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The Adult Transsexual

A lot of commonalities exist between the transsexual and the cross dresser, and just as many differences.   Let me start this with a bit of a preface about what the TS is and is not.

First, the transsexual is NOT a woman trapped in a man's body or vice versa.  That is a cliché first latched onto by the media in the 1960's to try and put a context to Christine Jorgensen.  Most transsexuals, including me, absolutely abhor this analogy.  We just "know" what we are.  We are not girly boys or transvestites or any other name or label.  We are transsexuals; plain and simple.  Some of us are shunning even that term for being just transgendered.

Now that we have that insult out of the way what is a transsexual?  The transsexual is a person whose "brain sex" which is their real sex and their physical sex are at odds.  It is about feelings.  There is no rationalization here, it is how we feel.

"I am physically a male but I feel female, always have and always will."  The transsexual has a very difficult time relating to their biological sex because it doesn't match their true feelings.  This doesn't mean that we are all silly and limp wristed and sashay down the streets with strained falsetto voices.  Neither are we drag queens or drag kings or "flaming homosexuals".  We are people just like you except we have these feelings we cant ignore.

The Evolution of the Transsexual

Most but not all transsexuals recognize they are different as young, very young children.  Personally, I always felt different from my earliest memories. 

As children we know we are different and our interests are not in the usual things of our biological sex but in our true gender.  This often set up situations where we were told that our interests and actions were inappropriate and we were encouraged to conform to our biological sex role either by coercion or through corporal punishment.  A very few children will absolutely insist on their gender role and for a very few of these, the parents would support them.  Today, parental support is becoming more commonplace though.

As a result of the corrections to our gender role we "learn" the right things and suppress the reality.  These are the barriers we erect around ourselves for protection.  We have already learned the terrible trio of guilt shame and fear by the time we start school so we are already set up as easy targets for our peers, and they can be merciless in their cruelty.  This discrimination only strengthens our resolve to hide and avoid detection.  Our biological gender role is well learned by the ninth grade.  It is so well learned that the true gender role is lost beneath the veneer of protection we have created.

With this situation now the norm, we set out to "prove" to the world we are totally normal.  Oh yeah, football, soccer, hockey.  Still our secret is ours and when alone we can "dress up" a little and be ourselves.  It is our only salvation from total madness.

We take on macho careers, marry and start families young.  Bear in mind this is the stereotype and not always the case.  (I make this statement from personal contact and listening to other transsexuals stories.)  I have noticed that from a statistical perspective there does seem to be a disproportionate number of TS's employed in law enforcement.  This is not to say this is the case here in London, only an observation made on a much larger population.

Some transsexuals will "hit the wall" in their late teens, others into their mid thirties or later.  There really is no prediction of this horrific time.

The Awakening

Remember that there is a lifetime of denial lived to this point, and as with any human being under such strain, eventually something has to give.  The awakening or hitting the wall or whatever term is used is best described as an event or series of events where there is an internal battle for control within the transsexual.

The child that was buried so many years before is no longer willing to stay hidden and as a result emerges; and with a vengeance.  When this happens the transsexual is at high risk for self inflicted injury or death.  It is during this time that families are often shattered and ruined as well as the life of the TS.  It doesn't have to be that way though.

First of all, it isn't going away; ever.  The TS needs to learn to live with it and this can be a long and painful period of growth.  I say growth because that child has to learn to grow up to be an adult.  The one key catalyst in all of this is a good therapist who is experienced in gender issues.  The trick here is that the problems aren't gender they are all the barriers erected over time.  The TS has to figure out how they are affecting him/her today in order to tear them down.  This period of growth can take years.  (In my case almost 3 years of therapy and that is considered fast.)

Until the TS has fully dealt with all of this, no reputable doctor is going to allow any form of transition to the true gender.  This doesn't mean it cant happen, it can.  With the money anyone can fly to Thailand and have GRS without going through all of the established medical protocols.  This is not a cure.  There is no cure for being a transsexual.

Gender Reassignment Surgery is only a physical alteration to align sexual characteristics with true gender.  That is all it is.  It does not solve the issues surrounding the TS.  It is no magic pill.  If the TS was unhappy before surgery the chance is that it will be the status quo afterwards.  This is why the therapy is so important.  Mistakes have been made.

Being Transsexual

The transsexual has the option to transition wholly, in part, or not at all.   The train of thought used to be that being TS meant that transition was a necessity.  In some circles that is still the thought but the reality is that many transsexuals are living without fully  transitioning or just transitioning in part.  There are many reasons for this, but the one common thread all transsexuals have, is that given the choice, and under the right circumstances, all would fully transition.

The non-transitioning or non-op transsexual accepts that they will endure a life rife with gender dysphoria.  Gender Dysphoria can be best described like a race horse in the starting gate and when the bell goes off the gate doesn't open.  The horse is trained to run with the wind when the bell goes off, but feels caged when it cant get out.  That is how the transsexual feels with gender dysphoria.  If this persists for a length of time of six months or more, the transsexual is said to have Gender Identity Disorder.  Now this is the Catch-22.

The transsexual has to have been in therapy and become mentally healthy only to be considered as having a "disorder" so s/he can proceed forward to transition.  Viewed in this light it is a paradox within the psychiatric community.  That said, the next issue of the DSM is supposed to remove this as a disorder for this very reason.  One can endure gender dysphoria without having a disorder.  This is the position being taken by many in the mental health field.  The current trend is to remove it as a sexual disorder and place it under the umbrella of Anxiety disorders.  This is appropriate in my opinion.

Transition: The Long Road Home

Transition is a long and often painful process, both physically and mentally but it is one the transsexual welcomes with open arms if it is the path being pursued.

To begin with it requires the transsexual to be both mentally and physically healthy.  In order to proceed, the TS requires two letters of recommendation from mental health professionals.  These must be either psychologists or psychiatrists and they must prove their expertise with gender issues.  Only under very rare circumstances will the approval of a therapist with a master's degree in social work be accepted.

Prior to getting the approvals to begin transition the TS can begin the process of beard removal.  It is not uncommon for the transsexual to begin living and working in their true gender during this time.  This approach usually makes getting the letters of recommendation much easier.

Once approved for transition the next step is to begin hormone therapy.  This is a very emotional time for the TS because they are going through puberty just as if they were a young teen.  Emotions are uncontrollable as the hormones begin to do their job of changing secondary sexual characteristics.  It is a very trying time and many transsexuals quit during this phase.  It is also expected that the transsexual will begin to live and work full time in their true gender during this period.  This is called the Real Life Experience.  Medical monitoring and  therapy are continued to ensure both mental and physical health.

Some transsexuals try to self medicate in their transition for a number of reasons, but they are playing with fire.  Major organ damage can occur and in some cases death.   The Harry Benjamin Standards of Care are seen as an impediment because the pdoc wont recommend transition, or there are no facilities in remote areas.  These are two of the most common reasons.   Proper medical supervision is the only way to ensure success and good health.  Hormone therapy can take several years to accomplish.

Then the TS can seek surgical procedures to finish the transition completely.  These can include, tracheal shave, breast augmentation, facial feminization, and last but not least, sexual reassignment surgery.  This is not an inexpensive process nor do most health plans cover it.  It is considered an elective procedure but dont try to tell the TS that it is a choice, you are likely to get more than an earful.

Even following full transition, medical monitoring is continued as is therapy with your pdoc.

Living Transitioned

Most t-girls prefer to live under the radar in their true gender just as the true male or female they are.  Marriage is not uncommon and although having their own child is not possible they are often adoptive parents.  Those of course are the success stories.

Many others are unable to proceed with a "normal" life and as a result, often turn toward the sex trade to survive.  This frequently happens before GRS.  There are no shortage of customers for these girls.  The reality of this high risk lifestyle is violence, HIV, Hepatitis, Chlamydia, Gonorrhea among other STD's.

Dying Transgendered

November 20 each year is designated as Transgender Day of Remembrance, a time to reflect on those who have suffered violence and/or died for no other reason than being transgendered.  There are many who die each year around the world; their deaths being unnecessary, and often rooted in cultural, religious, or societal ignorance, prejudice and discrimination.

As much as I dislike the word, my opinion is that as a part of society we are probably very high on the most hated list.  People do not understand and this places us at risk for violence.

Frequency of Transsexualism

This is a very difficult area to quantify.  There are wildly varying figures that range from a frequency of 1:2500 to 1:30,000 for M2F transsexuals.  The  reasons for these figures are as diverse as the numbers themselves.

First the high end numbers of 1:30:000 were derived in the 1960's when transsexualism became recognized.  The incidence of SRS was very low due to the fact that the surgical procedures were still in development, there was not widespread knowledge of the procedures and treatment and the assumption that only a transsexual woman (primary transsexual) would seek out this procedure.  Thus the best estimates given were 1:30,000 for M2F transsexuals and 1:100.000 for F2M transsexuals.  These figures were adopted and included in the DSM where they are still accepted today.

The transgender community knows better than this.  This is to say that in a city of 100.000 people, only 3 M2F transsexuals can be found.  This is completely absurd unless London is a hotbed of transsexual M2F's.  Hardly.

Lynn Conway took a more pragmatic approach to her estimates.  She allowed for the estimated number of transitioned M2F's and divided that number into the estimated number of males in the population  to arrive at a figure of 1:2500.  (http://ai.eecs.umich.edu/people/conway/TS/TSprevalence.html) This is of course only inclusive of transitioned people and is exclusive of the crossdresser and transgenderist.  This would probably reduce the numbers of incidence even more.  Conway suggests that it is possible to estimate a transgender occurrence of 1:500 for M2F.

Just as casual observation I would suggest her numbers are probably a bit low but not terribly so.  If the support group to which I belong is an indication, it is possible to suggest that M2F and F2M incidence is roughly equal.  Again, this is only a casual observation and has absolutely no basis in science or mathematics.

The one assertion that can be safely stated though is that the generally accepted numbers by the scientific community are terribly inaccurate.

The real difficulty of acquiring solid data is the fact that the trans community is very secretive and closeted.  The F2M population is able to easily pass under the radar simply by virtue of acceptable dress codes.  A female can easily dress in male attire and not be questioned about it whereas a male dressed in female attire is quickly observed.