Understanding Gender Dysphoria
[parts
by courtesy of The Gender Trust]
Most of us are perfectly comfortable with the fact that we are male or
female. In fact we normally never give it a thought. But there are a very few
people who feel they were born with the wrong body – men who feel they should
have been born women and vice versa. In many cases these people, referred to as
transsexuals, remember feeling this way even in childhood. When the feeling
becomes strong enough, the person may seek surgery to remove their testes or
ovaries, may have their external genitalia surgically altered and take hormones
to make them appear like the other sex. These extreme measures are accompanied
by discomfort and risk, so no one would entertain them on a whim. Rather, transsexuals
take such drastic measures because they feel so strongly and consistently that
they should have been born the opposite sex.
The rate of occurrence of transsexuality is not accurately known. Because of
the social stigma attached to being transsexual, arising from a widespread lack
of awareness of the true nature of the condition, it is something that is often
kept hidden. Therefore it is only possible to collect statistics on the numbers
of declared transsexuals and such figures undoubtedly represent only a
proportion of those affected. Not very long ago estimates of the rate of
occurrence of male-to-female transsexuality might have been around 1 in 100,000
of the male population. Today, with the greater awareness and openness that
exists, some estimates now put the figure at greater than 1 in 10,000. It is
known that other chromosomal or intersexed conditions can have rates of
occurrence of, or approaching, 1 in 1,000 of the population and it may well be
that this is the true order of magnitude of transsexuality.
Rates of occurrence of known female-to-male transsexuals are significantly
lower, typically being around !/3 to !/4 of the rate for male-to-female
transsexuals. However, this rate has varied somewhat with time and between
different parts of the world. This suggests that varying cultural factors might
play a role in the decision to be open about the condition.
When a member of the family or partner of a transsexual asks
this question, their interest in the answer is neither general nor academic.
Their concern is a practical one. They are asking: how did my son/daughter or
partner come to be as he or she is; is their condition reversible; if not, what
professional help is available to them, and how may I help? The aim of this
information is to provide you, in simple terms, with specific information,
derived from the latest medical research, which will be useful to you. But it
is important for you to understand that professional help is only one
ingredient in the successful rehabilitation of the transsexual. The other,
which only you can supply, is the love, concern and acceptance that are
manifested by those people who are important to them.
When we say that human gender identity is psychosexual in essence, we refer not
merely to their physical characteristics, but to an intricate, variable complex
of mental traits and tendencies, subtle and emphatic. For most of us, these
qualities and characteristics resolve themselves into a harmony that declares
itself as predominately masculine or feminine. This psychosexual identity which
we present to the world satisfies our cultural definitions, and many
comfortably be taken for granted by us and by those around us.
Not so for the transsexual. For them, the apparent sexual balance, as expressed
in the primary sex characteristics - i.e. the genitalia, is deceptive. It does
not reflect, indeed it contradicts, the inner balance they strongly feel, and
which to them represents their true psychosexual identity. In some instances of
transsexualism, where the secondary sex characteristics -i.e. heavy facial or
body hair in the male, feminine hips and pronounced breast development in the
female - shade into those of the opposite sex, the body itself has already
begun to bear out this inner conviction. But physical ambiguities are by no
means general in every instance in which an individual's powerful, intimate
sense of self contradicts their sex as recorded at birth.
There are other gender identity disturbances which are sometimes confused with
transsexualism, but which are distinct from it. The homosexual and the
transvestite person experience some conflict between sex and gender. But
neither of these has any desire to change his anatomy. The transsexual, on the
other hand, feels that they have been trapped in the body of the wrong sex and
they seek help to be freed from this predicament.
The best efforts of skilled, dedicated professionals in the
physical and psychological sciences have so far failed to uncover the origins
of the transsexual condition. The most impressive hypotheses put forward to
date, based upon careful and open-minded clinical studies, indicate that
several possible elements should be considered together: functioning of the
brain and of the endocrine glands, neurological mechanisms, cultural and other
environmental factors.
Most, if not all, specialists in gender identity are agreed that the
transsexual condition establishes itself very early, before the child is
capable of elective choice in the matter, possibly in the first two years of
life. Others believe it is set even earlier, before birth during the foetal
period.
These findings indicate that the transsexual has not made a choice to be as
they are, but rather that the "choice" has been made for them through
many causes preceding birth and beyond their control. When you fully understand
that the condition is confirmed so early in life, and that no individual can a
make a conscious decision to be a transsexual, this comprehension should allay
some of your anxieties and help you to deal with the transsexual with greater
sympathy. It will become clear, too, why psychotherapy is rarely, if ever,
successful. Yet, some sort of treatment is urgently indicated, for in many
instances the transsexual's suffering is so intense that suicide and self
mutilation are not uncommon. Therefore, many professionals have come to share
the view of the distinguished doctor who said: "If the mind cannot be
changed to fit the body, then perhaps we should consider changing the body to
fit the mind." Thus scientists, through painstaking clinical processes
have arrived at the same conclusion to which the transsexual's suffering led
them as they desperately sought a remedy for their daily sense of dissonance
between their mind and body.
Physicians and psychiatrists have been deeply impressed with the fortitude with
which many of their transsexual patients confront physical pain, economic
sacrifice, and complicated social and emotional adjustments in their commitment
to the liberating process of sex reassignment. Medical specialists who maintain
a careful, long-term follow-up on their transsexual patients have reported
that, where other efforts at treatment have failed, corrective surgery has
produced "subjective and objective improvement in life adjustment in a
majority of cases." The keys to success are: 1) proper screening, 2)
counselling, and 3) family support before, during, and after surgery.
Is it reversible? The vast majority of medical practitioners seriously
concerned with problems of gender identity in the adult have answered
"No", not in the "true" transsexual. But to this negative
answer they have mercifully added positive suggestions for treatment which
offer relief and hope to the transsexual: counselling, hormone therapy and
surgery.
Highly qualified doctors of physical and psychological medicine all over the
world, working singly or in teams, are increasingly concerning themselves with investigations
into the causes and treatment of transsexualism. Evidence as to causes, and
data as to effects of treatment, are accumulating, encouraging the hope that
earlier diagnosis and more effective preventive and ameliorative procedures, as
well as education of the general public, will successfully reduce this source
of human suffering.
But it cannot be too strongly stated that question "why" is the
scientist's proper job, his alone It is
harmful, and even destructive for the family of a transsexual to look back for
the causes of their difficulties. Such a search based on one case only and
biased by emotional involvement may easily mask an assignment of guilt either
to yourself, or to your child or partner. It would be better to look instead to
the present, and share this present with them, fulfilling their need for your
love, understanding, and acceptance.
One may regard a problem such as a transsexual child as something to be pushed
aside and forgotten; but in fact, by confronting such a problem one finds
opportunities for growth, a chance to learn about and appreciate qualities in
one's child which seemed undesirable when "out of context" in their
male or female bodies, but which now appear lovely. A difficulty avoided
inevitably returns to challenge us in a more acute form. So do not turn from a
loved one at the time of their greatest need.
No parent or partner of an adult transsexual is wholly prepared for the
revelation of their condition. There have generally been numerous clues,
usually from early childhood and always from adolescence, when the
psychosomatic crises of that period produce distress signals that are often
most dramatic. You may have no doubt shared in their embarrassments and
traumas, when, since their natural behaviour was inappropriate to their genetic
sex, they were rejected by their peers, looked at askance in public, and
finally retreated into a painful isolation. Remembering your own discomfort on
their behalf, recognise that the primary and more intense suffering was theirs
alone; just as it is they who now bear the heaviest burdens of readjustment to
a new life. Now that they have finally found a way to correct those conditions
that created painful experiences for you as well as for them, it should bring a
sense of relief to you, too.
Almost any biologically complementary couple may participate in procreation.
You are called upon to assist at a re-creation; your child's second birth. Mistakes are remedied so that they can begin
to fulfil; themselves personally and as a happily contributing member of
society. Through your vitally important, loving support, you can be a
participant in their adventure, sharing in the release and liberation of their
new life.