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Adapted for T-Vox from an article on Wikipedia.

A transsexual (sometimes transexual) person is one who establishes a permanent gender identity opposite to their assigned sex; with their sex usually having been assigned at birth. Transsexual men and women make, or desire to make, a transition from their birth sex to that of the opposite sex, usually with medical alteration to their body, taking the form of hormone therapy and often gender reassignment surgery. The stereotypical explanation is of a "woman trapped in a man's body" or vice versa, although many members of the transsexual community, as well as some outside the community, reject this description as failing to fully describe the experience.



The minimum requirements for a person to be considered transsexual are debated. Some feel that hormone-induced changes, without surgical changes, are sufficient to qualify for the label transsexual. Others, especially health care providers, believe there is a certain set of procedures that must always be completed. The general public often defines "a transsexual" (an incorrect use of the term, as 'transsexual' is an adjective, not a noun) as someone who had or plans to have "sex change" surgery. The current term in widest use for modification of sexual characteristics is gender reassignment surgery (GRS), a term which reflects the belief that transsexual people do not consider themselves to be changing their sex, but to be correcting their bodies.

However, it is also often accepted (and is also evident in the Diagnostic and Statistical Manual, version four, aka DSM IV) that to express desire to be of the opposite sex, or to assert that one is of the sex opposite to the one with which they were identified at birth, constitutes being transsexual. (This does not include delusions about ones current sex, regardless of the cause of the delusion.) In contrast, some transgender people often do not identify as being of or wanting to be the opposite sex, but as being of or wanting to be another gender.


Transsexual people are often construed as belonging to the LGBT or the Queer community, and many identify with the community; others do not, or prefer not to use the term. It should be noted that transsexuality is not associated with or dependent on sexual orientation. Transsexual men and women exhibit the same range of sexual orientations as non-transsexuals (known technically as cissexual people) do. They almost always use terms for their sexual orientation that relate to their target gender. For example, someone assigned to 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 female sex at birth, identifies as a man, and prefers male partners will identify as gay, not heterosexual.



Transsexuality should not be confused with cross dressing or the behaviour of drag queens, who can be described as transgender, but (usually) not transsexual. Also, Transvestic fetishism has usually little, if anything, to do with transsexuality.


Gender terms used to describe transsexual people always relate to the 'target' or 'acquired' gender. For example, a transsexual man is someone who was identified as female at birth owing to his genitals, but identifies as a man and who is transitioning, or has transitioned, to a male social gender role and a male-identified body (an alternative term is female-to-male transsexual or transman; compare also transwoman).


Those researching the topic should be aware that older medical texts often referred to the person's original sex; in other words, referring to a M2F transsexual as a "transsexual male". This usage is now sharply deprecated and little-used.

Among the transsexual community, the short form trans is more commonly used, e.g. trans guy, trans dyke, trans folk. Some also use the somewhat more controversial term tranny, e.g. tranny boy. Both abbreviated forms are also used by non-transsexual transgendered people, although "tranny" is often considered offensive, especially if used by those outside the community.

Some people prefer to spell transexual with one s, in an attempt to divorce the word from the realm of psychiatry and medicine and place it in the realm of identity, but this trend is most common in the United States and is almost never used in the United Kingdom.


Causes of transsexualism

There is no scientifically proven cause of transsexualism. However, many theories have been proposed which suggest that the cause of transsexualism has its roots in biology; an idea that evidence of transsexual siblings has shown may have some truth to it. Many religious conservatives and others still believe that the causes of transsexualism are predominantly psychological.

Proposed psychological causes

In the past, many psychological causes for transsexualism have been proposed; including "overbearing mothers and absent fathers", "parents who wanted a child of the other sex", "repressed homosexuality", "sexual abuse" or a variety of sexual "perversions". (Compare autogynephilia)

None of these theories however was able to be applied successfully to a majority of transsexual people, usually not even to a significant minority. Many theories also were developed in order to describe transsexual women, and when applied to transmen, they usually work even less. One such example was Ray Blanchard's theory that all transwomen could be divided into the categories of autogynephilic and homosexual. Many of these theories had also previously been applied to homosexuals, where they did not work out, either. This led to theories which consider physical reasons for transsexualism.

Experience with individuals who were surgically reassigned at birth (in order to correct deformities such as those caused by accidental castration) suggests strongly that the mental gender identification is determined at birth - individuals born male but raised as female often show the same symptoms of gender dysphoria as transsexuals. (Compare intersex)

"Curing" transsexualism


Reparative therapy aimed at gay or lesbian people has also been applied to transsexual and transgender people, since gender variant behaviour is seen by proponents of reparative therapy as an extreme form of homosexuality (a view that has long since disappeared from almost all scientific discourses). While the Kinsey scale expressed a similar view, the scientific community today rejects this part of Kinsey's theory, making reparative therapy as useless to transsexual people as it is for gay and lesbian people. Even though many of the major medical professional associations have repeatedly condemned reparative therapy as not only ineffective, but actually harmful, it continues to be advocated as a treatment for both homosexuals and transsexuals by several organizations with ties to the conservative Christian movement. However, reparative therapy is not considered either standard of care or good medical/psychological care currently in modern western medicine.

However, it should be remembered that not all therapy aimed at resolving gender conflicts, excluding somatic treatments to reassign physical sex, is entirely negative. Some people may have milder conflicts between gender identity and their physical sexual characteristics. These individuals may not actually wish to pursue sexual reassignment therapy, but may seek care to help deal with the conflicts they face. If individuals express this desire for psychological care without SRS, supportive and psychoeducational counseling may be helpful. Additionally some transsexuals, who may have a significant lifelong conflict between gender identity and their sexed-body may present for care without requesting SRS. Their reasons for forgoing transition may include family or professional concerns, perceptions of difficulty of transition, worry about perceived losses of social standing or role, firmly held religious beliefs, real or perceived inability to finance transition, and sometimes even advanced age or chronic medical problems. Regardless of their reasoning, if their decision is consistent, it should be respected. These individuals can often be helped by alternative methods to improve current functional status, promote acceptance of their gender identity as valid, and ameliorate mood symptoms caused by gender conflict through psychotherapy and sometimes medications. Additionally, these individuals sometimes benefit from partial somatic treatment. Low dose hormonal therapy only, validating patients desire to dress and live partially in the gender role appropriate to their gender, and even simply allowing the person a safe outlet to express themselves as a male or female can provide a great deal of comfort to patients who for one reason or another chose not to transition.

Physical causes

Many transsexual (and also many other transgendered) people have assumed that there is a physical cause of their transsexualism, because they claim to have had the feeling of being a girl or a boy for as long as they can remember. However, research into brain gender identity has been sparse.

While the article by Zhou, et al has been touted as strong evidence that transsexuality is based in structural and neurochemical similarities between the brain of transsexuals and brains typical of their gender identity, this article has numerous flaws.


(Schneider, Pickel & Stalla 2005)

Objections against research of causes



Closely related to the above argument is the belief of many people that transsexualism is not a disease or disorder and that no attempts should be made to cure transsexualism psychologically. However, a counterargument exists that cites the investigation into a reason why a brain-body dimorphism could develop is proposed as a valid reason why investigation into the causes of transsexuality should go ahead. The main argument being that investigation into why a phenomenon occurs does not necessarily have to reinforce any particular side in gender politics.

Gender reassignment therapy

Most transsexual men and women suffer from great psychological and emotional pain due to the conflict between their gender identity and their original gender role and anatomy. They find their only recourse is to change their gender role and undergo gender reassignment therapy. This may include taking hormones to modify their secondary sex characteristics or having sex reassignment surgery to change their primary sex characteristics.

Psychological treatment

Mental health approaches that attempt to change the gender identity to one considered appropriate for their assigned sex have universally been shown to be ineffective. It is generally accepted, therefore, that the only effective course of treatment for transsexuals is gender reassignment therapy.

The need for physical treatment is emphasized by the high rate of mental health problems, including depression, various addictions, and a suicide rate among untreated transsexual people many times the rate in the general population (some estimates are as high as between thirty and seventy-five percent); many of these problems in the majority of cases disappear or decrease significantly after a change of gender role.

Transgender and transsexual activists, but also many caregivers, however, point out that these problems are usually not related to the gender identity issue as such, but to problems that arise from dealing with those issues and social problems related to them. Also, those problems are much more likely to be diagnosed than similar problems 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. These professionals routinely evaluate their patients for these and similar problems, as a number of mental health problems are known to manifest in a way that can cause an idividual to believe they are transsexual.

A growing number of transsexual and transgender people therefore resent or even refuse often mandatory psychological treatment, since gender dysphoria itself is untreatable by psychological means, and they have no other problems that need treatment. This however can cause significant problems when they try to obtain physical treatment.

Therapists' records reveal most transsexuals do not believe they need psychological counseling, but acquiesce to legal demands in order to gain rights which are granted through the medical/psychological hierarchy. Legal issues such as a change of sex on legal documents, and sex reassignment surgery itself are usually impossible to obtain without a doctor's approval. This leads to the inevitability that transsexuals feel coerced into confirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference in order to see simple legal and medical hurdles granted. Transsexuals face the unattractive option of remaining invisible with no legal rights and possibly incongruent identification, or submitting to a medical hierarchy which alone has the ability to grant legal gender status.

Requirements for gender reassignment treatment

The requirements for hormone replacement therapy vary greatly. Often a minimum time period of psychological counseling or a time spent living in the desired gender role in order to ensure the patient can function psychologically in that role is required. This is not always possible; transsexual men especially often cannot "pass" this period without hormones. Transsexual women may also require hormones to pass in society as women; however, hormones are generally much more important to transsexual men as far as "passing" is concerned. This time period is usually called the Real Life Test (RLT). The most recent revision of the HBIGDA Standards of Care recognize this limitation for some transgender people. So the SOC state that patients may be approved for treatment after either a period of successful cross-living or a period of diagnostic psychotherapy - generally at least three months. Some doctors may prescribe hormones to any patient who requests them; however, most physicians are extremely reluctant to do so, especially for FTM transsexuals for whom some hormonally-induced changes may become virtually irreversible within a matter of weeks. Conversely, MTF transsexuals 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 obtaining hormones from black market sources, such as internet pharmacies which ship from overseas but this process is dangerous as the lack of medical supervision means there are no medical safeguards against the many side-effects (including the possibility of liver damage, suicidal levels of depression, kidney failure and thrombosis) of hormones and associated anti-hormone drugs.

Some surgeons who perform sex-reassignment surgery may require the patient to live as the opposite gender in as many ways as possible for a specified period of time (this is termed "cross-living" or Real Life Test) prior to the start of surgery. However some surgeons recognize that RLT without at least chest reconstruction may be difficult. So many are willing to perform some or even all elements of SRS without a RLT period. This is especially prevalent amongst surgeons who practice in Asia. However all UK surgeons, and almost all US surgeons, who perform vaginoplasty on MTF transsexuals require a minimum one-year RLT as well as recommendation letters from two psychotherapists.


Hormone replacement therapy

For information on hormone replacement therapy, see the article in the Medical category.

Gender Reassignment Surgery (GRS)

For information on Gender Reassignment Surgery (GRS), see the article in the Medical category

Legal and social aspects

Many Western societies today have some sort of procedure whereby an individual can change their name, and sometimes also their legal gender, to reflect their gender identity. Medical procedures for transsexual and transgender people are also available in most Western countries. However, transsexual and transgender people make strong challenges to the prevalence of gender roles in many cultures and often face considerable prejudice. The film Boys Don't Cry chronicles such a case.

Some people who have undergone a change of gender role will adopt or provide foster care for children, often for children who are also transsexual or transgender so they can live according to their gender identity. Societies are in some instances challenged to assimilate these men and women into their social institutions such as marriage and the role of parenting. Often, children exist from the time before transition. Many of these children stay with their transitioning/transitioned parent. Recent research shows that this does not harm the development of these children in any way. Much to the dismay of many transsexuals, older children frequently reject their transsexual parents and refuse to live with them. Equally distressing to transsexual parents, many younger children are barred from visiting their transsexual parents by family members or court order.



After this level of transition and development has been achieved, some transsexual men and women 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.



The choice to live completely stealth is believed to present its own psychological difficulties - that without anyone in which to confide there may be tendencies towards anxiety and depression. The term deep stealth is sometimes used for these individuals, referring to those that 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 whose status was only discovered at their death. For example the jazz musician Billy Tipton was deep stealth and his status was not even known by his wife and (adoptive) children. Moreover the tragedy of Mr Tipton's death illustrates just one of the dangers of going deep stealth. The fear of discovery as being transsexual often may keep people from seeking needed medical care. Mr 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.

Fortunately 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, and personal psychology to live at a certain place on the spectrum from 'out and proud' to 'deep stealth.' Billy Tipton's decision to be 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 to any place on the spectrum and the decision is a personal one.

Transsexual youth

Individuals may begin to come to terms with their gender identity at many different stages in their life. In most cases, the transsexual condition becomes apparent at some time in childhood, sometimes in very early childhood, where the child may be expressing behaviour incongruent with, and dissatisfaction related to, their assigned gender.


Coming out

Since transsexualism is still not widely accepted in many countries, transsexual youth may feel they need to remain in the closet until they feel that there is a time appropriate to reveal to their parents their gender identity -- understandably so, as parents have a great deal of influence in their children's lives, some parents can react negatively towards such news. Other parents can be very supportive, initially, or after such news has been broken to them. It is often impossible to predict how parents will react to such news, and the process is fraught with tension for many transsexual youth.

Transsexual youth also face many hardships when it comes to obtaining medical treatment for their condition. Psychiatrists and endocrinologists are very reluctant to give hormone treatment to transsexual youth under 16, and getting surgery is almost completely impossible.


Puberty is especially rough for trans youth. Unlike their peers, who may be excited about body changes and thrilled with growing up, trans youth are put into a particularly hard place in their lives. While everyone around them may seem happy about going through puberty, the changes that are happening to them are the opposite of what feels right. The androgyny of childhood melts away, and to their horror, they see changes in their body that only make them more uncomfortable and put them through considerable agony. And to make it worse, many endocrinologists insist on a youth going through the puberty of their genetic sex before they prescribe hormones that could have prevented the masculinization or feminization of an MTF or FTM, respectively.

Ensuring the child's security

Only in recent years have some transsexual or transgendered children received both counseling and in some cases also medical treatment, as well as the possibility to change their social role.

Families with a young child, who may identify already as a member of "the other" sex, and who chooses to change their gender roles through dress and behaviors, may decide to relocate this child and home to another area in order to afford the young person the best opportunity to live in the desired gender role among a novel set of peers and community.






As with every transition, in children and in adults, "experts" often raise the spectre of transitions gone wrong, that is people transitioning back to their original sex. These cases do in fact exist, however, every recent study done on the number of these cases states that their number is well below 1%, and that the reasons for retransitioning are very diverse. See this article in the International Journal of Transgenderism for examples.


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 is much more difficult, and this will often lead to social problems, depression, anxiety, or similar problems, and, in some rare cases, to a retransitioning. While there is no scientific study on the question, many trans*-organisations and groups claim from experience that the less pressure is felt by the patient to conform to any particular stereotype, the more satisfactory the outcome of the transition will be. This of course does not preclude any screening for mental problems which might lead to pseudo-transsexuality, nor a supportive psychological therapy if necessary.

Depictions of transsexuality in the media

The pornography industry is notable for its exploitative treatment of pre-operative male-to-female transsexuals, usually referred to by the pornography industry as "shemales" (a term regarded as offensive by many transsexuals). The general depiction is that of transsexuals as freaks, or as "women with a bit more".

However, the mainstream media, after years of insensitive depictions of transsexuals, is now making films with a more serious and nuanced depiction of transsexuals. Films containing depictions of transgender issues include The World According to Garp and The Crying Game. The film Different for Girls is notable for a sensitive depiction of a male-to-female transsexual who meets up with, and forms a romantic relationship with, her male former best friend. One of the newest films is Soldier's Girl which is based on a true story that made national headlines in the U.S.

Television is starting to show transsexuals in a little better light as well. Both of the series Law & Order and Nip Tuck, have had transsexual characters, but they were played by non-TS women. CSI had an episode dealing with a transsexual victim, and they used transsexual actresses and extras for those parts including Dr Marci Bowers and the subject of the movie Soldier's Girl, Calpernia Addams. Calpernia Addams has been in numerous movies and television shows. CSI also included a lot of educational information about who transsexuals are, and the hardships they face (1).



External links

Specific to Trans women

  • Mom, I Need to Be a Girl - a book by the mother of an MTF transsexual child. Available in Deutsch (German), Español (Spanish), Français (French), Português (Portuguese), and العربيّة (Arabic)
  • Transsexual Road Map - practical and medical information
  • Lynn Conway - her goal is to "illuminate and normalise the issues of gender identity and the processes of gender transition."
  • The Anne Who Would Be Queen - The truth about Anne Lawrence

Specific to trans men

  • FTM International - Female To Male International: practical and medical information
  • FTMA Network - Australian-wide network providing up to date contact, support and information.

Media treatment of transsexuality


Forked from Transsexuality Wikipedia article, 14 Nov 2005