As we have pointed out earlier in this book, human sexual development has at least three major aspects: biological sex, gender role, and sexual orientation. (See "The Development of Sexual Behavior.") We have also mentioned that some individuals may totally identify with a gender role that contradicts their biological sex. In other words, there are persons with male bodies who
TWO CASES OF TRANSSEXUALISM
From Female to Male Annie M. on her sixteenth birthday (left) and four years later after a "sex change operation" (right).
From Male to Female The English writer James Morris (left) became Jan Morris (right), remaining equally successful after a "sex change operation".
consider themselves females, and there are persons with female bodies who consider themselves males. Particularly after puberty, such people become very uncomfortable with their anatomical appearance and therefore try everything in their power (including a "sex change" operation) to make the body conform to their self-image. Their condition is called transsexualism (from Latin trans: across and sexualis: sexual).
The causes of transsexualism are not yet fully understood. We only know that gender roles are established at a very early age and that, after a certain critical time has passed, a person's sexual self-identification is irreversible. Thus, a hermaphroditic boy whose sex is misdiagnosed at birth may be brought up as a girl by his parents. When they finally discover their error, it may be too late to correct it, and the boy may continue to consider himself female. Unfortunately, there are also some rare cases where parents simply refuse to accept the biological sex of their child. (One example is the mother who deliberately forces her infant daughter into the role of the son she had really wanted.) However, in other cases children seem to adopt an inappropriate gender role all on their own and in open defiance of clear parental suggestions. In view of these facts, many sex researchers today believe that transsexualism may be caused by a combination of biological and social factors, and that some children may develop a transsexual disposition even before they are born.
As far as we know, transsexualism is as old as mankind itself, although transsexuals have been treated very differently in different cultures and historical periods. In ancient times a sex change was often seen as a religious mystery which inspired respect and awe. An ancient Greek myth, for example, tells of the blind prophet Teiresias who, as a young man, was miraculously changed into a woman and then, several years later, back into a man. Thus, he knew the sexual response of both males and females from personal experience, a fact which added to his authority. We also know that in some societies of the past (including some American Indian tribes) certain males were allowed or even encouraged to adopt a feminine gender role and live as "shamans", "alyhas", or "berdaches". They wore female clothes, married some great warrior or other important man in the community, and took care of his household. Very often they also enjoyed great prestige themselves because they were believed to possess magical powers. (Obviously, this social arrangement provided a convenient outlet not only for transsexuals, but also for other sexual minorities, such as hermaphrodites, transvestites, and effeminate homosexuals. More virile homosexuals, on the other hand, could find sexual fulfillment within their masculine role by marrying a berdache.)
The sexually intolerant modern Western societies have never offered a comparable simple solution. On the contrary, our Judeo-Christian culture has always been characterized by the fanatical oppression and persecution of sexual deviants, and thus, for a very long time, the approach to transsexualism was also mostly punitive. However, it is now recognized that verbal threats, criminal sanctions, physical force, and electroshock or aversion therapies can do nothing to change the condition.
Today, many professionals feel that transsexuals should be helped to achieve, or at least approach, their goal. Or, as a distinguished physician once put it: "If the mind cannot be changed to fit the body, then perhaps we should consider changing the body to fit the mind." Modern hormone therapy and new surgical techniques have now made it possible to alter a person's anatomical appearance considerably. Thus, with hormonal treatment and a so-called "sex change operation", a man may acquire so many female physical characteristics (including breasts and an artificial vagina) that he can generally pass for a woman. (To a lesser extent, the reverse is also possible. Still, it is easier for a surgeon to construct a vagina in a male than a penis in a female.) There are now a number of gender identity clinics in various parts of the country where transsexuals can find help. These clinics are usually associated with a university or a medical school. However, in recent years many private physicians and surgeons have also begun to specialize in this field. (In the last few years hundreds of persons have undergone "sex change" surgery in America, and hundreds more have applied for it.)
The "sex change" itself may extend over several years. It begins with hormone therapy (reversible) and eventually leads to the operation (i.e., irreversible corrective surgery). Even after surgery, the patient is usually asked to appear periodically for follow-up interviews in which the therapeutic results and the adjustment to the new life-style can be discussed.
Professional advice and assistance are important every step of the way. For instance, transsexuals who are being prepared for their sex reassignment surgery will, at some point, have to start wearing the clothing of their new sex. Unfortunately, in some parts of the country they may thereby violate certain state laws or local ordinances against cross-dressing. Sometimes, a special letter from the physician attesting to the treatment can ease the problem. Many county departments of medical services (mental health division) and state departments of health (bureau of special health services) also confirm such treatment on official letterhead. Once the treatment is completed, many other legal details still have to be worked out. Among other things, the "new" man or woman may need a new name, birth certificate, driver's license, social security card, and passport. In some cases, relocation and vocational rehabilitation may also be necessary. In countries outside the United States, especially in Europe, sex changes are often denied recognition by the law. The results of this official cruelty for the transsexual are devastating. It can only be hoped that the legislatures and judges in these countries will soon be better educated in regard to this problem.
Readers who want more practical information on these and other aspects of transsexualism may contact the Janus Information Facility, 1952 Union St., San Francisco, Ca. 94123. This nonprofit organization has published some useful pamphlets dealing with various problems confronting the transsexual. In addition, it keeps on file an extensive list of medical and other professionals involved in the treatment of transsexualism. Finally, the foundation also issues special ID cards for transsexuals undergoing treatment.