Gender Identity Disorder

Definition

Description

Causes and symptoms

Demographics

Diagnosis

Treatments

Prognosis

Resources

Definition

Gender identity disorder is a condition characterized by a persistent feeling of discomfort or inappropriateness concerning one’s anatomic sex. The disorder typically begins in childhood with gender identity disconnects and is manifested in adolescence or adulthood by a person dressing in clothing associated with the desired gender, as opposed to one’s birth gender and exhibiting other behaviors associated with the self-perceived sex identity. In extreme cases, persons with gender identity disorder may seek gender reassignment surgery, also known as a sex-change operation.

Description

Gender identity disorder is distressing to those who have it. It is especially difficult to cope with because it remains unresolved until gender reassignment surgery has been performed. Most people with this disorder grow up feeling rejected and out of place. Suicide attempts and substance abuse are common. Most adolescents and adults with the disorder eventually attempt to pass or live as members of the opposite sex.

Gender identity disorder may be as old as humanity. Cultural anthropologists and other scientists have observed a number of cross-gender behaviors in classical and Hindu mythology, Western and Asian classical history, and in many late nineteenth- and early twentieth-century pre-literate cultures. This consistent record across cultures and time lends support to the notion that the disorder may be, at least in part, biological in origin. Not all behavioral scientists share this conclusion, however.

Behavioral experimentation, particularly when a child is young, is considered normal. As they grow, children will often experiment with a variety of gender role behaviors as they learn to make the fine distinctions between masculine and feminine role expectations of the society in which they live. Some young boys occasionally exhibit behaviors that Western culture has traditionally labeled “feminine.” Examples of these behaviors include wearing a dress, using cosmetics, or playing with dolls.

In a similar manner, some young girls will occasionally assume masculine roles during play. An example of this behavior includes pretending to be the father when playing house. Some girls temporarily adopt a cluster of masculine behaviors. These youngsters are often designated as tomboys. Most experts agree that such temporary or episodic adopting of behaviors opposite to one’s gender is normal and usually constitute learning experiences in the acquisition of normal sex role socialization.

In cases that are considered pathological, however, children deviate from the typical model of exploring masculine and feminine behaviors. Such children develop inflexible, compulsive, persistent, and rigidly stereotyped patterns. On one extreme are boys who become excessively masculine. The opposite extreme is seen in effeminate boys who reject their masculinity and rigidly insist that they are really girls or that they want to become mothers and bear children.

Boys with these traits frequently avoid playing with other boys, dress in girls’ clothing, play predominantly with girls, try out cosmetics and wigs, and display stereotypically feminine gait, arm movements, and body gestures. Although much less common, some girls may similarly reject traditionally feminine roles and mannerisms in favor of masculine characteristics, including a refusal to urinate sitting down. Professional intervention is required for both extremes of gender behavior.

This disorder is different from transvestitism or transvestic fetishism , in which cross-dressing occurs for sexual pleasure. Furthermore, the transvestite does not identify with the other sex.

Adults with gender identity disorder sometimes live their lives as members of the opposite sex. They often cross-dress and prefer to be seen in public as a member of the other sex. Some people with the disorder seek sex reassignment surgery.

Persons with gender identity disorder frequently state that they were born the wrong sex. They may describe their sexual organs as being ugly and may refrain from touching their genitalia. People with gender identity disorder may also try to hide their secondary sex characteristics. For instance, males may try to shave off or pluck their body hair. Many men elect to take estrogens in an effort to enlarge their breasts. Females may try to hide their breasts by binding them. There is a growing movement among people who consider themselves transgendered to demand that the condition not be viewed or classified as a disorder but as part of a spectrum of sexual development.

Causes and symptoms

Causes

There is no clearly understood or universally agreed-upon cause for gender identity disorder. However, most experts agree that there may be a strong biological basis for the disorder.

The sex of a human baby is determined by chromosomes. Males have a Y chromosome and one X chromosome, while females have two X chromosomes. The Y chromosome carries a gene known as the testis-determining factor. This gene sets off a developmental pathway that is typically “male,” resulting in testes development and development of secondary sexual structures that are male, including a penis and scrotum and differentiation in the fetal brain . Embryos lacking testis-determining factor usually develop as females. The newly formed testes are responsible for releasing the hormones that continue the fetus on a male developmental pathway.

These prenatal events provide the biological basis for gender identity disorder. Hormone levels must be appropriate for male development during the appropriate developmental windows for typical male development to occur. In addition, the cellular pathways that recognize the signals the hormones send must also be in place. Changes in hormone levels from the norm or exposure to environmental compounds that behave like hormones in the fetus can alter male development, resulting in a feminized fetus if this alteration ends in inhibition of typical male development.

Disruptions of hormone signaling may arise from a variety of sources, including a disorder in the mother’s endocrine system, maternal stress , maternal medications, and some environmental, endocrine-active substances.

Post-mortem studies conducted on male-to-female transsexuals, non-transsexual men, and non-transsexual women show a significant difference in sex-specific brain structures. Studies have shown that in male-to-female transsexuals, for example, brain structures look like those of nontransgendered women. These studies indicate that one’s sense of gender resides in the brain and that it may be biochemically determined. A hypothesis underlying the link between gonadal sex and the sex of the brain is the organization-activation hypothesis. According to this hypothesis, the hormones that organize the body as masculine, e.g, result in the formation of a penis rather than a clitoris, also organize the brain as masculine. At puberty, hormones activate the brain for gender-specific sex behavior. In some cases, there may be a disconnect between gonadal development and brain sexual development.

In addition to biological factors, environmental conditions, such as socialization, are thought by some to contribute to gender identity disorder. Social learning theory, for example, proposes that a combination of observational learning and different levels and forms of reinforcement by parents, family, and friends determine a child’s sense of gender, which, in turn, leads to what society considers sex-appropriate or inappropriate behavior. Recent research, however, suggests that even when people who are transgendered or born with ambiguous genitalia are reared based on their “assigned” sex, they still retain their perceived sexual identity.

Symptoms

The onset of puberty increases the difficulties for people with gender identity disorder. The subsequent development of unwanted secondary sex characteristics, especially in males, increases a person’s anxiety and frustrations. In an effort to cope with their feelings, some men with gender identity disorder may engage in stereotypical, or even super-masculine, activities. For example, a man struggling with the disorder may engage in such “macho” sports as wrestling and football in order to feel more “male.” Unfortunately, the result is usually an increase in anxiety.

This anxious state is characterized by feelings of confusion, shame, guilt, and fear. These individuals are confused over their inability to handle their problem. They feel shame over their inability to control what society considers “perverse” activities. Even though cross-dressing and cross-gender fantasies provide relief, the respite is temporary. These activities often leave individuals with a profound shame over their thoughts and activities.

Closely associated with shame is guilt, particularly about being dishonest with family and friends. Sometimes people with gender identity disorder marry and have children without telling their spouse about their disorder. Typically, their self-identity is kept secret because they have the mistaken conviction that participation in marriage and parenting will eliminate their problems or “cure” them. The fear of being discovered further raises their anxiety. With some justification, people with gender identity disorder fear being labeled “sick” and being rejected and abandoned by people they love.

If an individual’s gender identity disorder is profound, a lifestyle adaptation such as occasional cross-dressing may be insufficient. In such a case, gender expression may move from a lifestyle problem to a life-threatening imperative. The result can be extreme depression that requires medical treatment. If sufficiently severe, the imperative may result in gender reassignment surgery. If an individual lacks the psychological commitment to undertake surgery, the result may be suicide.

Demographics

Gender identity disorder is more prevalent in males than in females. Reliable estimates of prevalence for either males or females are not available.

Diagnosis

A mental health professional makes a diagnosis of gender identity disorder by taking a careful personal history. He or she obtains the age of the patient and determines whether the patient’s sexual attraction is to males, females, both, or neither. Laboratory tests are neither available nor required to make a diagnosis of gender identity disorder. However, it is very important not to overlook a physical illness such as a tumor that might mimic or contribute to a psychological disorder. If there is any question that a physical problem might be the underlying cause of an apparent gender identity disorder, a mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as components of the physical evaluation.

According to the clinician’s handbook for diagnosing mental disorders, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revised (DSM-IV-TR), the following criteria must be met to establish a diagnosis of gender identity disorder.

• a strong and persistent cross-gender identification
• persistent discomfort with his or her sex or having a sense of inappropriateness in the gender role of one’s birth sex
• the disturbance is not concurrent with a physical intersex condition, in which a person is born, for example, with the genitalia that exhibit male and female characteristics
• the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

A strong and persistent cross-gender identification

In children, the disturbance is manifested by four (or more) of the following:

• repeatedly stating a desire to be, or insistence that he or she is, a member of the other sex
• strong preference for wearing clothes of the opposite gender. In boys, displaying a preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
• displaying strong and persistent preferences for cross-sex roles in make-believe play or experiencing persistent fantasies of being a member of the other sex
• having an intense desire to participate in the games and pastimes that are stereotypical of the other sex
• exhibiting a strong preference for playmates of the other sex

Among adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to become a member of the other sex, frequent passing as a person of the other sex, a desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex. These characteristics cannot be merely from a desire for any perceived cultural advantages of being the other sex.

Persistent discomfort with his or her sex or having a sense of inappropriateness in the gender role of one’s birth sex

Among children, the disturbance is manifested by any of the following:

• among boys, asserting that his penis or testes are disgusting or will disappear, asserting that it would be better not to have a penis, or having an aversion toward rough-and-tumble play and rejecting male stereotypical toys, games, and activities
• among girls, rejecting the gender-typical practice of urinating in a sitting position, asserting that she has or will grow a penis, or stating that she does not want to grow breasts or menstruate, or having a marked aversion toward normative feminine clothing

Among adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to alter sexual characteristics to simulate the other sex) or a belief that he or she was born the wrong sex.

Treatments

One common form of treatment for gender identity disorder is psychotherapy. The initial aim of treatment is to help individuals function in their biologic sex roles to the greatest degree possible. The World Professional Association for Transgender Health, which has formulated and published its own Standards of Care manual for working with transgendered people, does not support psychotherapy designed to “convert” a transgendered person from their own personal perception of their sex.

Adults who have had severe gender identity disorder for many years sometimes request reassignment of their sex, or sex-change surgery. Before undertaking such surgery, they usually undergo hormone therapy to suppress same-sex characteristics and to accentuate other-sex characteristics. For instance, the female hormone estrogen is given to males to make breasts grow, reduce facial hair, and widen hips. The male hormone testosterone is administered to females to suppress menstruation, deepen the voice, and increase body hair. Following the hormone treatments, pre-operative candidates are usually required to live in the cross-gender role for at least a year before surgery is performed.

KEY TERMS

Cross-dressing —Wearing clothing and other attire typically associated with the opposite sex.

Paraphilia —A disorder that is characterized by recurrent intense sexual urges and sexually arousing fantasies generally involving non-human objects, the suffering or humiliation of oneself or one’s partner (not merely simulated), or children or other non-consenting persons.

Transsexual —A person whose gender identity is opposite his or her biologic sex.

Transvestite —A person who derives sexual pleasure or gratification from dressing in clothing of the opposite sex.

Prognosis

If gender identity disorder persists into adolescence, it tends to be chronic in nature. There may be periods of remission. However, adoption of characteristics and activities typical for one’s birth sex is unlikely to occur.

Most individuals with gender identity disorder require and appreciate support from several sources. Families, as well as the person with the disorder, need and appreciate both information and support. Local and national support groups and informational services exist, and health care providers and mental health professionals can provide referrals.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual. 4th ed., text rev. Washington, D.C.: American Psychiatric Association, 2000.

Gelder, Michael, Richard Mayou, and Philip Cowen. Shorter Oxford Textbook of Psychiatry. 4th ed. New York: Oxford University Press, 2001.

Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.

PERIODICALS

Green, R. “Family concurrence of ‘gender dysphoria’: Ten sibling or parent-child pairs.” Archives of Sexual Behavior 29.5 (2000): 499–507.

Marks, I., R. Green, and D. Mataix-Cols. “Adult Gender Identity Disorder can Remit.” Comprehensive Psychiatry 41.4 (2000): 273-5.

Reiner, William G. “Gender Identity and Sex-of-rearing in Children With Disorders of Sexual Differentiation.” Journal of Pediatric Endocrinology and Metabolism 18 (2005): 549–53.

Wylie, Kevan. “ABC of Sexual Health: Gender Related Disorders.” British Medical Journal 329 (2004): 615–19.

Zucker, K. J., N. Beaulieu, S. J. Bradley, G. M. Grimshaw, and A. Wilcox. “Handedness in boys with gender identity disorder.” Journal of Child Psychology and Psychiatry 42.6 (2001): 767–76.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Telephone: (913) 906-6000. Web site: <http://www.aafp.org>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. Telephone: (847) 434-4000. FAX: (847) 434-8000. Web site: <http://www.aap.org/default.htm>.

American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. Fax: (202) 682-6850.

American Psychological Association. 750 First Street NW, Washington, DC 20002-4242. Phone: (800) 374-2721 or (202) 336-5500. Web site: <http://www.apa.org>.

World Professional Association for Transgender Health. 1300 South Second Street, Suite 180 Minneapolis, MN 55454. Telephone: (612) 624-9397. Fax: (612) 624-9541. <http://www.wpath.org/IJT.htm>.

L. Fleming Fallon, Jr., MD, Dr.PH

Emily Jane Willingham

Gender identity disorder

Definition

Gender identity disorder is a condition characterized by a persistent feeling of discomfort or inappropriateness concerning one's anatomic sex. The disorder typically begins in childhood with gender identity problems and is manifested in adolescence or adulthood by a person dressing in clothing appropriate for the desired gender, as opposed to one's birth gender. In extreme cases, persons with gender identity disorder may seek gender reassignment surgery, also known as a sex-change operation.

Description

Gender identity disorder is distressing to those who have it. It is especially difficult to cope with because it remains unresolved until gender reassignment surgery has been performed. Most people with this disorder grow up feeling rejected and out of place. Suicide attempts and substance abuse are common. Most adolescents and adults with the disorder eventually attempt to pass or live as members of the opposite sex.

Gender identity disorder may be as old as humanity. Cultural anthropologists and other scientists have observed a number of cross-gender behaviors in classical and Hindu mythology, Western and Asian classical history, and in many late nineteenth- and early twentieth-century pre-literate cultures. This consistent record across cultures and time lends support to the notion that the disorder may be, at least in part, biological in origin. Not all behavioral scientists share this conclusion, however.

Gender identity and gender-appropriate behaviors are generally learned. This learning first occurs at home and later outside the home. Behavioral experimentation, particularly when a child is young, is considered normal. As they grow, children will often experiment with a variety of gender role behaviors as they learn to make the fine distinctions between masculine and feminine role expectations of the society in which they live. Some young boys occasionally exhibit behaviors that Western culture has traditionally labeled "feminine." Examples of these behaviors include wearing a dress, using cosmetics, or playing with dolls.

In a similar manner, some young girls will occasionally assume masculine roles during play. An example of this behavior includes pretending to be the father when playing house. Some girls temporarily adopt a cluster of masculine behaviors. These youngsters are often designated as tomboys. Most experts agree that such temporary or episodic adopting of behaviors opposite to one's gender is normal and usually constitute learning experiences in the acquisition of normal sex role socialization.

In pathological cases, however, children deviate from the normal model of exploring masculine and feminine behaviors. Such children develop inflexible, compulsive, persistent, and rigidly stereotyped patterns. On one extreme are boys who become excessively masculine. The opposite extreme is seen in effeminate boys who reject their masculinity and rigidly insist that they are really girls or that they want to become mothers and bear children.

Such males frequently avoid playing with other boys, dress in girls' clothing, play predominantly with girls, try out cosmetics and wigs, and display stereotypically feminine gait, arm movements, and body gestures. Although much less common, some girls may similarly reject traditionally feminine roles and mannerisms in favor of masculine characteristics. Professional intervention is required for both extremes of gender behavior.

This disorder is different from transvestitism or transvestic fetishism , in which cross-dressing occurs for sexual pleasure. Furthermore, the transvestite does not identify with the other sex.

Adults with gender identity disorder sometimes live their lives as members of the opposite sex. They often cross-dress and prefer to be seen in public as a member of the other sex. Some people with the disorder request sex-change or sex reassignment surgery.

Persons with gender identity disorder frequently complain that they were born the wrong sex. They may describe their sexual organs as being ugly and may refrain from touching their genitalia. People with gender identity disorder may try to hide their secondary sex characteristics. For instance, males may try to shave off or pluck their body hair. Many elect to take female hormones in an effort to enlarge their breasts. Females may try to hide their breasts by binding them.

Causes and symptoms

Causes

There is no clearly understood or universally agreed-upon cause for gender identity disorder. However, most experts agree that there may be a strong biological basis for the disorder.

The sex of a human baby is determined by chromosomes. Males have a Y chromosome, in addition to a X chromosome, while females have two X chromosomes. The Y chromosome contains a gene known as the testes determining factor. This gene causes cells in an embryo to differentiate and develop male genitals. Embryos without the testes determining factor continue to develop undifferentiated as females.

The newly formed male testes release significant quantities of male hormones during the third month of pregnancy, further enhancing male differentiation. This sudden surge of hormones occurs again in males sometime between the second and twelfth week after birth. It is important to note that there is no corresponding feminizing hormonal surge sequence observed in females at this age.

These facts provide the biological basis for gender identity disorder. Male hormonal surges must occur not only in sufficient amounts, but also during a short window of time to cause masculinization of the developing infant. If there is insufficient androgen, the hormone primarily responsible for masculinization, or the surge comes too early or too late, the developing infant may be incompletely masculinized.

Disruptions of hormonal surges may come from a variety of sources. A partial list includes a disorder in the mother's endocrine system, common maternal stress , or maternal medications or some other toxic substances yet to be identified.

Recent post-mortem studies conducted on male-to-female transsexuals, non-transsexual men, and non-transsexual women show a significant difference in the volume of a portion of the hypothalamus that is essential for sexual behavior. While further investigations are needed, these initial studies seem to confirm that one's sense of gender resides in the brain and that it may be chemically determined.

In addition to biological factors, environmental conditions, such as socialization, seem to contribute to gender identity disorder. Social learning theory, for example, proposes that a combination of observational learning and different levels and forms of reinforcement by parents, family, and friends determine a child's sense of gender, which, in turn, leads to what society considers sex-appropriate or inappropriate behavior.

Symptoms

The onset of puberty increases the difficulties for people with gender identity disorder. The subsequent development of unwanted secondary sex characteristics, especially in males, increases a person's anxiety and frustrations. In an effort to cope with their feelings, some men with gender identity disorder may engage in stereo-typical, or even super-masculine, activities. For example, a man struggling with the disorder may engage in such "macho" sports as wrestling and football in order to feel more "male." Unfortunately, the result is usually an increase in anxiety.

This anxious state is characterized by feelings of confusion, shame, guilt, and fear. These individuals are confused over their inability to handle their problem. They feel shame over their inability to control what society considers "perverse" activities. Even though cross-dressing and cross-gender fantasies provide relief, the respite is temporary. These activities often leave individuals with a profound shame over their thoughts and activities.

Closely associated with shame is guilt, particularly about being dishonest with family and friends. Sometimes people with gender identity disorder get married and have children without telling their spouse about their disorder. Typically, it is kept secret because they have the mistaken conviction that participation in marriage and parenting will eliminate or cure their gender identity problems. The fear of being discovered further raises their anxiety. With some justification, people with gender identity disorder fear being labeled "sick," and being rejected and abandoned by people they love.

If an individual's gender identity disorder is profound, a lifestyle change such as occasional cross-dressing may be insufficient. In such a case, gender expression may move from a lifestyle problem to a life-threatening imperative. The result can be extreme depression that requires medical treatment. If sufficiently severe, the imperative may result in gender reassignment surgery. If an individual lacks the psychological commitment to undertake surgery, the result may be suicide.

Demographics

Gender identity disorder is more prevalent in males than in females. Accurate estimates of prevalence for either males or females are not available.

Diagnosis

A mental health professional makes a diagnosis of gender identity disorder by taking a careful personal history. He or she obtains the age of the patient and determines whether the patient's sexual attraction is to males, females, both, or neither. Laboratory tests are neither available nor required to make a diagnosis of gender identity disorder. However, it is very important not to overlook a physical illness such as a tumor that might mimic or contribute to a psychological disorder. If there is any question that a physical problem might be the underlying cause of an apparent gender identity disorder, a mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as components of the physical evaluation.

According to the clinician's handbook for diagnosing mental disorders, the Diagnostic and Statistical Manual of Mental Disorders , fourth edition text revised (DSM-IV-TR), the following criteria must be met to establish a diagnosis of gender identity disorder. More specific descriptions and examples of the first two criteria follow the list.

• A strong and persistent cross-gender identification.
• Persistent discomfort with his or her sex or having a sense of inappropriateness in the gender role of one's birth sex.
• The disturbance is not concurrent with a physical intersex condition, such as hermaphroditism in which a person is born with the genitalia of both male and female.
• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

A strong and persistent cross-gender identification

In children, the disturbance is manifested by four (or more) of the following:

• Repeatedly stating a desire to be, or insistence that he or she is, a member of the other sex.
• Strong preference for wearing clothes of the opposite gender. In boys, displaying a preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing.
• Displaying strong and persistent preferences for cross-sex roles in make-believe play or experiencing persistent fantasies of being a member of the other sex.
• Having an intense desire to participate in the games and pastimes that are stereotypical of the other sex.
• Exhibiting a strong preference for playmates of the other sex.

Among adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to become a member of the other sex, frequent passing as a person of the other sex, a desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex. These characteristics cannot be merely from a desire for any perceived cultural advantages of being the other sex.

Persistent discomfort with his or her sex or having a sense of inappropriateness in the gender role of one's birth sex

Among children, the disturbance is manifested by any of the following:

• Among boys, asserting that his penis or testes are disgusting or will disappear, asserting that it would be better not to have a penis, or having an aversion toward rough-and-tumble play and rejecting male stereotypical toys, games, and activities.
• Among girls, rejecting the gender-typical practice of urinating in a sitting position, asserting that she has or will grow a penis, or stating that she does not want to grow breasts or menstruate, or having a marked aversion toward normative feminine clothing.

Among adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (request for hormones, surgery, or other procedures to alter sexual characteristics to simulate the other sex, for example) or a belief that he or she was born the wrong sex.

Treatments

One common form of treatment for gender identity disorder is psychotherapy . The earlier the intervention, the greater likelihood of success. Early intervention can lead to reduced levels of transsexual behavior later in life. The initial aim of treatment is to help individuals function in their biologic sex roles to the greatest degree possible.

Adults who have had severe gender identity disorder for many years sometimes request reassignment of their sex, or sex-change surgery. Before undertaking such surgery, they usually undergo hormone therapy to suppress same-sex characteristics and to accentuate other-sex characteristics. For instance, the female hormone estrogen is given to males to make breasts grow, reduce facial hair, and widen hips. The male hormone testosterone is administered to females to suppress menstruation, deepen the voice, and increase body hair. Following the hormone treatments, pre-operative candidates are usually required to live in the cross-gender role for approximately a year before surgery is performed.

Prognosis

If gender identity disorder persists into adolescence, it tends to be chronic in nature. There may be periods of remission. However, adoption of characteristics and activities appropriate for one's birth sex is unlikely to occur.

Prevention

Providing gender-appropriate clothing and toys in infancy and early childhood is helpful in preventing or mitigating gender identity disorder. Avoiding derogatory comments about a child's toy, clothing, or activity preference reduces the potential for inadvertent psychic harm.

Most individuals with gender identity disorder require and appreciate support from several sources. Families, as well as the person with the disorder, need and appreciate both information and support. Local and national support groups and informational services exist, and health care providers and mental health professionals can provide referrals.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual. Fourth edition, text revised. Washington, D.C.: American Psychiatric Association, 2000.

Gelder, Michael, Richard Mayou, and Philip Cowen. Shorter Oxford Textbook of Psychiatry. 4th ed. New York: Oxford University Press, 2001.

Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.

PERIODICALS

Green, R. "Family concurrence of 'gender dysphoria': ten sibling or parent-child pairs." Archives of Sexual Behavior 29, no. 5 (2000): 499-507.

Marks, I., R. Green, and D. Mataix-Cols. "Adult gender identity disorder can remit." Comprehensive Psychiatry 41, no. 4 (2000): 273-275.

Zucker, K. J., N. Beaulieu, S. J. Bradley, G. M. Grimshaw, and A. Wilcox. "Handedness in boys with gender identity disorder." Journal of Child Psychology and Psychiatry 42, no. 6 (2001): 767-776.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Telephone: (913) 906-6000. Web site: <http://www.aafp.org>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. Telephone: (847) 434-4000. FAX: (847) 434-8000. Web site: <http://www.aap.org/default.htm>.

American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. FAX: (202) 682-6850.

American Psychological Association. 750 First Street NW, Washington, DC, 20002-4242. Phone: (800) 374-2721 or (202) 336-5500. Web site: <http://www.apa.org>.

L. Fleming Fallon, Jr., M.D., Dr.P.H.

GAY AND LESBIAN STUDIES

Gay and lesbian studies are academic programs dedicated to the study of historical, cultural, social, and political issues of vital concern to lesbian, gay, and, increasingly, bisexual and transgendered individuals. The focus of such programs is on lesbian and gay lives and social institutions, as well as about homophobia and oppression related to sexual orientation. Gay and lesbians studies programs have encouraged many traditional disciplines to reassess their theoretical and political grounding and to consider sexuality and sexual diversity as critical facts determining social behaviors and political structures.

Goals

The goals of gay and lesbian studies programs are as varied as the programs themselves. The general goals include discovering and recovering the history and culture of homosexuality and bringing homosexuality to the forefront of academic studies, away from being an unspeakable or untouchable subject. The existence of gay and lesbian studies programs helps to challenge the invisibility of homosexuality in society and to expose students to gay and lesbian oppression as it has existed historically. Another goal of lesbian and gay studies is to explore the lives of lesbian and gay people through investigation of identity issues, experiences of oppression, and struggles for recognition. The programs seek to find a common understanding and language in which homosexuals and heterosexuals can better understand gay and lesbian lives. Many programs have an activist agenda that includes such goals as critiquing and transforming the social, political, cultural, economic, ethnic, and gender situations that continue to oppress gay and lesbian people.

In 2000 Jeffery Weeks, a professor of sociology at the University of London, identified five additional goals for gay and lesbian studies. The first is to find ways for society to learn to live with differences in sexual orientation and to provide a forum for discussing differences. The second is to adopt political and cultural stances that work toward sexual justice, which involves seeking fairness and equity in the treatment of all sexual orientations. The third goal is to challenge heterosexual norms that have been created throughout history. By addressing the second and third goals, homosexuality can be validated and affirmed while heterosexual norms are questioned so that equality of sexual orientations can be reached. The fourth goal is to question the existing body of knowledge related to sexual orientation, especially addressing who has the right to speak authoritatively on gay and lesbian issues. The fifth goal is to create spaces for debate, analysis, negotiations, disagreements, and finding common ground regarding issues of sexual orientation.

History

Gay and lesbian studies emerged from the civil rights movement, yet the roots of this discipline stretch back to the middle of the twentieth century. The Kinsey studies of human sexuality in the 1940s and 1950s challenged scientific assumptions related to sexuality and, by raising the visibility of homosexuality, provided a platform for gay and lesbian studies. Gay and lesbian studies, although taking place in academia, have been strongly influenced by the political and cultural development of gay and lesbian communities, especially in urban areas throughout the United States. As the political and cultural environment within society changed during the latter half of the twentieth century, so too did the frameworks in which gay and lesbian intellectuals and scholars worked. Specifically, during the 1950s and 1960s the homophile movement, combined with the gay liberation and lesbian feminism movements that began after the riots at the Stonewall Inn in 1969, helped to create the political climate that allowed for the development of the early stages of lesbian and gay studies in the 1970s. Additionally, the AIDS crisis in the 1980s added yet another layer that helped mature gay and lesbian studies. In 1991 the Center for Lesbian and Gay Studies (CLAGS) was founded at the City University of New York Graduate School. CLAGS is the first and only university-based research center in the United States dedicated to the study of historical, cultural, and political issues of concern to lesbian, gay, bisexual, and transgendered individuals.

Another way of understanding the historical development of gay and lesbian studies is to consider the focus of scholarly activity and its diversification during the last three decades of the twentieth century. Jeffrey Escoffier, deputy director for policy and research of the Office of Gay and Lesbian Health in New York City, in 1992 identified several different interdisciplinary paradigms that arose during that period. The first, "Search for Authenticity, 1969–1976," was formed by the Stonewall generation as an effort to encourage research and writing from gay liberation and feminist perspectives. For example, during this period the Gay Academic Union was formed in New York City with the goal of confronting homophobia in academia. Although the union lasted only a short while, it did provide a forum for academics interested in issues related to sexual orientation and led to further organizing and eventually to program development.

"Social Construction of Identity, 1976–present" focuses on homosexual identity and how this identity is shaped and formed not only by homosexual behavior but also by cultural and societal action. "Essentialist Identity: Lesbian Existence and Gay Universals, 1975–present" is the complement to the socially constructed aspect of identity and concentrates on the structures and similarities in the gay and lesbian experience that span historical periods. "Difference and Race, 1979–present" addresses how culture, ethnicity, and race combine with homosexuality. One of its many concerns is that gay and lesbian studies and scholarship not remain focused on white culture, but rather emphasize the diversity of experience in gay and lesbian lives. The final paradigm, "The Pursuit of Signs: The Cultural Studies Paradigms, 1985–present," builds on the social construction of identity paradigm to include all forms of texts, cultural codes, signifying practices, and modes of discourse that form attitudes toward homosexuality.

Current Configurations

At the beginning of the twenty-first century, gay and lesbian studies programs vary widely in terms of focus, structure, and connections with other academic units. Most programs are at large institutions, both public and private, and most of these institutions are in urban areas. There are few programs at small, private, rural liberal arts colleges. Most programs are gay and lesbian specific while some also include the general categories of gender and sexuality. Others have expanded to include emphases on bisexuality, transgender issues, and queer theory. The majority of the lesbian and gay studies programs offer undergraduate minors or certificate programs. Few institutions offer undergraduate majors or graduate degrees strictly in gay and lesbian studies. Some institutions offer undergraduate programs in which lesbian and gay studies can be combined with a traditional major (e.g., a major in history with a focus on gay and lesbian studies); others offer the opportunity to create degree programs through individualized learning or liberal studies programs; and some institutions offer dual or integrated graduate degree programs where lesbian and gay studies can be combined with programs in other disciplines.

Because lesbian and gay studies focuses on a group of subjects instead of a concept, it is difficult to place the field within a specific academic discipline. Therefore, virtually all programs are interdisciplinary in nature, working with other departments on campus covering a wide span of disciplines including biology, anthropology, anatomy, cultural anthropology, English, literature, film and video, history, art history, political science, psychology, religion, sociology, ethnic studies, and women's studies. Additionally, lesbian and gay studies programs are most often linked to or coupled with women's studies or gender studies.

The disadvantages of interdisciplinarity include diffused academic power and influence, constrained resources, and a lack of a disciplinary home. The advantage of interdisciplinarity is that once established, lesbian and gay studies programs are difficult to isolate and sequester. Interdisciplinary study then results in a change in how gay and lesbian lives, experiences, and reality are experienced, studied, and understood. It forces scholars to integrate the oftenfragmented disciplines into which the academic experience has been sorted. Scholarship and study in separate disciplines makes it easier to ignore diversity and complexity and allows important questions to go unasked, a few chosen issues to be raised, select individuals to be studied, and leaves a large portion of the lesbian and gay population ignored. Interdisciplinarity reinforces the fact that no longer are there only the categories of heterosexual and homosexual, but that there are many variations in between. Interdisciplinary study encourages a constant questioning of the assumptions underlying theories that are being used and why they are being used.

Two growing areas under the rubric of lesbian and gay studies are lesbian studies as a self-contained unit and queer theory. There have been some efforts to separate lesbian studies from gay studies and women's studies because of concerns about sexism (in gay studies) and heterosexism and homophobia (in women's studies). The argument is that lesbian oppression has been ignored and needs to be investigated from the perspective of multiple disciplines separate from gay studies.

The category of queer theory first appeared in the early 1990s. Teresa de Lauretis is the theorist often credited with inaugurating the phrase. Queer theory expands the focus of lesbian and gay studies from socially constructed or essentialist identities to sexual practices and sexual representations. Queer theorists view sexuality along a continuum and question whether it is ever fixed at one point. Queer theory challenges all identity categories, such as heterosexual, homosexual, male, and female and analyzes the power imbalances that are inherent in them.

See also: Sexual Orientation.

bibliography

Carroll, Lynne, and Gilroy, Paula J. 2001. "Teaching 'Outside the Box': Incorporating Queer Theory in Counselor Education." Journal of Humanistic Counseling, Education, and Development 40 (1):49–57.

Corber, Robert J. 1998. "Scholarship and Sexuality: Lesbian and Gay Studies in Today's Academy." Academe 84 (5):46–49.

de Lauretis, Teresa. 1991. "Queer Theory: Lesbian and Gay Sexualities." Differences: A Journal of Feminist Cultural Studies 3 (2):iii–xviii.

Escoffier, Jeffrey. 1992. "Generations and Paradigms: Mainstreams in Lesbian and Gay Studies." In Gay and Lesbian Studies, ed. Henry L. Minton. Binghamton, NY: Harrington Park Press.

Minton, Henry L. 1992. "The Emergence of Gay and Lesbian Studies." In Gay and Lesbian Studies, ed. Henry L. Minton. Binghamton, NY: Harrington Park Press.

Namaste, Ki. 1992. "Deconstruction, Lesbian and Gay Studies, and Interdisciplinary Work: Theoretical, Political, and Institutional Strategies." In Gay and Lesbian Studies, ed. Henry L. Minton. Binghamton, NY: Harrington Park Press.

Schuyf, Judith, and Sandfort, Theo. 2000. "Conclusion: Gay and Lesbian Studies at the Crossroads." In Lesbian and Gay Studies: An Introductory, Interdisciplinary Approach, ed. Theo Sandfort. Thousand Oaks, CA: Sage.

Weeks, Jeffrey. 2000. "The Challenge of Lesbian and Gay Studies." In Lesbian and Gay Studies: An Introductory, Interdisciplinary Approach, ed. Theo Sandfort. Thousand Oaks, CA: Sage.

Wilton, Tamisin. 1995. Lesbian Studies: Setting the Agenda. London: Routledge.

Patrick Love

Transgender

BIBLIOGRAPHY

Transgender is an umbrella term that describes different ways in which people transgress the gender boundaries that are constituted within a society. Groups encompassed by this term include people who have an atypical gender expression, sex, sexual identity, or gender identity. An understanding of transgender requires an awareness of the difference between the terms sex and gender —terms that often are conflated.

Sex is a biological construct. It refers to a person’s physical anatomy, usually determined by their genetics and exposure to hormones. While sex often is considered dichotomous, so that individuals are classified as male if they have a penis and as female if they have a vagina, intersexed persons are an exception to this dichotomy because they have features of both sexes (Fausto-Sterling 2000). The debate about the treatment of intersexed infants whose sex organs do not appear traditionally male or female has been heated. On one side, people feel that genital surgery should be performed early so that the infant has the genitalia of one sex and can be raised without confusion about their sexual identity —that is, without confusion about how they understand and label their own sex. On the other side, organizations of intersexed people, such as the Intersex Society of North America, have protested this practice on the grounds that the sex assigned to the child in surgery may not correspond with their sexual identity as they mature. Instead, they argue that intersexed children should be raised with their geni-talia unaltered until they are old enough to determine if they would like genital surgery and, if so, to select which sex is a better fit for them.

Unlike sex, gender is a social construct. Within social groups, sets of traits are linked together come to form genders, such as masculinity and femininity, through repeated performance and symbolism. The set of traits may depend upon the culture and time, such that enacting femininity in one country may appear different from doing so within another country or within another era. While many cultures recognize two genders attributed to male or female physical sexes, other cultures have formed genders that are based upon a combination of the sexes and personalities of individuals. For instance, some Native American tribes recognized “two-spirit” people as having distinct genders with valued social roles—so “masculine women” might become warriors and “feminine men” healers (Feinberg 1996).

In most cultures, however, gender is thought to be dictated by one’s physical sex, without any recognition of the cultural assignment of gender traits to one sex or another. When people fall outside the norms of gender transgression—that is, enacting traits that are attributed to the other sex—they may fall into one of the categories of transgender identity. People who adopt gender expressions (i.e., appearances that reflect gendered traits) that are not consistent with their sex by wearing clothing that is associated with the other sex may identify as cross-dressers or as transvestites. Because women are permitted a broader range of apparel in the West, male cross-dressers are more common and noticeable than female cross-dressers. Cross-dressing does not indicate a person’s sexual orientation; in fact, most male cross-dressers identify as heterosexual (Docter and Prince 1997).

Transsexual people have a sexual identity that does not match their physical sex. While some desire sex-reassignment surgery so that their anatomy can match their sense of self, not all transsexuals want to change their bodies. Surgery is costly, and can have mixed results. Hormone therapy may be used as well, as a complement to surgery or independently, and is less costly. To receive services, many clinics require that transsexual people first meet the Harry Benjamin Standards of Care (Meyer et al. 2001), which detail a list of steps that people complete to show that they are ready for surgery—such as living for a year as the other sex. Transmen or FTM (female-to-male) and transwomen or MTF (male-to-female) are common labels to describe the sex of those who transition from one sex to the other.

Sexual orientation refers to one’s emotional, physical, and sexual attraction to another person. Individuals who are attracted to the other sex are heterosexual, to the same sex are homosexual, and to both sexes are bisexual. While having a sexual orientation other than heterosexual does not necessitate a transgender sexual identity or gender expression, there are forms of gender or gender expression within some nonheterosexual communities that fall under a transgender rubric. For instance, being in drag is slang that connotes appearing and acting, for entertainment purposes, in a way that is typical for the other sex—with drag queens being men emulating women and drag kings being women emulating men (Volcano and Halberstam 1999). Within lesbian communities, terms like butch and femme describe the gender identities of women who display different sets of gendered traits. Although they often are misunderstood as mimicking heterosexual genders, these genders are composed of traits that do not fall neatly into masculine or feminine genders but have unique meanings within those communities (Levitt and Hiestand 2004).

People who are transgender tend to experience more discrimination and harassment than those who are not, even when compared to gay or lesbian people who are not transgender (Herek 1995; Levitt and Horne 2002). There is debate within the psychological community on how to understand transgender. A diagnosis for gender identity disorder remains listed in the 2000 edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Many mental health professionals believe that this diagnosis should be abolished because it is based upon a false understanding of gender and that treatment should focus on creating supportive environments for transgender youth rather than pathologizing them (Hiestand and Levitt 2005). At the same time, others believe that the diagnosis is necessary so people can obtain insurance coverage for treatments (Brown and Rounsley 1996), and still others persist in conceptualizing transgen-der as a mental disorder inherent to the individual.

Groups of transgender people have organized to fight for supportive legislation and medical and mental health treatments that meet their needs and respect diversity within gender experiences. Such organizations as the International Foundation for Gender Education and the National Center for Transgender Equality also work to educate the public about transgender issues and concerns.

SEE ALSO Discrimination; Gender; Gender, Alternatives to Binary; Harassment; Sexual Orientation, Determinants of;Sexual Orientation, Social and Economic Consequences; Sexuality

BIBLIOGRAPHY

American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders ( DSM -IV-TR). 4th ed., text rev. Washington, DC: Author.

Brown, Mildred L., and Chloe Ann Rounsley. 1996. True Selves: Understanding Transsexualism—For Families, Friends, Coworkers, and Helping Professionals. San Francisco: Jossey-Bass.

Docter, Richard F., and Virginia Prince. 1997. Transvestism: A Survey of 1032 Cross-dressers. Archives of Sexual Behavior 26 (6): 589–605.

Fausto-Sterling, Anne. 2000. Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books.

Feinberg, Leslie. 1996. Transgender Warriors: Making History from Joan of Arc to Dennis Rodman. Boston: Beacon Press.

Herek, Gregory M. 1995. Psychological Heterosexism in the United States. In Lesbian, Gay, and Bisexual Identities Over the Lifespan: Psychological Perspectives, eds. Anthony R. D’Augelli and Charlotte J. Patterson, 321–346. New York: Oxford University Press.

Hiestand, Katherine, and Heidi M. Levitt. 2005. Butch Identity Development: The Formation of an Authentic Gender. Feminism and Psychology 15 (1): 61–85.

International Foundation for Gender Education. http://www.ifge.org.

Intersex Society of North America. http://www.isna.org.

Levitt, Heidi M., and Katherine Hiestand. 2004. A Quest for Authenticity: Contemporary Butch Gender. Sex Roles: A Journal of Research 50 (9–10): 605–621.

Levitt, Heidi M., and Sharon G. Horne. 2002. Explorations of Lesbian-Queer Genders. Journal of Lesbian Studies 6 (2):25–39.

Meyer, Walter, III (Chairperson), Walter O. Bockting, Peggy Cohen-Kettenis, et al. February 2001. The Standards of Care for Gender Identity Disorders–Sixth Version. The International Journal of Transgenderism 5 (1). http://www.symposion.com/ijt/soc_2001/index.htm.

National Center for Transgender Equality. http://www.nctequality.org.

Volcano, Del LaGrace, and Judith “Jack” Halberstam. 1999. The Drag King Book. New York: Serpent’s Tail.

Brandy L. Smith

Heidi M. Levitt

Gender Identity Disorder

What Is Gender Identity Disorder?

What Is Cross-Gender Identification?

Resource

Gender identity disorder (GID) is identified by strong and long-lasting gender identification that is opposite to one’s biological sex. A person with this condition insists that he or she is of the other sex or desires to be the opposite sex. People with this condition are often referred to as transsexuals.

Keywords

for searching the Internet and other reference sources

Cross-gender

Transgender

Transsexual

What Is Gender Identity Disorder?

To understand this disorder, a few terms must be defined:

• Gender: is the category (male or female) a person is assigned to on the basis of sex. The term is used in discussing the different roles, identities, and expectations that our society associates with males and females.
• Gender identity: This term refers to a person’s own perception of their maleness or femaleness.
• Feminine and masculine: These terms often are used to describe behaviors generally associated with females or males. For example, contact sports have long been considered primarily masculine activities, and taking care of babies has been considered a feminine activity.
• Sex: This term usually refers to the biological (physical) differences between females and males. Specifically, these characteristics are the sex chromosomes* and certain anatomical features, for example, the penis or the vulva*.

* chromosomes

(KRO-mo-some) are threadlike chemical structures inside cells on which the genes are located. There are 46 chromosomes (23 pairs) in normal human cells. Genes on the X and Y chromosomes (known as the sex chromosomes) determine whether a person is male or female. Females have two X chromosomes; males have one X and one Y chromosome.

* vulva

genitals is the name for the external sex organs of the female.

Stigma

Boys with GID seem to suffer more than girls, probably because of culturally influenced rejection by their peers. In some studies, five times as many boys as girls saw a doctor for GID. Among adults, two or three times as many men as women sought help for GID. This difference probably is due to the greater social difficulties experienced by males who show cross-gender behavior.

Some people identify with, or conform to, traditional roles and expectations the culture sets for males and females. Others do not. For example, someone who is biologically female may like to play football, and someone who is biologically male may like to ballet dance. Still, under most circumstances, this does not interfere with people’s sense that that they are female or male, and does not mean that they have gender identity disorder.

What Is Cross-Gender Identification?

GID goes beyond a failure or reluctance to identify with traditional roles or expectations about being female or male. A person with GID who is biologically female has the sense of being male. Likewise, a person with GID who is biologically male has a strong inner sense of being a female. When cross-gender identification causes much distress or impairs a person’s functioning in life, that person is said to have GID.

Distress

GID distress may result in a person’s refusal to attend school or social events where feminine or masculine clothing or behavior is expected, because they fear teasing or rejection by their peers. This may result in isolation from other children because of the person’s insistence on behaving and acting like a member of the opposite sex. Children with this disorder often express wishes to be the other sex or beliefs that they will “grow up to be” the opposite sex. Young children with this condition may be unhappy about their assigned sex. Older children may fail to develop age-appropriate same-sex relationships with their peers. For adolescents, GID can be very difficult, because the person may struggle with feelings of uncertainty about the cross-gender identification or be concerned about being unacceptable to his or her own family or peers.

Intersex conditions

GID is not the same as physical intersex conditions. Intersex conditions may be marked, for example, by genitals* that are not completely male or female. Or the person with this condition may be genetically* male but physically female (or the reverse). For

* genitals

(JE-ni-tals) are all the organs of the human reproductive system.

* genetically

(je-NE-ti-klee) means due to heredity and stemming from genes, the material on the chromosome in cells of the human body that helps determine physical and mental characteristics, such as hair and eye color. The X and Y chromosomes contain genetic information that determines sex.

example, a male with an intersex condition would have the XY sex chromosomes of males, even though his genitals might appear female. GID should not be confused with nonconformity to traditional or typical gender roles, as may be seen in the case of “tomboyism” or “stay-at-home dads.” People who do not conform with all aspects of traditional gender roles seldom have any desire to be the opposite sex.

Cross-dressing

There also is a difference between GID and transvestitism. A person who is a transvestite becomes sexually excited by dressing in the clothes of the opposite sex, that is, cross-dressing. This behavior, engaged in for the sole purpose of sexual excitement, most often occurs among heterosexual* or bisexual* men. Transsexuals (people with GID) cross-dress to gain a sense of physical and emotional completeness rather than sexual excitement.

* heterosexual

(he-te-ro-SEKshoo-al) refers to a tendency to be sexually attracted to the opposite sex.

* bisexual

(bi-SEK-shoo-al) means being sexually attracted to both sexes.

The causes of GID are uncertain. Some researchers think that biological factors play a role, and others think that environmental factors, such as social learning, are involved. No one can really say why GID occurs. The more important question may be how to resolve the problems that GID may create.

The distress GID causes is real, and, for some adults with this condition, the only effective relief for this distress is a sex-reassignment procedure, which usually involves sex-change operations. These procedures are the subject of a great deal of controversy, and the scientific community continues to debate the possible benefits of sex-change surgery. These procedures can take several years to complete.

Screening

These sex-change procedures begin with lengthy and detailed screening interviews. These interviews determine the existence and severity of GID. The person then is instructed about adopting a lifestyle that agrees with his or her gender identity. If people successfully adjust to this lifestyle change over a period of several months to a year, they begin hormone therapy to develop more of the physical traits of the desired sex. This step also can last one year or longer.

Surgery and other treatment

If the person continues to adjust successfully to these activities, the final stage is hormone* therapy and sex-change surgery. For males wishing to become females, hormone treatments may produce enough breast development, although some people choose later to have breast enlargement surgeries. In male to female reassignment, body and facial hair growth is reduced by the hormone treatments and hair may also be removed by electrolysis*. People who undergo sex-change surgery to become females are able to have sexual intercourse.

* hormones

are chemicals that are produced by different glands in the body. A hormone is like the body’s ambassador. It is created in one place but is sent through the body to have specific effects in different places.

* electrolysis

(ee-lek-TRAW-li-sis) is a method of destroying hair roots by passing an electric current through them.

Females wishing to become males have surgeries to remove the breasts, the uterus*, and the ovaries* and to seal off the vagina*. The operation to construct a penis is extremely complicated, and the resulting penis is not capable of a natural erection. There are, however, artificial devices available that can help the person successfully engage in sexual intercourse.

* uterus

(YOO-te-rus) is the organ in females for containing and nourishing the fetus during pregnancy. It is also called the womb.

* ovaries

(O-va-reez) are the sexual glands in females from which eggs are released.

* vagina

(va-JY-na) is the canal in females that leads from the uterus to the outside of the body.

Follow-up

There have been several worldwide studies conducted to assess the outcomes of sex-change surgery. These studies have shown that 9 of 10 transsexuals who undergo hormonal and surgical sex-reassignment procedures experience a satisfactory result. One of the studies found that 94 percent of the people who underwent the surgery and answered questionnaires stated that if they had it to do over again, they would make the same choice.

See also

Body Image

Gender Identity

Sexual Development

Resource

Book

Boenke, Mary. Trans Forming Families: Real Stories About Transgendered Loved Ones. Imperial Beach, CA: Walter Trook Publishing, 1999. Includes 31 stories of parents of gender variant children. For older readers.