Transsexualism has profound implications for our conceptions of gender categories. In the Western world, we tend to think of gender in terms of biology; if you have XX chromosomes and female genitalia, you are female, and if you have XY chromosomes and male genitalia, you are male. This is not universally true, however. A male transsexual is convinced that he is really a female “trapped” in a man’s body. Another way to put it is that a transsexual’s gender identity is inconsistent with his or her biological sex. This is called gender dysphoria (dis-FOR-ee-uh). Overall, more males than females experience gender dysphoria, though the exact degree of difference in men and women is in dispute (H. Bower, 2001).
Some cases of transsexualism have received great publicity. In 1952, George Jorgenson, an ex-Marine, went to Denmark to have his genitals surgically altered to resemble those of a female. George changed his name to Christine, went public, and became the first highly publicized case of a transsexual who underwent sex reassignment surgery (SRS). Jorgenson desired to be a girl from an early age, avoided rough sports, and was a small, frail child with underdeveloped male genitals (Jorgenson, 1967). Jorgenson’s story is typical of other transsexuals, who knew from an early age that they were somehow different.
Another famous case was that of Richard Raskind, an eye doctor and tennis player, who had sex reassignment surgery and then tried to play in a professional women’s ten-
nis tournament as Renee Richards. When it was discovered that she was a genetic male, Richards was barred from playing on the women’s tennis tour.
More recently, in the early 1990s, the case of Barry Cossey received much publicity. Cossey, who was passing as a female showgirl by the age of 17, eventually underwent sex reassignment surgery, and became known as “Tula.”[1] For a long time, Cossey kept her sex change a secret and went on to become a well-known model, even appearing in bathing suit and brassiere advertisements. After she received a role in the James Bond spy thriller For Your Eyes Only (in which she appeared primarily in a skimpy bathing suit), a British tabloid uncovered her past and announced: “James Bond Girl Was a Boy!” Cossey then wrote an autobiography and began appearing on the talk-show circuit as a crusader for the rights of transsexuals. She even appeared fully nude in Playboy in 1991.
Today in the United States, transexualism is viewed as an identifiable and incapacitating disease, which in selected patients can be successfully treated through reassignment surgery (Harish & Sharma, 2003). However, outside the United States, transsexualism is not as socially acceptable. For example, Japan approved sex reassignment surgery in 1996, and by 2001 a total of seven patients had undergone SRS in Japan (Ako et al., 2001; Matsubara, 2001). Even though Japan has always been considered a leader in many areas (such as technology and education), the country has been very reluctant to deal with issues of gender dysphoria.
Most transsexuals report a lifelong desire to be a member of the other sex. The desire is often temporarily satisfied by cross-dressing, but, unlike transgenderists, transsexuals do not find cross-dressing satisfying in itself. The personal accounts of transsexuals are usually tales of suffering and confusion over who they are and what gender they belong to, and therapy is useful only in establishing for them that they do, in fact, deeply believe themselves to be emotionally and psychologically of the other sex. Gender reassignment surgery was developed to help bring transsexuals’ biology into line with their inner lives.
The process of seeking gender reassignment is long and complicated. The first step is psychological counseling to confirm that the individual is truly gender dysphoric; one cannot just see a doctor and ask for a sex change. The next step is to live as a member of the other sex, and if a person does so successfully for a designated period, hormones are then administered to masculinize or feminize his or her appearance. Finally, sex reassignment surgery (SRS) is performed. It may take two or more surgeries to complete the transition.
For male-to-female (MtoF or M2F) transsexuals, the scrotum and testicles are removed. The penis is removed, but the penile skin, with all its sexually sensitive nerve endings, remains attached. This skin is then used to form the inside of the vagina, which is constructed along with a set of labial lips to simulate female genitalia as closely as possible. Finally, silicone implants create breasts. MtoF transsexuals can engage in sexual intercourse as females and achieve orgasm. Many also report that their male lovers cannot tell they have had SRS.
Female-to-male (FtoM or F2M) transsexuals have a number of choices to make. First, the female internal sex organs are usually removed. Because the testosterone they take enlarges their clitoris, many do not have artificial penises constructed but make do with an enlarged clitoris (which can be anywhere from one to three inches long). Others have an artificial penis constructed from their abdominal skin, and a scrotum is made from the labia, into which are placed prosthetic testicles. The surgical building of a penis (also known as phalloplasty) is still a difficult procedure and, as of 2003, no ideal technique had been developed (Harish & Sharma, 2003). Although the penises may look fairly real, they cannot achieve a natural erection, so penile implants of some kind are usually used (we will discuss these implants more in Chapter 14). The results of fe — male-to-male SRS are rarely as good as that of male-to-female.
In fact, SRS in general is controversial, with some studies showing healthy postoperative functioning (Y. L. S. Smith et al., 2001), and others showing no alleviation of the psychological suffering that many male and female transsexuals feel (Cohen-Ketteris
& Gooren, 1999). Some clinics have stopped performing transsexual surgery altogether. But some people seeking gender reassignment have longed for years to bring their bodies into line with their sense of gender identity, and SRS is their ultimate goal. As surgical techniques improve, some SRS problems may be resolved.
Question: It seems like there has been very little written over the years about the transgendered experience. Is it true that transgen — dered men and women were too afraid to write articles or research studies?
Historically, the transgendered community has been relatively quiet in terms of actively publishing research. Prior to 1990, transgendered men and women made very few research contributions to the professional literature (with the exceptions of Magnus Hirschfeld, whom we discussed in Chapter 2). Transsexuals were even quieter—in fact, not one transsexual authored a research study or textbook prior to 1990 (Denny & Wiederman, 2004). Even so, we have learned much about the transgendered experience through various autobiographies. It is estimated that over 100 such autobiographies were published from 1952 to 2000 (Denny & Wiederman, 2004). Today the transgendered community is actively engaged in research and continues to contribute rich autobiographies that help us more fully understand the transgendered experience.