving out those who have sexual identity disorders without gender concerns).[54] According to the Standards of care formulated by WPATH,[56][57] formerly the Harry Benjamin International Gender Dysphoria Association, this diagnostic label is often necessary to obtain sex reassignment therapy with health insurance coverage, and the designation of gender identity disorders as mental disorders is not a license for stigmatization or for the deprivation of gender patients' civil rights.[citation needed]
Twin studies suggest that there are likely genetic causes of transsexuality, although the precise genes involved are not fully understood.[58][59] One study published in the International Journal of Transgender Health found that 20% of identical twin pairs in which at least one twin was trans were both trans, compared to only 2.6% of non-identical twins who were raised in the same family at the same time, but were not genetically identical.[59]
Sex reassignment therapy (SRT) is an umbrella term for all medical treatments related to sex reassignment of both transgender and intersex people. Individuals make different choices regarding sex reassignment therapy, which may include masculinizing or feminizing hormone replacement therapy (HRT) to modify secondary sex characteristics, sex reassignment surgery (such as orchiectomy) to alter primary sex characteristics, chest surgery such as top surgery or breast augmentation, or, in the case of trans women, a trachea shave, facial feminization surgery or permanent hair removal.
To obtain sex reassignment therapy, transsexual people are generally required to undergo a psychological evaluation and receive a diagnosis of gender identity disorder in accordance with the Standards of Care (SOC) as published by the World Professional Association for Transgender Health.[56] This assessment is usually accompanied by counseling on issues of adjustment to the desired gender role, effects and risks of medical treatments, and sometimes also by psychological therapy. The SOC are intended as guidelines, not inflexible rules, and are intended to ensure that clients are properly informed and in sound psychological health, and to discourage people from transitioning based on unrealistic expectations.
After an initial psychological evaluation, trans men and trans women may begin medical treatment, starting with hormone replacement therapy[57][60] or hormone blockers. In these cases, people who change their gender are usually required to live as members of their target gender for at least one year prior to genital surgery, gaining real-life experience, which is sometimes called the "real-life test" (RLT).[57] Transsexual individuals may undergo some, all, or none of the medical procedures available, depending on personal feelings, health, income, and other considerations. Some people posit that transsexualism is a physical condition, not a psychological issue, and assert that sex reassignment therapy should be given on request. (Brown 103)
Like other trans people, transsexual people may refer to themselves as trans men or trans women. Transsexual people desire to establish a permanent gender role as a member of the gender with which they identify, and many transsexual people pursue medical interventions as part of the process of expressing their gender. The entire process of switching from one physical sex and social gender presentation to another is often referred to as transitioning, and usually takes several years. Transsexual people who transition usually change their social gender roles, legal names and legal sex designation.[citation needed]
Not all transsexual people undergo a physical transition. Some have obstacles or concerns preventing them from doing so, such as the expense of surgery, the risk of medical complications, or medical conditions which make the use of hormones or surgery dangerous. Others may not identify strongly with another binary gender role. Still others may find balance at a midpoint during the process, regardless of whether or not they are binary-identified. Many transsexual people, including binary-identified transsexual people, do not undergo genital surgery, because they are comfortable with their own genitals, or because they are concerned about nerve damage and the potential loss of sexual pleasure, including orgasm. This is especially so in the case of trans men, many of whom are dissatisfied with the current state of phalloplasty, which is typically very expensive, not covered by health insurance, and commonly does not achieve desired results. For example, not only does phalloplasty not result in a completely natural erection, it may not allow for an erection at all, and its results commonly lack penile sexual sensitivity; in other cases, however, phalloplasty results are satisfying for trans men. By contrast, metoidioplasty, which is more popular, is significantly less expensive and has far better sexual results.[61][62][63]
Transsexual people can be heterosexual, gay, lesbian, or bisexual; many choose the language of how they refer to their sexual orientation based on their gender identity, not their birth assigned sex.[21]
Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex are typically ineffective. The widely recognized Standards of Care[57] note that sometimes the only reasonable and effective course of treatment for transsexual people is to go through sex reassignment therapy.[57][64]
The need for treatment of transsexual people 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.[65] These problems are alleviated by a change of gender role and/or physical characteristics.[66]
Many transgender and transsexual activists, and many caregivers, note that these problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-variant individuals. Some transsexual people reject the counseling that is recommended by the Standards of Care[57] because they do not consider their gender identity to be a cause of psychological problems.
Brown and Rounsley[67] noted that "[s]ome transsexual people acquiesce to legal and medical expectations in order to gain rights 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 difficult to obtain without a doctor or therapist's approval. Because of this, some transsexual people feel coerced into affirming outdated concepts of gender to overcome simple legal and medical hurdles (Brown 107).
People who undergo sex reassignment surgery can develop regret for the procedure later in life, largely predicted by a lack of support from family or peers, with data from the 1990s suggesting a rate of 3.8%.[68][69] In a 2001 study of 232 MTF patients who underwent GRS with Dr. Toby Meltzer, none of the patients reported complete regret and only 6% reported partial or occasional regrets.[70] A 2009 review of Medline literature suggests the total rate of patients expressing feelings of doubt or regret is estimated to be as high as 8%.[71] An issue reported by some is the inability to find sexual partners.[
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3 Transsexual