The initial step of a sex change involves extensive screening interviews, during which a person’s motivations for undergoing the change are thoroughly evaluated. Individuals with real conflicts and confusion about their gender identity are not considered for surgical alteration. Individuals with an apparently genuine incongruence between their gender identity and their biological sex are then […]

The mental health field has traditionally considered only two possible solutions for overcoming the gender dysphoria of transsexuals: changing gender identity to match the physical body or changing the body to match gender identity (Carroll, 1999). Other options exist, however, and clinical evidence has indicated that some preoperative trans­sexuals have discovered that it may be […]

Alexander John Goodrum (2000) wrote an informative article on transsexualism and transgenderism in which he discussed how people should communicate or inter­act with individuals with variant gender identities and/or behaviors. We summarize his suggestions as follows: ■ It is important to refer to transsexual or transgendered individuals appropriately. If someone identifies himself as male, refer […]

In the 1960s and early 1970s, when medical procedures for altering sex were first being developed in the United States, approximately three out of every four people requesting a sex change were biological males who wished to be females (Green, 1974). Although most health professionals believe that males seeking sex reassignment still outnumber females, evidence […]

We have learned that gender-identity formation is a complex process influenced by many factors, with congruity between biological sex and gender identity by no means guaran­teed. We have become increasingly aware of the rich diversity in gender identities and roles. Many people fall somewhere within a range of variant gender identities. The com­munity of gender-variant […]

Scientists have argued for decades about the relative importance of nature (biological determinants) versus nurture (social learning and the environment) in shaping human development. Today it seems clear that gender identity is a product of both biological fac­tors and social learning. The evidence is simply too overwhelming to conclude that nor­mal infants are psychosexually neutral […]

Proponents of the social-learning interpretation of gender-identity formation refer to various studies of intersexed children born with ambiguous external genitals who are assigned a particular sex and reared accordingly. Much of the early work in this area was performed at Johns Hopkins University Hospital by a team headed by John Money. When these treatment approaches […]

Thus far we have considered only the biological factors involved in the determination of gender identity. Our sense of femaleness or maleness is not based exclusively on biological conditions, however. Social-learning theory suggests that our identification with either masculine or feminine roles or a combination thereof (androgyny) results primarily from the social and cultural models […]

The ambiguous sex characteristics associated with pseudohermaphroditism can also result from genetically induced biological errors that produce variations in prenatal hor­monal processes. We consider three examples of disorders caused by hormonal errors: androgen insensitivity syndrome, fetally androgenized females, and DHT-deficient males. Androgen Insensitivity Syndrome A rare genetic defect causes a condition known as androgen insensitivity […]

Errors occasionally occur at the first level of biological sex determination, and indi­viduals are born with one or more extra sex chromosomes or missing one sex chromo­some. More than 70 atypical conditions of the sex chromosomes have been identified. These irregularities are associated with various physical, health, and behavioral effects. We consider two of the […]