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2007/01/26 | Category: Naomi | Comments: 0
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Transsexualität oder Transsexualismus ist laut ICD-10, der Internationalenen Klassifizierung von Krankheiten der Weltgesundheitsorganisation, eine Form der Geschlechtsidentitätsstörung (vergleiche auch Transgender als nicht-klinischen Begriff). Sie liegt vor, wenn ein Mensch körperlich eindeutig dem männlichen oder weiblichen Geschlecht angehört, sich jedoch als Angehöriger des anderen Geschlechts empfindet und danach strebt, auch körperlich diesem Geschlecht soweit als möglich angeglichen zu werden.
Menschen, die physisch weiblich sind, aber ein männliches Identitätsgeschlecht haben, werden als Frau-zu-Mann-Transsexuelle oder Transmänner bezeichnet; Menschen, die physisch männlich sind, aber ein weibliches Identitätsgeschlecht haben, bezeichnet man entsprechend als Mann-zu-Frau-Transsexuelle oder Transfrauen. Die in älterer medizinischer Literatur gebräuchlichen Wendungen transsexueller Mann für Transfrauen bzw. transsexuelle Frau für Transmänner, die das körperliche anstelle des empfundenen Geschlechts in den Vordergrund stellen, werden von den meisten Transsexuellen abgelehnt und gelten heute als veraltet. Transsexuelle Menschen mit medizinischer oder juristischer Geschlechtsanpassung bezeichnen sich oft nicht mehr als transsexuell, sondern entweder als Mann mit transsexueller Vergangenheit bzw. als Frau mit transsexueller Vergangenheit oder einfach als Mann bzw. Frau.
Inhaltsverzeichnis [Verbergen]
1 Ursachen
2 Begriffsgeschichte
3 Verlauf
4 Medizinische Maßnahmen
5 Juristische Maßnahmen
5.1 Deutschland
5.2 Österreich
5.3 Schweiz
5.4 Andere
6 Kontroversen
6.1 Begriffskritik
6.2 Einstufung von Transsexualität als Krankheit
6.2.1 Übernahme der Kosten für geschlechtsangleichende Maßnahmen
7 Literatur
8 Weblinks
9 Quellen und Anmerkungen
Ursachen
Bei der Transsexualität soll es sich laut Experten wie z.B. der Deutschen Gesellschaft für Sexual-Forschung in Hamburg-Eppendorf, die 1950 von Hans Giese initiiert wurde, oder der International Academy for Sex Research, die von Volkmar Sigusch ins Leben gerufen wurde, um eine Störung der Geschlechtsidentität handeln, deren Ursachen unbekannt seien. Diese Sichtweise beruht vor allem auf Vermutungen der Harry Benjamin International Gender Dysphoria Association, Inc., deren Ansichten auf Forschungen von Harry Benjamin, M.D. (1885-1986), einem deutsch-amerikanischen Psychologen, basieren. Früher wurden grundsätzlich psychische Ursachen für die Transsexualität angenommen; allerdings konnte bisher kein Modell entwickelt werden, das auf einen Großteil der Betroffenen zutrifft. Einige Untersuchungen deuten auch auf körperliche Ursachen bzw. Prädispositionen hin; so ist beispielsweise im Handbuch der medizinischen Therapie Ausgabe 2005/2006 zu lesen, dass "in der pränatalen Entwicklungsphase dieselben Sexualhormone sowohl die Morphologie der Gentitalien als auch die Morphologie und die Funktion des Gehirns beeinflussen"; diese Hypothese wurde durch von Zhou und Kollegen publizierte Daten gestützt. Daher wird auch eine Kombination von physischen und psychischen Ursachen für möglich gehalten.
Begriffsgeschichte
Das Phänomen von Menschen, welche die Geschlechtsrolle wechselten, ist seit der Antike bekannt. Da allerdings erst seit dem Beginn des 20. Jahrhunderts überhaupt die Möglichkeit der entsprechenden medizinischen Behandlung bestand, unterschied man vor dem 20. Jahrhundert nicht zwischen Transsexualität und Transvestitismus beziehungsweise der genauen Ausprägung der Geschlechtsidentitätsstörung. Auch die Frage, ob überhaupt in jedem bekannten Einzelfall eine Geschlechtsidentitätsstörung vorlag, oder ob es eventuell andere Ursachen für den jeweiligen Geschlechtsrollenwechsel gab, kann mangels Unterlagen nicht mehr geklärt werden. Für einen Überblick siehe Geschichte des Transvestitismus
Der deutsche Arzt und Sexualforscher Magnus Hirschfeld prägte 1910 die Bezeichnung „Transvestiten“ für Menschen, die sich gelegentlich oder regelmäßig als Angehörige des anderen Geschlechts verkleiden. Für Menschen, die sich nicht nur in der Kleidung, sondern auch körperlich dem jeweils anderen Geschlecht anzupassen versuchen, schuf er 1923 – in der letzten Ausgabe seines Jahrbuchs für sexuelle Zwischenstufen – den Begriff des „seelischen Transsexualismus“. Hirschfeld identifizierte Transsexualismus dabei noch nicht als eine von Transvestitismus verschiedene Abweichung, sondern als eine besonders intensive Ausprägung derselben. Harry Benjamin, der Hirschfeld, dessen Publikationen und dessen Institut für Sexualwissenschaft kannte, griff den Begriff 1953 in seinem Artikel Transvestism and Transsexualism wieder auf und etablierte ihn 1966 mit seinem Buch The Transsexual Phenomenon in der Sexualmedizin. Zeitweilig wurde David O. Cauldwell, der das Wort in seinem schon 1949 erschienenen Artikel Psychopathia transexualis aufgegriffen hatte, fälschlich als Urheber dieses Begriffs angesehen. In den Arbeiten von Cauldwell und Benjamin wurde der Begriff des Transsexualismus bereits in seiner heutigen Bedeutung verwendet. In den 90er Jahren wurde der Begriff Transsexualität aus dem diagnostischen und statistischem Handbuch Psychischer Störungen, dem DSM-IV, entfernt, und durch den Begriff Geschlechtsidentitätsstörung ersetzt, im ICD-10 (Internationale Klassifizierung von Krankheiten der Weltgesundheitsorganisation) wird dagegen noch der Begriff Transsexualität und Geschlechtsidentitätsstörung synonym verwendet. Er findet sich unter Klasse F (Psychische Störungen und Verhaltensstörungen) und dem Unterpunkt F64.0.
Verlauf
Zahlreiche transsexuelle Menschen entwickeln bereits im Vorschulalter das Gefühl, „anders“ zu sein, können dieses oft aber noch nicht konkret zuordnen. Andere berichten, dass sie bereits im Vorschulalter ein Bewusstsein dafür entwickelten, entgegen ihrem körperlichen Geschlecht eigentlich ein Junge bzw. Mädchen zu sein, oder zumindest ´kein´ Mädchen bzw. Junge. Gelegentlich tritt dieses Bewusstsein erst in der Pubertät oder im Erwachsenenalter auf. Besonders in diesen Fällen stellt sich die Frage, ob nicht Erinnerungen aus der Kindheit verdrängt wurden. Wenn diese Veranlagung von der Umwelt des Kindes oder Jugendlichen überhaupt wahrgenommen wird, wird sie in der überwiegenden Mehrheit der Fälle entweder nicht ernst genommen oder — für die Betroffenen schlimmer — es wird versucht, durch erzieherische Maßnahmen eine zum körperlichen Geschlecht passende Geschlechtsidentität herzustellen. Wie auch viele Fälle von Intersexualität belegen, ist dies grundsätzlich zum Scheitern verurteilt, da die Geschlechtsidentität wenn nicht bereits bei der Geburt, dann spätestens im Kindergartenalter feststeht. Der genaue Zeitpunkt ist umstritten.
Der von transsexuellen Menschen empfundene psychische Druck nimmt normalerweise mit der Zeit zu, besonders während der Pubertät und ihm jungen Erwachsenenalter. Neben psychosomatischen Krankheiten und verschiedenen anderen psychischen Problemen sind vor allem Depressionen und Drogenmissbrauch eine häufige Folge. Die meisten Transsexuellen sehen sich früher oder später gezwungen, ihre Umwelt über ihre Transsexualität zu informieren und ihre Geschlechterrolle „offiziell“ und permanent zu wechseln. Oft ist der entsprechende Entschluss Ergebnis einer besonderen Krisenphase, die häufig als existenzbedrohend empfunden wird.
Der Zeitpunkt, an dem im Einzelfall die jeweiligen psychischen Probleme mit Transsexualität oder einer Geschlechtsidentitätsstörung in Verbindung gebracht werden, ist individuell höchst unterschiedlich. Er hängt u.a. auch mit den verfügbaren Informationen und dem sozialen Klima zusammen, in dem der Betroffene lebt. Insgesamt jedoch sinkt das Durchschnittsalter, in dem Betroffene versuchen, eine medizinische Behandlung zu erreichen, seit Jahren.
Unabhängig davon, ob sie als transsexuell erkannt werden, versuchen betroffene Kinder meist, den Erwartungen ihrer Umgebung zu entsprechen und die dem körperlichen Geschlecht entsprechende Geschlechterrolle zu leben. Da der diesbezügliche Druck auf körperlich männliche Transsexuelle im allgemeinen größer ist als der Druck, unter dem körperlich weibliche Betroffene leben, verläuft die typische Entwicklung bei Transmännern und Transfrauen unterschiedlich:
Transfrauen bemühen sich häufig zunächst darum, dem klassischen Bild eines Mannes möglichst weitgehend zu entsprechen. Es ist keineswegs selten, dass sie zunächst heiraten und eine Familie gründen, insbesondere dann, wenn sie ohnehin Frauen als Partnerinnen bevorzugen. Auch ist bei Transfrauen eine ausgesprochen „männliche“ Berufswahl keineswegs selten. Ihr Unbehagen in der männlichen Rolle äußert sich oft in einem Wechselspiel zwischen transvestitischen Phasen und Phasen der Überkompensation, in denen sie zum Beispiel alle Frauenkleider wegwerfen und versuchen, besonders männlich zu erscheinen.
Transmänner heiraten etwas seltener und bekommen auch seltener Kinder. Bei der Berufswahl entscheiden sie sich fast immer entweder für „geschlechtsneutrale“ oder für „typisch männliche“ Berufe. Ihr Unbehagen in der weiblichen Geschlechtsrolle drückt sich vor allem dadurch aus, dass „männliche“ Verhaltensweisen in den Alltag integriert werden, was bei Frauen eher akzeptiert wird als weibliche Verhaltensweisen bei Männern. Transmänner, die noch als Frauen leben, wirken daher oft „burschikos“ oder „emanzipiert“. Auch werden sie häufig für lesbisch gehalten, auch dann, wenn sie als Partner Männer bevorzugen.
Der Wechsel der Geschlechtsrolle kann, muss aber nicht, zu großen sozialen Problemen führen. Partnerschaften zerbrechen häufig, aber nicht immer. Kinder verkraften den Rollenwechsel eines Elternteils meistens wesentlich besser als erwartet; Ausnahmen sind besonders Kinder in der Pubertät und Kinder, die von außen stark gegen den betroffenen Elternteil beeinflusst werden. Auch der Verlust des Arbeitsplatzes, der früher als so selbstverständlich galt, dass von vorneherein zur eigenen Kündigung geraten wurde, ist wesentlich seltener geworden – unter anderem deshalb, weil der Europäische Gerichtshof die Kündigung eines Menschen wegen eines beabsichtigten Geschlechtsrollenwechsels mittlerweile zur verbotenen Diskriminierung aufgrund des Geschlechts erklärt hat. Ungeachtet dessen begeben sich selbst die Transsexuellen, die das bisher nicht getan haben, aus Anlass ihres Geschlechtsrollenwechsels in psychologische oder psychotherapeutische Betreuung; denn ohne den Nachweis professioneller Begleitung ist es nahezu unmöglich, die für die Inanspruchnahme medizinischer und juristischer Begleitmaßnahmen erforderlichen Gutachten zu erhalten.
In den letzten Jahren steigt die Zahl der Eltern transsexueller Kinder, die deren Transsexualität als solche erkennen; ebenso steigt die Zahl der Eltern, die mit Akzeptanz anstatt mit Ablehnung reagieren. In diesen Situationen werden zunehmend medizinische Maßnahmen eingesetzt, die den Eintritt der Pubertät verzögern. Auf diese Weise soll verhindert werden, dass sich Geschlechtsmerkmale entwickeln, die später nur mit großem Aufwand und oft fragwürdigem Erfolg wieder rückgängig gemacht werden müssten oder nicht mehr rückgängig zu machen sind. Daher wächst auch die Zahl der transsexuellen Menschen, die sich bereits während oder kurz nach der Pubertät zum Wechsel der Geschlechtsrolle entschließen.
Medizinische Maßnahmen
Die medizinischen Maßnahmen dienen dazu, den Körper soweit als möglich dem empfundenen Geschlecht anzugleichen; die immer noch häufige Bezeichnung Geschlechtsumwandlung ist falsch, da sich die meisten Geschlechtsmerkmale nicht in die des anderen Geschlechts umwandeln lassen. Die medizinischen Maßnahmen bestehen aus Hormontherapie, geschlechtsangleichenden Operationen und gegebenenfalls der dauerhaften Entfernung des Bartes durch eine Epilation.
Bei der Hormonbehandlung werden die Sexualhormone des körperlichen Zielgeschlechts zugeführt und die Bildung der körpereigenen Sexualhormone unterdrückt. Sie leitet eine Art zweite Pubertät und damit die Entwicklung der sekundären Geschlechtsmerkmale ein. Bei Transfrauen wird die Hormonbehandlung oft durch eine Behandlung mit Antiandrogenen ergänzt.
Bei Transfrauen wird die Haut dünner und trockener, das Körperfett verlagert sich hin zu Gesicht, Brust (Gynäkomastie) und auch zu Hüften und Gesäß. Die Körperbehaarung geht zurück. Auch testosteronbedingter Haarausfall kann sich teilweise zurückbilden. Der Bartwuchs wird allerdings kaum beeinflusst. Die Hoden schrumpfen, die Produktion von Sperma bleibt aus (Hodenatrophie). Die Libido geht zurück. Langfristig bildet sich auch die Muskulatur zurück, und die körperliche Belastbarkeit sinkt.
Entsprechend wird bei Transmännern die Haut grobporiger, das Fett verlagert sich von der Hüfte hin zur Taille, die körperliche Leistungsfähigkeit nimmt als Folge weiteren Muskelaufbaus zu, Bartwuchs setzt ein, die Körperbehaarung kann zunehmen, und die Klitoris wird größer. Das Testosteron bewirkt ein Ende der Regelblutungen, das Einsetzen des Stimmbruchs und häufig eine Intensivierung der Libido.
Vollständig rückgängig machen lassen sich die Auswirkungen der ersten, natürlichen Pubertät weder bei Transmännern noch bei Transfrauen. Eine Umwandlung oder Ausbildung der primären Geschlechtsorgane ist ausgeschlossen. Zum Vermeiden gesundheitlicher Schäden durch Hormonmangel ist eine lebenslange Hormonsubstitution erforderlich.
Anstelle von oder zusätzlich zu Hormonbehandlungen sind auch geschlechtsangleichende Operationen möglich; im allgemeinen gilt zumindest der Wunsch nach diesen Maßnahmen als notwendige Bedingung für die Diagnose "Transsexualität".
Bei Transfrauen umfassen diese in der Regel die Epilation des Barts und die geschlechtsangleichende Operation, bei der Penis, Skrotum zusammen mit den Hoden entfernt werden und eine künstliche Vagina gebildet wird, mit der meist ohne weiteres Geschlechtsverkehr ausgeübt werden kann. Weil das von der Hormonbehandlung bewirkte Brustwachstum häufig nur gering ist, unterziehen sich viele Transfrauen einer Brustvergrößerung. Operationen am Kehlkopf zum Anpassen der Stimmlage sind ebenfalls verbreitet. Im deutschsprachigen Raum seltener ausgeführt werden Operationen zur Annäherung biometrischer Merkmale des Gesichts an den weiblichen Normbereich. Diese betreffen vor allem Unterkiefer, Kinn und Augenbrauenwülste.
Bei Transmännern bestehen die operativen Maßnahmen in der Regel aus einer Brustentfernung, dem Entfernen von Gebärmutter und Eierstöcken sowie dem Aufbau eines für den Geschlechtsverkehr geeigneten künstlichen Penis. Die Entfernung von Gebärmutter und Eierstöcken ist nicht zuletzt wegen des durch die Zufuhr männlicher Hormone steigenden Risikos von Krebs an diesen Organen angezeigt. Die Bildung von Hoden und damit das Erlangen einer Zeugungsfähigkeit sind nicht möglich. Der Aufbau eines adäquaten männlichen Gliedes ist bezüglich Aussehen, Funktion und Größe noch stark eingeschränkt. Daher verzichten die meisten Transmänner auf diesen Eingriff. Für Einzelheiten siehe ebenfalls Geschlechtsangleichende Operation
Juristische Maßnahmen
Die meisten europäischen Staaten sowie einige außereuropäische Staaten, darunter Deutschland, Österreich, Belgien, die Niederlande, Luxemburg, Schweden und die Schweiz, erlauben transsexuellen Menschen, den Vornamen oder die in den Zivilstandsregistern eingetragene Geschlechtsangabe an ihr gefühltes Geschlecht anzupassen. Die entsprechenden Verfahren wurden dabei meist nicht vom Gesetzgeber, sondern von der Rechtsprechung etabliert und erfordern in der Regel die Zustimmung eines Gerichts. Neben den Niederlanden und Schweden verfügen Deutschland und Österreich über spezielle einschlägige Gesetze beziehungsweise Erlasse:
Deutschland
In Deutschland legt das so genannte Transsexuellengesetz eine Reihe von Voraussetzungen fest, bei deren Vorliegen Transsexuelle eine Anpassung ihres Personenstands beziehungsweise Änderung ihres Vornamens (welcher in Deutschland eindeutig das Geschlecht wiedergeben muss) zusteht. Eine Anpassung des Personenstands setzt unter anderem voraus, dass der Antragsteller unverheiratet sowie fortpflanzungsunfähig ist und sein Erscheinungsbild durch operative Eingriffe an sein neues Geschlecht angepasst wurde. Eine Vornamensänderung setzt keine körperverändernden Maßnahmen voraus.
Österreich
Der Transsexuellenerlass[1] wurde im Juli 2006 vom österreichischen Verfassungsgerichtshof als verfassungswidrig aufgehoben.
In Österreich legte der Transsexuellenerlass des Bundesministeriums für Inneres eine Reihe von Voraussetzungen fest, bei deren Vorliegen die Personenstandsbehörde eine Änderung der im Geburtenbuch eingetragenen Geschlechtszuordnung auf dem Verwaltungsweg vorzunehmen hatte. Der Erlass basierte auf § 16 des österreichischen Personenstandsgesetzes, der festschreib, dass die Personenstandsbehörde „eine Beurkundung zu ändern“ hatte, „wenn sie nach der Eintragung unrichtig geworden ist“. Eine Änderung des Vornamens ist hingegen nur entsprechend der im Namensänderungsgesetz festgehaltenen allgemeinen Vorschriften zur Namensänderung möglich gewesen. Laut § 3 (1) dieses Gesetzes musste zumindest der erste Vorname „dem Geschlecht des Antragsstellers“ entsprechen, wobei weder biologische noch psychologische Kriterien eine Rolle spielten, sondern ausschließlich der Eintrag im Geburtenbuch maßgeblich war. Transsexuelle Menschen, die die Geschlechtszuordnung im Geburtenbuch nicht ändern lassen konnten oder wollten, konnten damit auch keinen ersten Vornamen wählen, der für ihr gefühltes Geschlecht charakteristisch wäre, sondern lediglich einen geschlechtsneutralen Vornamens eintragen lassen. Die Behörden legten diese Bestimmung relativ tolerant aus; neben mehreren hundert anderen Vornamen werden zum Beispiel „Carmen“, „Eve“, „Gaby“, „Simone“ oder das in Italien als männlich geltende „Andrea“ als geschlechtsneutral akzeptiert.
Schweiz
Auch in der Schweiz gibt es kein spezielles Transsexuellengesetz. Nach der Rechtsprechung können jedoch auf gerichtlichen Antrag nach einer Geschlechtsanpassung Vorname und Geschlechtsangabe in den Zivilstandsregistern "berichtigt" werden.
Andere
Ähnlich ist die Lage in Belgien und Luxemburg, wo die Rechtsprechung ebenfalls eine Änderung oder Berichtigung nach den allgemeinen Vorschriften zulässt.
Kontroversen
Begriffskritik
Viele Betroffene lehnen das Wort „Transsexualität“ ab, da der Wortbestandteil „Sexualität“ ihrer Ansicht nach nahelegt, Transssexualität sei kein Identitätsproblem, sondern ähnlich wie zum Beispiel Homosexualität lediglich eine von der Norm abweichende sexuelle Präferenz. Transsexualität ist jedoch eine Frage des Identitätsgeschlechtes und keine Spielart von Sexualität im eigentlichen Sinn: Transsexuelle sind keine Menschen mit außergewöhnlichen sexuellen Vorlieben, sondern Menschen, die sozusagen mit den falschen Geschlechtsorganen geboren wurden. Statt als „Mann-zu-Frau-Transsexuelle“ bzw. „Frau-zu-Mann-Transsexuelle“ möchten diese Kritiker lieber einfach als „Transfrauen“ bzw. „Transmänner“ bezeichnet werden. Ein in den 1980er Jahren in Deutschland eingeführter Alternativbegriff ist "Transidentität", seit den 1990ern setzt sich auch der allerdings wesentlich weiter gefasste Begriff Transgender zunehmend durch. Im deutschen Sprachraum allgemein verbreitet sind diese Begriffsalternativen seit Mitte der 1990er; die Begriffskritik selbst kam allerdings bereits in den 1980ern auf.
Der Begriff der "Transsexuaität" wird seit einigen Jahren auch deswegen stark kritisiert, weil die Kriterien für ihr Vorliegen auf einem binären Geschlechtsbild beruhen (siehe Heteronormativität und Transgender) und sich zu stark auf die Möglichkeiten der medizinischen Veränderung des Körpers und zu wenig auf die sozialen Umstände beziehen.
Einige Transsexuelle lehnen den Begriff Transgender sowohl als Überbegriff als auch als Bezeichnung für Transsexuelle ab. Siehe dazu Transgender „versus“ Transsexualität.
Einstufung von Transsexualität als Krankheit
Ob und inwieweit Transsexualität als Krankheit bezeichnet werden sollte, ist umstritten. Die Diskussion ähnelt der Diskussion darüber, ob und inwieweit Behinderungen als Krankheiten anzusehen sind. Befürworter der Klassifikation von Transsexualität als Krankheit argumentieren, dass die Gesellschaft einem „Kranken“ üblicherweise weniger Ablehnung entgegenbringt als einem „Perversen“ oder „Verrückten“, und dass es einem Transsexuellen auch selbst leichter falle, sich zu akzeptieren, wenn er sich als „krank“ und nicht als „pervers“ oder „verrückt“ identifizieren kann. Gegner dieser Klassifikation bestreiten dies nicht nur, sondern sind im Gegenteil der Ansicht, dass die steigende Akzeptanz etwa von Homosexualität unter anderem gerade darauf zurückzuführen sei, dass diese heute nicht mehr als Krankheit gilt. Sie weisen auch darauf hin, dass etwa Schizophrene und Alkoholiker breiter und vor allem bleibender Geringschätzung ausgesetzt sind, obwohl Schizophrenie und Alkoholismus heute allgemein als Krankheiten anerkannt werden.
Übernahme der Kosten für geschlechtsangleichende Maßnahmen
Befürworter der Klassifikation von Transsexualität als Krankheit argumentieren auch, dass diese Einstufung es erleichtern würde, medizinische Behandlungen bzw. die Übernahme ihrer Kosten durch Krankenkassen durchzusetzen. Gegner halten dieses Argument allerdings für nicht zutreffend. Das Bundessozialgericht entschied bereits 1987, dass nicht jeder "vom Leitbild des gesunden Menschen abweichende Körper- oder Geisteszustand" bereits eine Krankheit sei, so auch nicht die Transsexualität. Es könne jedoch durch die Transsexualität ein Leidensdruck entstehen, welcher einen Krankheitswert habe und damit die Pflicht zur Kostenübernahme durch die Krankenversicherungen begründe. (Urteil vom 6. Aug. 1987 (Az: 3 RK 15/86)) (s.auch Begutachtungsleitlinien des MDS [s.unten: Literatur])
Trotz dieser und etlicher anderer entsprechender Urteile wird die Frage, warum die medizinischen Maßnahmen (größtenteils) von den Krankenversicherungen (gesetzlichen wie privaten) übernommen werden müssen, immer noch gestellt. Meist werden dafür zwei Argumente angeführt:
Jeder Mensch hat das Recht, ein möglichst gesundes und zufriedenes Leben zu führen. Ein Leben in einer Geschlechtsrolle, welche als unpassend empfunden wird, macht dies unmöglich. Für das Leben in einer anderen Geschlechtsrolle sind fast immer auch medizinische Maßnahmen notwendig; das notwendige Ausmaß dieser Maßnahmen kann nur im Einzelfall bestimmt werden. (S.o., Leidensdruck)
Eine Nichtbehandlung führt fast immer zu schweren psychischen, oft auch psychosomatischen Krankheiten, welche dann auf jeden Fall behandelt werden müssen. Da jedoch das zugrunde liegende Problem nicht gelöst wird, ist ein langfristiger Behandlungserfolg allerdings nicht zu erwarten. Es ist jedoch keineswegs billiger, die Behandlung der Transsexualität nicht zu bezahlen; denn bereits ein einziger Monat in einer psychiatrischen Klinik kostet im Schnitt mehr als eine genitalangleichende Operation von Mann zu Frau.
Im schlimmsten Fall kann der psychische Druck zum Suizid führen.
Literatur
Harry Benjamin: Transvestism and Transsexualism. In: International Journal of Sexology. Volume 7, 1953, S. 12–14
Harry Benjamin (Hrsg.): The Transsexual Phenomenon. Warner Books, New York 1967, ISBN 0-446-82426-7
Harry Benjamin: Transvestism and Transsexualism in the Male and Female. In: The Journal of Sex Research. Volume 3, 1967, S. 107–127, ISSN 0022-4499
Nadia Brönimann, Daniel J. Schüz: Die weiße Feder. 2. Auflage. Lübbe, Bergisch Gladbach 2003, ISBN 3-404-61525-5
Judith Butler: Körper von Gewicht. Die Diskursiven Grenzen des Geschlechts. Frankfurt, 1995, ISBN 3-518-11737-8
David O. Cauldwell: Psychopathia transexualis. In: International Journal of Sexology. Volume 16, 1949, S. 274–280
Richard Green, John Money (Hrsg.): Transsexualism and Sex Reassignment. Johns Hopkins Press, Baltimore 1969, ISBN 0-801-81038-8
Joanne Meyerowitz: How Sex Changed: A History of Transsexuality in the United States. Harvard University Press, Cambridge Massachusetts 2004, ISBN 0-674-01379-4
Pfäfflin, Friedemann: Begutachtung der Transsexualität. In: Foerster, K. (Hrsg.): Psychiatrische Begutachtung. München: Elsevier, 2004; S. 525 – 538.
Sieß, Gerhard: Die Änderung der Geschlechtszugehörigkeit. Das Transsexuellengesetz und seine praktische Anwendung in der Freiwilligen Gerichtsbarkeit. Konstanz: Hartung-Gorre, 1996. (Konstanzer Schriften zur Rechtswissenschaft; Bd.103)
MDS – Medizinischer Dienst der Spitzenverbände der Krankenkassen: Abschlußbericht der Projektgruppe P29b „Behandlungsmaßnahmen bei Transsexualität“. Stand: 23. April 2001. Projektgruppenleitung Fr. Dr. Bauer, Medizinischer Dienst der Spitzenverbände der Krankenkassen, 45116 Essen.
Weblinks
Wiktionary: Transsexualität – Bedeutungserklärungen, Wortherkunft, Synonyme und Übersetzungen
Harry Benjamin International Gender Dysphoria Association, wissenschaftliches Forschungsinstitut (englisch)
[International Journal of Transgenderism]
www.dgti.org - Deutsche Gesellschaft für Transidentität und Intersexualität
Trans*-FAQ auf transmann.de
„Vom Geschlechtsumwandlungswahn zur Geschlechtsumwandlung“ – Artikel von Rainer Herrn auf Genderwunderland
„Trans-Sexuell?“ – Vortrag von Walter Greiner
transsexualisme: chronologie et bibliographie de 1910 à 1972 - Sehr umfassende Liste älterer wissenschaftlicher Publikationen zum Thema, enthält einen weiterführenden Link auf ein Verzeichnis der Publikationen bis 1998
Quellen und Anmerkungen
↑ Oesterreich: Transsexuellenerlass des Bundesministeriums für Inneres.
Von „http://de.wikipedia.org/wiki/Transsexualit%C3%A4t“
Kategorie: Transsexualität
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Transsexualism is a condition in which a transsexual person self-identifies as a member of the gender opposite to the one assigned to them at birth. Transsexualism is considered a taboo subject in many parts of the world. The justifications for negative beliefs about transsexualism may be perceived as being supported by religious beliefs or cultural norms. It has become more widely known in Western nations in the late 20th century due to the sexual revolution, but remains a highly controversial topic.
Contents [hide]
1 Gender dysphoria
2 Defining transsexualism
2.1 Gender terminology for transsexual people
2.2 Alternative terminology
3 Prevalence
4 Causes of transsexualism
5 Sex reassignment therapy
5.1 Psychological treatment
5.1.1 Diagnosing transsexualism
5.2 Requirements for sex reassignment therapy
5.3 Hormone replacement therapy
5.4 Sex reassignment surgery
6 Legal and social aspects
6.1 Coming out
6.2 Employment issues
6.3 Stealth
7 Regrets and detransitions
8 Depictions of transsexualism in the media
9 Transsexualism in non-Western cultures
10 Notes
11 References
12 See also
13 External links
[edit] Gender dysphoria
Transsexualism often manifests itself as a dysphoria toward ones biological birth sex, as well as conflict living in ones social role. If untreated, it can lead to mental and emotional problems, and sometimes, suicide. Dutch researcher Peggy Cohen-Kettenis estimates that 40% of untreated transsexual people are either institutionalized or die prematurely. However, with proper treatment, transsexual people often become fully functional members of society[1]. The suicide statistics of treated transsexual people (Cohen-Kettenis et al, 1988) do not differ remarkably from non-transsexual populations.
Most 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 hormones and sex reassignment surgery. The entire process of switching from one physical and social gender presentation to the other is often referred to as transition, and usually takes several years.
To obtain sex reassignment therapy, transsexual people are usually required to receive psychological therapy and a diagnosis of gender identity disorder. Under the Harry Benjamin Standards of Care they are also required to live as members of their target sex for at least one year prior to surgery (so-called Real-Life Test or Real-Life Experience), although this time may be longer if the psychotherapist has concerns about the transsexual person's readiness. The intentions of the standard are to prevent people from transitioning when such a transition would be inappropriate (as a dramatic example, a person seeking to transition in order to veil their identity from police), or ill-advised (as an example a strong crossdresser, who still identifies themselves as their assigned gender). These standards are open to the criticism of being ineffective, or being too strict, discouraging genuinely transsexual people from seeking treatment. Meta-reviews of post-operative transsexuals prior to 1991 reveal a rate of serious regrets of <1% for transsexual men and <2% for transsexual women, while studies published after 1991 have reported a decrease in the rates for both, likely due to improved psychological and surgical treatments[2]. While such studies lend support for existing protocols concerning care of transsexuals, post-operative follow-up research is considered to be lacking.
Currently, the causes of transsexualism are unknown, and estimates of prevalence vary substantially.
[edit] Defining transsexualism
Transsexualism (also known as transsexuality) is a complex condition that is defined differently by different people. Many terms have been proposed through the years to describe transsexual people and the processes they go through. As with any terms used by a group, or to refer to a particular group, some of these terms are controversial, or have become controversial, not only to society at large, but even among the transsexual community.
The definition of "transsexuality" is somewhat debated. One common definition is that a transsexual is a person who believes that his or her body does not reflect his true 'inner' gender. Another common definition is that a transsexual is a person who has had or plans to have medical or surgical treatments that alter his or her body to better reflect what the individual believes is his or her true gender. The first definition allows greater freedom for individuals to self-identify as a transsexual. The latter defines the term based on actual or planned operative status and makes it more an external label than a term of self-definition.
When surgery is undertaken it is commonly referred to as sex reassignment surgery by 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 they were assigned at birth, as sufficient for being transsexual[2]. 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, some transgender people often 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 trait, disease, behavior, desire, mental illness, perversion, paraphilia, political identity, lifestyle and sin. The terms perversion and sin are obviously derogatory, and many people consider the use of such labels offensive whether they are or are not transsexual 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 ones queer kin 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 not still currently 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 the current animosity is reflective of this historical division. (Denny 176.)
Regardless of definition, transsexualism should not be confused with cross dressing or with the behaviour of drag queens and drag kings, which can be described as transgender but not transsexual. Also, transvestic fetishism usually has little, if anything, to do with transsexualism. As a general rule, transsexual people tend to dress and behave in a manner consistent with the gender they identify with, crossdressers tend to dress (and sometimes behave) in a manner consistent with stereotypical ideals of the opposite gender as opposed to the real-life behavior of that gender, and "drag queens" or "drag kings" tend to dress and behave in a flamboyant manner which parodies rather than emulates the opposite gender.
[edit] Gender terminology for transsexual people
Transsexual people almost universally prefer to be referred to by the gender pronouns and terms associated with their target gender. For example, a transsexual man is a person who was assigned the female gender 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 and has or will have a masculine body. Transsexual people are sometimes referred to with "assigned-to-target" gender terms such as "female-to-male" for a transsexual man or "male-to-female" for a transsexual woman. These terms may be abbreviated as "M2F", "F2M", "MTF", "F to M", etc. These terms are particularly helpful in preventing confusion, because to some people the term "transsexual woman" is a female transitioning to become a male, and to others a male transitioning to become a female. When the terms transmen and transwomen are used though, it is typical for them to be used to refer to the gender that the person identifies with, regardless of their appearance or state of transition.
Transsexual people are often considered as part of the LGBT community, and although many do identify with this community, others do not, or prefer not to use the terms at all. Transsexual people typical feel it important that transsexualism does not depend upon, nor related to sexual orientation. Transsexual men and women exhibit a range of sexual orientations just as non-transsexual (some times referred to as cissexual) people do, and they will almost always use terms for their sexual orientation that relate to the gender that they identify with. For example, someone assigned the male gender at birth but who identifies as a woman, and who is attracted solely to men, will identify as heterosexual, not gay. Likewise, someone who was assigned the female gender at birth, identifies as a man, and prefers male partners will identify as gay, not heterosexual. Transsexual people, like other people, can be bisexual or asexual as well.
Older medical texts often referred to transsexual people as members of their original sex by referring to a male-to-female transsexual as a "male transsexual". They also described sexual orientation in relation to the person's assigned sex, not their gender of identity; in other words, referring to a male-to-female transsexual who is attracted to men as a "homosexual male transsexual." This usage is considered by many to be scientifically inaccurate and clinically insensitive today. As such someone who would have been referred to as a "homosexual male transsexual" would now be called and most likely identify herself as a heterosexual transsexual woman. Although this usage is dwindling, some medical textbooks still refer to transsexual people as members of their assigned sex, but now many use "assigned-to-target" terms.
There are still are and probably always will be people outside the transsexual community, who refer to transsexual people with terms associated with their assigned gender at birth, for example calling a male-to-female transsexual "him". This usage, generally considered insensitive or insulting (especially if intentional), has been (though not exclusively) based on biological arguments such as the unchanging karyotype, which is usually consistent with the sex assigned to the person at birth. It may also be based on the absence of reproductive capability after transition and sex reassignment surgery. Arguments for this usage have also typically been based on religious dogma. Conservative groups such as the Traditional Values Coalition are among those who refer to transsexual people as members of their assigned sex at birth.
[edit] Alternative terminology
The transsexual community typically use the short form "trans", or simply "T" as a substitution for the full word "transsexual", e.g. TS, trans guy, trans dyke, T-folk, trans folk. Some may even use term that have become controversial to some, such as tranny and/or trans, despite others considering these terms to be offensive. Those who do use these terms claim that they are diminishing the power of the term as an insult, just as some members of the gay and African-American communities have embraced slurs directed at them. Others feel that the terms are insulting or inaccurate regardless of the context. Some feel that such words are problematic because they do not differentiate between transsexual people, and people who are merely "playing" with gender.
Some people may prefer to spell transsexual with only one s, thus writing transexual. They will typically assert that they are attempting to divorce the word from the realm of psychiatry and medicine and place it in the realm of identity. This trend is most common in the United States, and is almost never used in the United Kingdom. [1] Some consider this usage to be silly and/or incorrect.
Some prefer the term transsexed over transsexual, as they believe the term sexual found in transsexual is misleading and implies that transsexualism is a sexual orientation. Another justification made for this preference is that they feel it more closely parallels with the term intersex, which is considered by them to be important as more transsexual groups are welcoming them because they feel both groups have much in common. It is, by some definitions, possible to be both intersexed and transsexed. Other attempts to avoid the misleading -sexual have been the increasing acceptance of transgender or trans* and in some areas, transidentity.
Some transsexual people may also prefer transgendered over transsexual, because the issue is about gender rather than sexuality. They make a parallel with intergender, whose issue is about being between (inter) the genders rather than "intersexual". It is often assumed, particularly by transsexual people, that transsexualism is a subset of intersex. "Intersex" previously referred only to those who are genitally intersexed, i.e., with genitals that don't look classically male or female. (Despite the fact that human genitals show an extremely wide variation in general, intersexed people typically have quite obviously ambiguous genitalia that frustrate attempts to assign them within a binary sex system.) However, since sex in humans is composed of many different attributes, such as genes, chromosomes, regulatory proteins, hormones, hormone receptors, body morphology, brain sex, and gender identity, any variation among any of those attributes could fall under the rubric of "intersex." Transsexualism, in this view, simply becomes a form of being neurologically intersexed. (See below for research of physiological causes of transsexualism).
Harry Benjamin agreed with German sexologist Magnus Hirschfeld [2]that transsexuals were a form of neurological intersex. [3]Hirschfeld coined the terms the terms "Transvestite" and "Transsexual, and in 1930 supervised the first known sex reassignment surgery on Lili Elbe [4]of Denmark."
Some people prefer that transsexualism be referred to as Harry Benjamin's Syndrome, [5] as it follows the naming conventions of intersex conditions. This term is named for Harry Benjamin, a pioneer in sex reassignment and research on transsexual people. Many transsexual people who prefer this term assert that scientific research has strongly suggested that their condition is biological rather than psychological in nature. They also feel that 'trans' is misleading, as they believe that their gender was fixed in their brains, and has never changed. Thus that nothing about their steps in correcting themselves is actually "trans" at all, but rather they are simply taking steps to assert what they feel that they are already.
While the above gives a fairly comprehensive view of terminology, it's important to note that some people may feel that both 'trans' and 'sexual', are misleading, and others may take objections to terminology that are unique to their perspective. While a large variety of other terms exist from those presented here, they have not been excluded with bias, although almost all of them are somewhat controversial.
[edit] Prevalence
There are no reliable statistics on the prevalence of transsexualism. The DSM-IV (1994) quotes prevalence of roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek sex reassignment surgery in the USA. The most reliable population based estimate of the incidence occurrence is from the Amsterdam Gender Dysphoria Clinic[3] The data, spanning more than four decades in which the clinic has treated roughly 95% of Dutch transsexuals, gives figures of 1:10,000 assigned males and 1:30,000 assigned females.
[edit] Causes of transsexualism
Main article: Etiology of Transsexualism
Many psychological causes for transsexualism have been proposed, while research has 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 a transsexual may feel is stigmatizing. They usually consider 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. Individuals with this viewpoint sometimes prefer the term "Harry Benjamin Syndrome" over "transsexualism." [6]
[edit] Sex reassignment therapy
Most transsexual men and women suffer from psychological and emotional distress due to the conflict between their gender identity and their assigned gender role and/or anatomy. They often find that their only recourse is to change their gender role and possibly undergo sex reassignment therapy. This may include hormone therapy to modify their secondary sex characteristics and/or sex reassignment surgery to alter their primary sex characteristics.
[edit] 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. Therefore, it is generally accepted that the only reasonable and effective course of treatment for transsexual people would be sex reassignment therapy.[citation needed]
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[4]. Many of these problems, in the majority of cases, disappear or decrease significantly after a change of gender role and/or physical characteristics[5].
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. Thus exposing 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 counseling, but rather they will acquiesce to legal and medical expectations in order to gain rights which are thusly granted through the medical/psychological hierarchy. (Brown 103) 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. (Brown 107) 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.
[edit] Diagnosing transsexualism
The current diagnosis for transsexual people who present themselves for psychological treatment is "gender identity disorder". 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. (Brown 105)
Some people who desire sex reassignment therapy do 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 which 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 do 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. (Brown 106-107) Most professionals believe that sex reassignment therapy is not appropriate for such individuals. (Brown 107) 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. [7].
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. (Brown 108) 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. [8] 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. Some who feel that transsexualism is a physical rather than a mental condition have proposed the diagnosis of Benjamin's syndrome to replace GID.
Andrea James 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, [9]although some people who feel that transsexualism is an inborn trait, believe that defining it as an "interest" would place emphasis on the hypothesis that transsexualism is a "lifestyle choice".
Other people, under the position that transsexual 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. (Brown 103)
Additionally, the rules or requirements for diagnosis are almost always determined by non-transsexual medical gatekeepers who have the power to allow or deny a transsexual person's will to transition, based on their own perceptions of how a transsexual person should act and/or appear, which are sometimes prejudiced or based largely on cultural stereotypes. For example, they may reject the hair of a transsexual man as being "too long", even though many non-transsexual men like to wear long hair.
[edit] Requirements for sex reassignment therapy
Main article: Standards of Care for Gender Identity Disorders
The requirements for hormone replacement therapy vary greatly. Often, a minimum time period of psychological counseling, or a time period spent living in the desired gender role is required. This time period of "cross-living" is usually known as the Real-Life-Test (RLT) or Real-Life-Experience (RLE). This is not always possible; transsexual men frequently cannot "pass" this period without hormones. Transsexual women may also require hormones to pass as women in society. Most transwomen also require facial hair removal, voice training or voice surgery, and sometimes, facial feminization surgery, to be passable as females; these treatments are usually provided upon request with no requirements for psychotherapy or "cross-living". The most recent revision of the HBIGDA Standards of Care recognizes this limitation for some transgender people. Therefore, the SOC state that patients may be approved for hormone treatment after either a period of successful cross-living or a period of diagnostic psychotherapy - generally at least three months. Some doctors are willing to prescribe hormones to any patient who requests them; however, most physicians are reluctant to do so, especially for transmen. In transmen, some hormonally-induced changes may become virtually irreversible within weeks, whereas transwomen usually have to take hormones for many months before any irreversible changes will result. Some transsexual men and women are able to avoid the medical community's requirements for hormone therapy altogether by either obtaining hormones from black market sources, such as internet pharmacies which ship from overseas, or more rarely, by synthesizing hormones themselves.
Some surgeons who perform sex reassignment surgeries may require their patients to live as members of their target gender in as many ways as possible for a specified period of time, prior to any surgery. However, some surgeons recognize that this so-called real-life test for transmen, without breast removal and/or chest reconstruction, may be difficult. Therefore, many surgeons are willing to perform some or all elements of sex reassignment surgery without a real-life test. This is especially common amongst surgeons who practice in Asia. However, almost all surgeons practicing in North America and Europe who perform genital reassignment surgery require letters of approval from two psychotherapists; most Standards of Care recommend, and most therapists require, a one-year real-life test prior to genital reassignment surgery, though some therapists are willing to waive this requirement for certain patients. A recent study done on transwomen has shown that a real-life test of less than one year, or no real-life test at all, does not increase the likelihood that a patient will regret genital reassignment surgery. [10] Many transsexual people opt for a real-life experience longer than is officially required, to remove any doubts they may have of whether they should undergo surgery.
[edit] Hormone replacement therapy
Main article: Hormone replacement therapy (trans)
For transsexual men and women, hormone replacement therapy (HRT) causes the development of many of the secondary sexual characteristics of their desired gender. However, many of the existing primary and secondary sexual characteristics cannot be reversed by HRT. For example, breasts will grow in transsexual women but they will not regress in transsexual men. Facial hair will grow in transsexual men, but will not regress in transsexual women. However, some characteristics, such as distribution of body fat and muscle, as well as menstruation in transsexual men, may be reversed by hormonal treatment. Generally, those traits that are easily reversible will revert upon cessation of hormonal treatment, unless chemical or surgical castration has occurred, though for many transsexual people, surgery is required to obtain satisfactory physical characteristics.
As with all medical activities, health risks are associated with hormone replacement therapy, especially when higher doses are taken, as is common for pre-operative transsexual patients. It is always best advised that all changes in therapeutic hormonal treatment should be done with a physician's supervision, as starting, stopping or even changing doses can have physical and psychological health risks.
Although some transsexual women use herbal phytoestrogens as alternatives to pharmaceutical estrogens, little research has been done on the safety or effectiveness of such products, with the best evidence being anecdotal that the best results appear to be minimal and very subtle when compared to conventional hormone therapy; that is, if any noticeable changes happen at all.
[edit] Sex reassignment surgery
Main article: Sex reassignment surgery
The surgical and medical procedures undertaken to align transsexual individuals' physical appearance and genital anatomy with their gender identity are sometimes known collectively as Sex Reassignment Surgery (SRS). Other proposed terms for SRS include Gender Confirmation Surgery, Gender Realignment Surgery, Gender Reassignment Surgery, and Transsexual Surgery. The aforementioned terms may also specifically refer to genital surgeries like vaginoplasty and phalloplasty, even though more specific terms exist to refer exclusively to genital surgery, the most common of which is Genital Reassignment Surgery (GRS).
SRS tends to be expensive and is not always covered by public or private health insurance. In many countries with comprehensive nationalized health care, such as Canada and most European countries, SRS is covered under these plans. However, requirements for obtaining SRS and other transsexual services under these plans are sometimes more stringent than the requirements laid out in the Harry Benjamin Standards of Care, and in Europe, many local Standards of Care exist. In other countries, such as the United States, no national health plan exists and the majority of private insurance companies do not cover SRS. There are also significant medical risks associated with SRS that should be considered by those who are contemplating the surgery.
Prior to surgery, transsexual men and women are often referred to as pre-operative (pre-op); those who have already had the surgery may be referred to as post-operative (post-op) or simply identified as members of the sex to which they have transitioned. Not all transsexual people undergo sexual reassignment surgery (either because of the high cost of such surgery, medical reasons, or other reasons), although they live constantly in their preferred gender role; these people are often called non-operative (non-op).
A more modern idea suggests that the focus on surgery status is misplaced, and therefore, an increasing number of people are refusing to define themselves in terms of operative status, often defining themselves based on their social presentation instead. Many transsexual people believe that SRS is only a small part of a complete transition.
[edit] Legal and social aspects
Many Western societies have procedures whereby an individual can change their name, and sometimes, their legal gender, to reflect their gender identity (see Legal aspects of transsexualism). 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 are were 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. [11] 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 transgender and help them live according to their gender identity.[citation needed] 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.[12]
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.
[edit] Coming out
[edit] Employment issues
Transsexual people have historically had difficulty maintaining employment. Most transsexual people find it necessary to remain employed during transition in order to cover the costs of living and transition. However, employment discrimination against trans people is rampant and many of them are fired when they come out or are involuntarily outed at work. [13] Transsexual people must decide whether to transition on-the-job, or to find a new job when they make their social transition. The transsexual community usually regards this as a personal decision, though those who are fired during transition will have to find new jobs. Finding employment is often a challenge, especially for those in mid-transition.
Legal policies regarding name and gender changes in many countries make it difficult for pre-op transsexual people to conceal their trans status from their employers. [14] Because the Harry Benjamin Standards of Care require a one year RLT prior to SRS, some feel this creates a Catch 22 situation which makes it difficult for transpeople to remain employed or obtain SRS.
In many countries, laws are providing increasing protection from workplace discrimination to transpeople, and an increasing number of companies are including "gender identity" in their non-discrimination policies. [15] However, these laws and policies often have gaps, and they are not always fully implemented and enforced. California has strigent anti-discrimination laws to protect transsexual persons in the workplace and specifically prohibits employers from terminating or refusing to hire persons who are discovered to be transsexual. Member states of the European Union provide employment protection as part of gender discrimination protections following the European Court of Justice decisions in P v S and Cornwall County Council [16].
[edit] Stealth
After transsexual men and women are living full-time as members of their target gender, they may wish to blend in with other members of their new sex, and will avoid revealing their past. They do this believing that it will provide greater peace and security on the other side of a stressful and potentially dangerous transition, and/or because they wish to be seen only as members of their target sex, not as transsexuals.
This behaviour, known as stealth, is recognized by most people in the transsexual community as an individual decision that one must make. Some, however, within and outside the transsexual community, feel that one should be upfront about his or her past, and that stealth living is somehow dishonest. Some draw a parallel with a perceived need for lesbian and gay people to "come out", and may perceive a failure to do so as betrayal of a greater community, seeing hope for advancement of civil rights and public image in the visibility of greater numbers. However, most people within the community understand that revealing ones transsexual history is a deeply personal choice. Moreover, this is part of an individual's medical history, and as such should be his or hers alone to disclose.
The equating of "coming out" (whereby a transsexual person who has hidden their true gender identity while maintaining their originally assigned gender role, reveals their true self) with honesty or social activism has been countered by the explanation that, because of prejudice, sensationalism, and the triggering of unconscious personal feelings and emotions, knowledge of someone's transsexual past can prevent the average person from being able to see the transitioned person's true self.
The decision to live completely stealth is believed to present its own psychological difficulties. Many believe that post-transition transsexual people who have no one in which to confide may have tendencies towards anxiety and depression. The term deep stealth is sometimes used for those who have completely isolated themselves from their past, their birth families, the medical professionals directly involved in their treatment process, and from the support structures that may have helped them through transition. Several examples exist of people who have gone deep stealth and whose status was discovered only at their death. For example, the jazz musician Billy Tipton was deep stealth and his status was unknown, even by his wife and (adopted) children. Tipton's death illustrates one of the dangers of going deep stealth. This fear of discovery as being transsexual may often keep people from seeking needed medical care. Tipton bled to death from an ulcer that could have been readily treated at the time had he been able to seek medical care without fear of discovery.
However, many believe that fear of discovery, as mentioned above, is justifiable. Several examples also exist of people who have been denied medical treatment upon discovery of their trans status, whether it was revealed by the patient or inadvertently discovered by the doctors. For example, Leslie Feinberg was once turned away from a hospital emergency room where s/he had sought treatment for encephalitis. (Feinberg 2) Like Tipton, Feinberg was presenting as a man but had female genital anatomy. He nearly died after being denied treatment. Feinberg's case demonstrates one of the many dangers of actually being discovered. Additionally, Tyra Hunter died after being denied care by paramedics and emergency room physicians after she was injured in an automobile accident.
The majority of the transsexual and transgender community has learned to accept that people choose, for many reasons, including political beliefs, religion, family responsibilities, career, perception of how well they will be accepted by others, and personal psychology, to live at a certain place on the spectrum from 'out and proud' to 'deep stealth'. By this view, Billy Tipton's decision to live deep stealth was no more or less valid than Jamison Green's decision to be out and politically active, as detailed in his book 'Becoming a Visible Man'. There are risks and benefits associated with every point on the spectrum and the decision is widely considered a personal one.
[edit] Regrets and detransitions
After transitioning, transsexual people sometimes regret their transition, or even choose to detransition to their original sex. However, every recent study done on the number of detransitions states that their number is well below 1%, and that the reasons for detransitioning are very diverse. [17] The majority of transsexual people who detransition, but not all of them, consider themselves regretful.
Although the incidence of regret is not known, there are many documented cases of regret. Evidence suggests [citation needed] that regret is more common among self-identified autogynephiles, transsexual people with co-existing psychiatric problems, patients with surgical complications, and patients having religious views that their transition was "wrong". 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. [18] Jerry Leach, a Christian minister who claims to have backed out of SRS a few weeks before his scheduled surgery date, and reverted to living as a man, also claims that he is contacted by many post-op transsexual people with stories of regret. There are some recent claims that examination of his own personal story of transition reveals some inconsistencies and implausibilities. [citation needed] He runs a website on which he has posted some stories of regretful trans patients. [19]. Among notable regretful trans patients are Renee Richards and Danielle Bunten Berry. [20]
These cases are often cited as reasons for the lengthy triadic process outlined in the Standards of Care, which specifies a treatment process combining psychological, hormonal, and surgical care. While many have criticized this process as being too slow for some, it is argued that without the safeguards within the Standards of Care, the incidence of unsuccessful surgical transitions would be much higher. This is also questioned by many critics, especially with regard to particular demands of some caregivers. The article above states that in some of these cases, transitioning could have been prevented if some demands made by caregivers, or demands perceived as coming from the caregivers, had been less rigid; particularly, if the patients had not felt that talking about any problems or doubts would jeopardize their further treatment. An unwavering demand for medical treatment and the absolute conviction of "doing the right thing" is often seen as a necessity for the diagnosis of transsexualism, and therefore the prerequisite for any further treatment; consequently, further treatment has been denied to people who uttered any doubts or even questions.
Critics claim that when patients cannot talk about problems or doubts, but have to present themselves as having neither, the patients, anxious to get treatment they perceive at this point to be absolutely necessary, will face these problems or doubts after transitioning, when dealing with them may be much more difficult, and this will often lead to social problems, depression, anxiety, or other problems. They believe that, in some cases, this may lead to a retransitioning. While there is no scientific study on the question, many trans*-organizations and groups claim that patients who feel less pressure to conform to any particular stereotype will have more satisfactory outcomes after transition. This does not preclude any screening for mental problems which might lead to pseudo-transsexualism, nor supportive psychological therapy, if necessary.
Additionally, some people detransition after SRS because their desire was to undergo SRS and continue living in the gender role assigned to them at birth. [21] However, they transition temporarily in order to satisfy the requirement of a real-life test.
[edit] Depictions of transsexualism in the media
Although many transsexual people are modest about their bodies, and are found in all walks of life and professions, transsexual women are commonly featured in pornographic works. When depicted without having undergone vaginoplasty, they are usually referred to as "shemales". While some pre-operative transwomen call themselves and others like them "shemales," the term is regarded as offensive by many transsexual people. [22]
Films depicting transgender issues include The World According to Garp and The Crying Game. The film Different for Girls is notable for its depiction of a transsexual woman who meets up with, and forms a romantic relationship with, her former best friend from her all-male boarding school. Ma Vie en Rose portrays a six-year-old child who is gender variant.
Two notable films depict transphobic violence based on true events: Soldier's Girl (about the relationship between Barry Winchell and Calpernia Addams, and Winchell's subsequent murder) and Boys Don't Cry (about Brandon Teena's murder).
Transsexual people have also been depicted in some popular television shows. In Just Shoot Me, David Spade's character meets up with his childhood male friend, who has transitioned to living as a woman. After initially being frightened, he eventually forms sexual attraction to his friend, but is scorned, as he is 'not her type'. In a 1980s episode of The Love Boat, McKenzie Phillips portrays a transwoman who is eventually accepted as a friend by her old high school classmate, series regular Fred Grandy.
The series Law & Order and Nip/Tuck have had transsexual characters, but they were played by non-transsexual women or professional cross-dressers. The series Without a Trace featured an episode in which a transsexual woman went missing and is almost killed by her ex-wife's husband after visiting her family, which she abandoned before transtioning. CSI: Crime Scene Investigation had an episode dealing with a transsexual victim, Ch-Ch-Changes. Many transsexual actresses and extras appeared on the episode, including Marci Bowers and Calpernia Addams. The transwoman victim, Wendy, was played by Sarah Buxton, a cisgender woman. [23] Addams has appeared in numerous movies and television shows, including the 2005 movie Transamerica, in which Felicity Huffman portrays a pre-op transsexual woman. [24]
In fall 2005, the Sundance Channel aired a documentary series known as Transgeneration. This series focused on four transsexual college students, including two transwomen and two transmen, in various stages of transition. [25] In February 2006, LOGO aired Beautiful Daughters, a documentary film about the first all-trans cast of The Vagina Monologues, which included Addams, Lynn Conway, Andrea James, and Leslie Townsend. [26]
Thomas Harris' Silence of the Lambs included a serial killer who considered himself a transexual. After being turned down for sex reassignment surgery due to not meeting necessary psychological evaluations, he then harvested female bodies to make a feminine suit. While the movie and novel initially sparked more intolerance toward transexuals, it has since diminished from public criticism of transsexuality. [27]
See also: Transgender in film and television
[edit] Transsexualism in non-Western cultures
See also: Transgender#Transgender in non-Western cultures
Transsexual people enjoy varying degrees of acceptance in non-Western societies.
Before the Islamic Revolution in 1979, the issue of transsexualism in Iran had never been officially addressed by the government. Beginning in the mid-1980s, however, transgendered individuals have been officially recognized by the government and allowed to undergo sex reassignment surgery. (See Transsexuality in Iran)
This stance might be considered liberal from an American or European viewpoint, but some Iranian clerics use the stance to stress heteronormativity on the part of Iranian and Islamic society. Homosexuality is still forbidden and punishable by death in Iran, and the viewpoint is that males who are attracted to other males should become women. Furthermore, in many societies where homosexuality is poorly accepted, social acceptance of transsexual people is high, and many societies which accept homosexuality are not tolerant of transsexual people.
This heteronormative stance is also seen in countries such as Brazil and Thailand. Thailand is thought to have the highest prevalence of transsexualism in the world. In Thailand, kathoey (who are often, but not always, transsexual) are accepted to a greater extent than in most countries, but are not completely free of societal stigma. Feminine transsexual kathoey are much more accepted than gay male kathoey; this may be seen as an example of heteronormativity. Due to the relative prevalence and acceptance of transsexualism in Thailand, there are many accomplished Thai surgeons who are specialized in sex reassignment surgery. Thai surgeons are a popular option for Western transpeople seeking surgery, largely due to the lower cost of surgery in Thailand.
Transsexual people are gaining acceptance in much of Latin America, and gender reassignment surgeries are on the rise in Mexico, Argentina and Brazil. [citation needed]
Transgender-related issues remain largely taboo in much of Africa and in developing countries around the world. [6]
[edit] Notes
^ Lynn Conway - TS Successes
^ BehaveNet - Gender Identity Disorder
^ Mortality and morbidity in transsexual subjects treated with cross-sex hormones - PUBMED
^ Seattle and King County Health - Transgender Health
^ The International Transsexual Sisterhood - Study On Transsexuality
^ Mukasa, Juliet V. (2006-10-23). "Transgender Human Rights Issues in Africa". '. Retrieved on 2006-12-24.
[edit] References
Brown, Mildred L. and Rounsley, Chloe Ann (1996); True Selves; Jossey-Bass.
Feinberg, Leslie (1998); Trans Liberation; Beacon Press.
Harry Benjamin International Gender Dysphoria Association (2001); Standards of Care for Gender Identity Disorders, Sixth Version. [28]
Kruijver, Frank P. M. Zhou, Jiang-Ning Pool, Chris W. Hofman, Michel A. Gooren, Louis J. G. and Swaab, Dick F., (2000); Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic nucleus; J. Clin. Endocrinol. Metab., May 2000; 85: 2034 - 2041.
Schneider, Harald J. Pickel, Johanna and Stalla, Gunter K., (2005); Typical female 2nd-4th finger length (2D:4D) ratios in male-to-female transsexuals--possible implications for prenatal androgen exposure; Psychoneuroendocrinology, In Press, Available online 2 September 2005. [29]
Xavier, J., & Simmons, R. (2000). The Washington transgender needs assessment survey, Washington, DC: The Administration for HIV and AIDS of the District of Columbia Government. [30]
Spencer A. Rathus, Jeffery S. Nevid, Lois Fichner-Rathus (2002). "Human Sexuality in a World of Diversity"; Allyn & Bacon
Denny, Dallas, (2006); Transgender Communities in Transgender Rights.
[edit] See also
List of transgender-related topics
List of transgender-rights organizations
List of LGBT-related organizations
List of transgendered people
[edit] External links
Basic TG/TS/IS Information - including Successful Transwomen and Successful Transmen
FTM International - Female To Male International: practical and medical information
FTM Australia - Comprehensive information for all men identified female at birth in Australia.
Hudson's FTM Resource Guide - Comprehensive information for female to male trans men and allies - USA-based
Gender.org - The home of Gender Education & Advocacy, a nonprofit corporation using the web to provide education and advocacy for transsexual and transgender issues.
Definition and Synopsis of the Etiology of Adult Gender Identity Disorder and Transsexualism - prepared by 24 internationally recognized experts, published by the Gender Identity Research and Education Society (GIRES)(See: http://www.gires.org.uk)
Harry Benjamin Syndrome - An information site that supports the concept backed by indicative research that Harry Benjamin Syndrome,(HBS),(aka transsexualism),should be classified as an intersex medical condition.
How to Respect a Transsexual Person
The International Journal of Transgenderism - The Official Journal of the Harry Benjamin International Gender Dysphoria Association (HBIGDA)
Transsexuality - Jennifer Diane Reitz's Help & Support Site. Home of the COGIATI gender test, a controversial assessment of gender identity and transsexuality.
Lynn Conway - her goal is to "illuminate and normalize the issues of gender identity and the processes of gender transition."
Dr Becky's Website - List of therapists, physicians, medical info, etc.
Trans Family - A support group for transgendered and transsexual people, their parents, partners, children, other family members, friends, and supportive others. Based in Cleveland Ohio, but providing resources for transgender people and their families around the world.
TransParentcy - Organization to support transgender parents and their advocates (lawyers, mental health professionals, friends, family) by providing information and resources to diffuse and/or disspell the myths about any adverse impact being transgendered/transsexual might have on ones children.
Transsexual Road Map - practical and medical information
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Category:Transgender
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Transgender (IPA: [tʰɹænz'dʒɛndɚ], from trans (Latin) and gender (English) ) is an overarching term applied to a variety of individuals, behaviors, and groups involving tendencies that diverge from the normative gender role (woman or man) commonly, but not always, assigned at birth, as well as the role traditionally held by society.
Transgender is the state of one's "gender identity" (self-identification as male, female, both or neither) not matching one's "assigned gender" (identification by others as male or female based on physical/genetic sex). Transgender does not imply any specific form of sexual orientation (transgender people may identify as queer, heterosexual, homosexual, bisexual, pansexual or asexual.)
Definitions are set forth below, but the precise definition for transgender remains in flux.
"Of, relating to, or designating a person whose identity does not conform unambiguously to conventional notions of male or female gender, but combines or moves between these" (Oxford English Dictionary, Draft Entry 2004)
"People who were assigned a gender, usually at birth and based on their genitals, but who feel that this is a false or incomplete description of themselves."
"Non-identification with, or non-presentation as, the gender one was assigned at birth."
A transgender individual may have characteristics that are normally associated with a particular gender, identify elsewhere on the traditional gender continuum, or exist outside of it as "other," "agender," "intergender," or "third gender." Transgender people may also identify as both male and female, or along several places on either the traditional transgender continuum, or the more encompassing continuums which have been developed in response to the significantly more detailed studies done in recent years.
Contents [hide]
1 Origins
2 Transgender Identity
2.1 Transsexual
2.2 Cross-dresser
2.3 Drag
2.4 Genderqueer
2.5 Androgyne
3 Contrast with "sexual orientation"
4 Transgender Individuals in non-Western cultures
5 Citations
6 See also
7 External links
[edit] Origins
The term transgender was coined in the 1970s by Virginia Prince in the USA, as a contrast with the term "transsexual," to refer to someone who does not desire surgical intervention to "change sex," and/or who believes that they fall "between" genders, not identifying fully, or strictly, as either male or female. [1](Holly. 1991 “The Transgender Alternative.” TV/TS Tapestry Journal 59:31-33).
Often in older writings (pre ~1990s), but more rarely today, the term transgender is used to refer to those who live as the gender not assigned to them at birth, without medical or surgical intervention. In the Netherlands, the term is often applied to this specific group.
This group is also sometimes known as "transgenderists" or "non-op transsexual people". (See "Transsexual" below.)
More recently, this term has been used to describe anyone who does not strictly adhere to the gender norms of their peers, whether in terms of physiology or choice of fashion. This would include anyone, male or female, who chooses to wear clothing normally worn by the opposite sex.
[edit] Transgender Identity
Transgender identity includes many overlapping sub-categories. These include transsexual; cross-dresser; transvestite; consciously androgynous people; genderqueer; people who live cross-gender; drag kings; and drag queens. Usually not included, because in most cases it involves a paraphilia and is not a specific gender issue, are transvestic fetishists. These terms are explained below.
Many people also identify simply as transgender, although they may fit the definition of any of one of the specific categories.
The extent to which intersex people (those with genitalia or other physical sexual characteristics that are not strictly either male or female) are included in the transgender category is often debated. Not all intersex people disagree with the gender they were assigned at birth. Those who do may self-identify or be identified as transgender.
Although some transgender people have had medical sex reassignment therapy, also called sex reassignment surgery, others have not, being quite happy living as they are. In other words, not all transgender people are transsexual, but all transsexual people are transgender. (See below for criticism.) Given the general confusion over and misuse of the term transgender, some individuals who move across the gender divide regularly have begun to label themselves as "ambigendered" as they are comfortable with expressing their identity in either gender [citation needed].
The term "transman" refers to female-to-male ("FTM") transgender people, and "transwoman" refers to male-to-female ("MTF") transgender people, although some transgender people identify only slightly with the sex not assigned to them. There is a developing awareness that terms such as "FTM" and "MTF" are subjugating language that reinforces the stereotype of gender as a binary system. [1] "Genderqueer" is a recent evolution in attempts to signify gendered experiences that do not fit into binary concepts. In the past, it was generally assumed that there were considerably more transwomen than transmen. However, as more research is performed, it seems more likely that the actual ratio is closer to 1:1. [2]
"Cisgender" is sometimes used to refer to non-transgender persons, and refers to those individuals who identify themselves with the gender associated with their birth sex.
The terms "gender dysphoria" and "gender identity disorder" are used in the psychiatric and medical community to explain these tendencies as a psychological condition and the reaction to its social consequences. Strictly speaking, gender dysphoria and gender identity disorder are considered to be mental illnesses, as recorded in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the standard for mental healthcare professionals. Because of the countless historical recordings of such behavior, however, there is strong debate as to whether they should actually be considered a mental illness at all. Most transgender people reject the idea, and consider their being transgender as a simple variation of human behaviour rather than a mental illness. [2] Some have argued in favor of the idea of "gender giftedness."
Many mental healthcare providers know little about transgender life. People seeking help from these professionals often end up educating the professional rather than receiving help[citation needed]. Among those therapists who profess to know about transgender issues, many believe that transitioning from one sex to another — the standard transsexual model — is the best or only solution. This usually works well for those who are transsexual, but is not the solution for other transgender people, particularly cross-gender people who do not identify as plainly male or female.
[edit] Transsexual
Main article: Transsexual
Transsexual people are often people who desire to have, or have achieved, a different physical sex from their original physical sex. One typical (though oversimplified) explanation is of a "woman trapped in a man's body" or vice versa. Many transsexual women state that they were in fact always female gender, despite physically being male; transmen feel exactly the opposite.
The process of physical transition for transsexual people usually includes hormone replacement therapy and may also include sexual reassignment surgery (a.k.a. gender reassignment surgery). Having a strong wish for surgery does not have to be present to meet the requirement for the diagnosis, as a number of transwomen do not feel uncomfortable with the male appendage. For transwomen, electrolysis for hair removal is often desired, while many transmen have breast-reduction surgery as early as possible.
Some spell the term transexual with one s in order to reduce the association of their identity with psychiatry and medicine.
There are some scientific studies suggesting physical causes of transsexuality (see the main transsexual article).
Reference to "pre-operative", "post-operative" and "non-operative" transsexuals indicates whether they have had, or are planning to have sex reassignment surgery. This can be misleading, because there are a number of different types of surgery that may be used, and the terms are rarely used with precision. Some suggest that the term "non-op transsexual" is an oxymoron, as many erroneously believe the definition of transsexual should include at least a strong wish for such surgery. However, surgery is usually desired if one has a dysphoric feeling with respect to their appearance, and those having no such dysphoria usually elect not to have surgery.
Note that for various medical and financial reasons, people may have the wish, but not the ability, to undergo sex reassignment surgery, however, they are still transsexual. Further confusing the term is that the individuals concerned have various motivations, ranging from dissatisfaction with medical options available (particularly among transmen), to the perception that one's genitals have little bearing upon identity. Currently, there are no broadly agreed terms, even within the larger transgender community, to accurately define the various groups of "non-op transsexual people".
Transgender is sometimes used as a euphemistic synonym for transsexual people. Some prefer this because it avoids the concept of "sex" in "transsexual", which may give the incorrect impression that transsexuality is motivated by erotic desire. However, many transsexual people do not self-identify as "transgender," contending that the term inaccurately describes and marginalizes their specific gender identity. In addition, many transsexuals identify simply as "men" or "women," though different than that assigned at birth, and do not wish to be associated with the connotation of being in-between genders. Some feel that their gender identity has remained constant, and that they have changed sex, but not gender.
Some criticize the use of the term "transsexual" because sex reassignment does not render an individual reproductively viable nor does it change their sex chromosomes. From a functional viewpoint of sex, the transition is cosmetic rather than fundamental, and the individual is not "really" changing their sex. This argument is particularly used by some feminists to dispute transsexual women's claims of identification and association with other women. This ignores, however, cases of non-transsexual people who are infertile or intersexual people who have a non-standard chromosomal configuration. For example, women with Androgen Insensitivity Syndrome (AIS) are born physiologically female, but their sex chromosomes are XY. An analogous condition exists where an XX fetus is exposed to testosterone in utero, and develops male genitalia.
In an effort to respect the identity of those transsexual people who do not identify as transgender, the constructions trans, trans*, or transgender and transsexual are sometimes used to describe all trans-people.
Further, many people whom this article would define as transgender reject the term altogether, along with other related terms (transsexual, crossgender, etc.). This is most commonly seen with people who have changed sex but who do not define themselves as transsexual. A common statement is that a transsexual is someone who is undergoing a change from one sex to another; someone who has already done so is simply a "man" or a "woman".
[edit] Cross-dresser
Main articles: cross-dressing, transvestism, drag king, drag queen, transvestic fetishism
A person who is cross-dressing is any person who, for any reason, wears any amount of clothing normally considered belonging to the opposite sex. Cross-dressers may have no desire or intention of adopting the behaviors or practices common to the opposite gender, and generally do not wish to undergo medical procedures to facilitate physical changes.
Contrary to common belief, the vast majority of cross-dressers, which comprises most of those who wear clothing normally intended for the opposite sex, are heterosexual.[3]
[edit] Drag
Drag involves wearing highly exaggerated and outrageous costumes or imitating movie and music stars of the opposite sex (e.g. Rupaul). It is usually defined as a form of performing art practiced by drag queens and drag kings. Drag is generally more theatrical, often comedic and sometimes deliberately grotesque, and this has made it somewhat controversial, with some feminists considering it a caricature of women. Drag is often found in a gay or lesbian context, although it is a common aspect of straight culture as well, with many straight men dressing in drag at Halloween and straight comics like Dame Edna and the Monty Python troupe including drag in their acts. The word "drag" is sometimes more loosely applied to crossdressing in general and transgender people who are not performers will sometimes refer to themselves as drag queens or drag kings. The term "drag king" can also apply to people from the female-to-male side of the transgender spectrum who do not see themselves as exclusively male identified, therefore generally covering wider ground than "drag queen".
Transvestic fetishism is a narrower term used in the medical community to refer to one who has a fetish for wearing the clothing of the opposite gender. This is considered a derogatory term by some, as it implies a hierarchy of value in which the sexual element of transgender behavior is of low social value. Many reject the term "transvestite" for this reason, preferring "cross-dresser". It is often difficult to distinguish between fetishism that happens to have female clothing as an object and transgender behaviour that includes sexual play.
[edit] Genderqueer
Main article: Genderqueer
This refers to a combination of gender identities and sexual orientations. One example could be a person whose gendered presentation is sometimes perceived as male and sometimes as female but whose gender identity is female, gendered expression is “butch” and sexual orientation is lesbian. It suggests nonconformity or mixing of gendered stereotypes, conjoining both gender and gayness, [4] "pluralistic challenges to the male/female, woman/man, gay/straight, butch/femme constructions and identities." [5] Genderqueerness is both unintelligible and abjected in the binary sex/gender system. "[O]ur embodiments and our subjectivities are abjected from social ontology: we cannot fit ourselves into extant categories without denying, eliding, erasing, or otherwise abjecting personally significant aspects of ourselves . . . When we choose to live with and in our dislocatedness, fractured from social ontology, we choose to forgo intelligibility: lost in language and in social life, we become virtually unintelligible, even to ourselves." [6]
[edit] Androgyne
Main article: Androgyne
An androgyne is a person who does not fit cleanly into the typical masculine and feminine gender roles of their society. Many androgynes identify as being mentally "between" male and female, or as entirely genderless. The former may also use the term bigender or "pangender", or ambigender the latter non-gendered or agender. They may experience mental swings between genders, sometimes referred to as being gender fluid.
Intergender is also a word that androgynes can use to describe being between or beyond genders.
Androgyne used to be primarily used as a synonym for hermaphrodite (a term since replaced by the word intersex), but this usage has fallen out of favor.
Androgyny can be either physical or psychological; it does not depend on birth sex. A person who identifies as an androgyne may have been born intersexed, or may have typical sexual organs, either male or female.
Occasionally, people who do not actually define themselves as androgynes adapt their physical appearance to look androgynous. This outward androgyny has been used as a fashion statement, and some of the milder forms of it (women wearing men's pants or men wearing two earrings, for example) are not perceived as transgender behavior.
[edit] Contrast with "sexual orientation"
(Trans-)gender identity is a fundamentally different concept than that of sexual orientation (compare LGBT, section “Controversy”). Sexual orientations among transgender people vary just as much as they do among cisgender (non-transgender) people.[citation needed] There is, however, for both transgender and cisgendered individuals, an important relationship between their gender identity and sexual identity.[citation needed] Although few studies have been done, some transgender groups report that their members are more likely to be attracted to people of the same gender identity than their cisgendered counterparts.[citation needed] For example, transwomen are more likely than ciswomen to be attracted to other women, and transmen are more likely than cismen to be attracted to other men. Within the transgender community, some attribute this phenomenon to the negative feelings associated with their previous gender.[citation needed]
Transgender people who are attracted to others of the same gender can identify as gay, lesbian, bisexual, or pansexual. Thus, a transwoman who is attracted to female-identified individuals would be properly referred to as a lesbian, and a transman who is attracted to male-identified individuals would be correctly referred to as a homosexual male. In turn, trans people who are attracted to people of a gender identity opposite their own would be considered heterosexual.
In professional literature, the terms "homosexual" and "heterosexual" are often used for transgender people incorrectly based on their birth sex, instead of their gender identity.[citation needed] Transgender people may feel misunderstood by caregivers because of this practice.[citation needed] It is also quite confusing when a relationship that is considered gay or lesbian by both partners is re-labeled heterosexual, or a relationship that consists, as far as the partners are concerned, of a man and a women is re-labeled homosexual. Compare Homosexuality and transgender.
Many Western societies have some sort of procedure whereby an individual can change their name, and sometimes their legal gender, to reflect their gender identity (see Legal aspects of transsexualism). Medical procedures for transgender people are also available in most Western and many non-Western countries. However, because gender roles are an important part of many cultures, those engaged in strong challenges to the prevalence of these roles, such as many transgender people, often face considerable prejudice.[citation needed]
Some people, more often politicians than medical professionals, have claimed that being transgender is merely "a choice and a lifestyle" (for example U.S. Rep. John Culberson, R-Texas)[citation needed]; in this context, it is usually seen as an extreme form of homosexuality.
[edit] Transgender Individuals in non-Western cultures
This article primarily describes Western modes of transgenderism, but many other cultures have or have had similar phenomena:
The so-called berdache in many Native American groups is recognized as a separate gender, a woman-living-man, not as a man who wants to be a woman. The term "berdache" is a misnomer, however, as no Native American group actually used the term; different ethnic groups had different names for the role, such as the winkte. The spouse of such a person is not viewed as being gender-different themself, but as a normal male. In some societies there is a corresponding gender for women living as males.
In Thai culture, there is the kathoey, who is very similar to the English definition of transgender, but is sometimes broader, including effeminate gay males.
South Asian cultures have hijra, who can be born intersex, or (more commonly), are assigned a male sex at birth and later choose to live as a third sex, surgically removing their male genitals and wearing women's clothes. See, for example, the Peoples’ Union for Civil Liberties, Karnataka (PUCL-K). (2003). Human Rights Violations against the Transgender Community: A Study of Kothi and Hijra Sex Workers in Bangalore, India. [3]
Chinese cultures have a wide variety of transgender modes of existence. See transgender in China.
In Iran, Ayatollah Khomeini instituted state procedures to help pay for sex-change operations in those who identified as transgender. See Transsexuality in Iran.
Mukhannathun are gender-variant (typically male-to-female) persons of the Islamic faith who are "accepted within the boundaries of Makkah and Madinah (Islam)".
Muxe are a third gender (physically male) in Zapotec culture.
The ancient Galli were castrated followers of the Phrygian goddess Cybele, who can be regarded as transgender in today's terms.
[edit] Citations
^ Cromwell, Jason (1999):28 Transmen & FTMs: Identities, Bodies, Genders & Sexualities (Urbana and Chicago:University of Illinois Press).
^ Landén, M., Wålinder, J. et al. (1996). Incidence and sex ratio of transsexualism in Sweden. Acta Psychiatrica Scandinavica, 93(4), 261–263.
^ Doctor, Richard F., Prince, Virginia (1997). Transvestism: A survey of 1032 cross-dressers. Archives of Sexual Behavior 26(6), 589-605.
^ Wilchins, Riki Anne (2002) ‘It’s Your Gender, Stupid’, pp.23-32 in Joan Nestle, Clare Howell and Riki Wilchins (eds.) Genderqueer: Voices from Beyond the Sexual Binary. Los Angeles:Alyson Publications, 2002.
^ Nestle, Joan (2002) ‘Genders on My Mind’, pp.3-10 in Joan Nestle, Clare Howell and Riki Wilchins (eds.) Genderqueer: Voices from Beyond the Sexual Binary. Los Angeles:Alyson Publications, 2002:9.
^ Hale, Jacob C. (1998) ‘Consuming the Living, Dis(Re)Membering the Dead in the Butch/FTM Borderlands’, Gay and Lesbian Quarterly 4:311, 336 (1998).
[edit] See also
Compton's cafeteria riot First known instance of TG resistance to police harassment in the U.S.
National Center for Transgender Equality
List of transgendered people
List of transgender-related topics
List of transgender-rights organizations
Transgender publications
Queer
TG (fanart)
Body dysmorphic disorder
Gender identity disorder
Cisgender
Postgenderism
Transgender Law Center
[edit] External links
European transgender network
FTM Australia - for all men identified female at birth in Australia.
Hudson's FTM Resource Guide - information for female to male trans men and allies.
Gender Identity Support Group - Melbourne, Australia Gender Identity Support Group is a non-profit organisation
NCTE National Center for Transgender Equality
Seahorse - Melbourne, Australia The Seahorse Club of Victoria, Inc. is a support and social group for the transgender community.
Susanna Valenti: a Transgender Pioneer
Transgender Law Center
Trans Melbourne Gender Project
TransGender Victoria - Melbourne, Australia Our Mission is to achieve justice and equity for all transgender people
The Urban TransMan Comprehensive site for TransMen, especially those living in urban communities.
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Androgyny · Boi · Gender identity · Gender identity disorder · Genderqueer · Cisgender · Pangender · Transgender · Transman · Transwoman · Transsexualism
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Zur Philosophie des Qigong Dancing
Die Ziele des Qigong sind heute vor allem auf die Pflege der Gesundheit, die Kräftigung und Abhärtung des Körpers sowie auf die Verlangsamung des Alterungsprozesses ausgerichtet.
Qigong Dancing beschreibt einen neuen Weg, die über 4000 Jahre alte Tradition des Qigong um die individuelle Persönlichkeit in der Verbindung mit spielerischem und begegnungsstarkem Tanz zu bereichern.
Der Tanz lässt jedem Übenden Raum, seine eigene Persönlichkeit ins Qigong einzubringen und damit zu arbeiten. So kann Gesunderhaltung mit dem Bedürfnis nach persönlichem Ausdruck verbunden werden.
Schon immer hat es der Tradition des Qigong entsprochen, die Übungssysteme der Zeit und den Möglichkeiten der Menschen entsprechend weiterzuentwickeln. Daraus entstand eine Vielzahl unterschiedlicher Ansätze.
Qi wird als das dynamische Prinzip bezeichnet, welches den lebenden Körper beseelt. I.M. Qigong wird das "wahre Qi", das heißt alle physiologischen Funktionen in ihrer Gesamtheit kultiviert. Vereinfacht kann Qi als Lebensenergie umschrieben werden. Gong bedeutet die Arbeit des Übenden, durch die eine Fertigkeit reifen kann.
Dancing ist das englische Wort für "Tanzen" hinzu. Qigong Dancing bedeutet also: Der Tanz mit der Lebensenergie.
Inhalt des Qigong-Dancing ist sowohl das Üben traditioneller Qigongformen als auch unsere Energie im individuellen Tanz zur Entfaltung zu bringen. "Form" und "Nicht-Form" bereichern einander. Die Übungen tragen zu einer Entspannung im ganzen Körper bei.
So kann das Qi in den sogenannten Meridianen, den Leitbahnen für das Qi, ungehindert fließen. Qigong zu üben heißt, seine Lebensenergie zu aktivieren, zu pflegen und damit zu seiner Gesundheit beizutragen.
Im Mittelpunkt des Qigong Dancing stehen Tierübungen, die auf das "Spiel der 5 Tiere" des Arztes Hua Tuo zurückgehen, der von 190 - 265 lebte.
Inspiriert durch Zhuangzi (4. - 2. Jh. v. Chr.), der Atemübungen in Verbindung mit Tierqualitäten beschrieb, Huainanzi´s "Bewegungen der 6 Tiere" und die eigene Beobachtung und Nachahmung von Tieren entwickelte er das "Spiel der 5 Tiere". Die Übungen zählen zum medizinischen Qigong, weil sie das Qi im Körper zirkulieren lassen und damit die Gesundheit stärken.
Das Spiel der Tiere gibt feste Bewegungsmuster vor, durch die man die jeweils zugeordneten Organe, Energiepunkte und Leitbahnen aktiviert und das Qi im ganzen Körper zum Fließen bringt.
Durch das regelmäßige Üben erreicht man eine Sensibilität für den eigenen Körper und dessen Befinden. Die festen Bewegungsabläufe und charakteristischen Qualitäten der Tiere sind Grundlage für Qigong Dancing.
Über die vorgegebenen Bewegungen tauchen wir in den freien Tanz, dem Qigong Dancing. Mit Musik können die verschiedenen Aspekte spielerisch ausprobiert, nachempfunden und in eigene Bewegungen umgesetzt werden. In der Begegnung mit anderen Menschen wird zum Ausdruck | |
