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Originally Published in the J2CP
Information Packet
Transsexualism:
Information for the Family is published on TGGuide.com
with permission of the Author. This article and photographs may
not be reprinted without permission of the author.
PREFACE
Nothing in life had prepared me for that cold, windy day in Portland, Oregon,
when my 32-year-old son confessed to me that he was a transsexual. First, the
word had to be explained to me, for this was not a word in my vocabulary. Then,
after the realization of what this meant with all its ramifications and
complexities, I experienced a whole range of emotions--fear, quilt, anger,
despair and even mourning. I wished that I could close my eyes and make this
strange, new problem in my life disappear. But no amount of wishful thinking
solves the dilemma, nor does rejection of our transsexual child.
What is needed is an understanding of the phenomenon known as transsexualism, an
acceptance of our loved ones who are unique in this regard, and above all, love
and support of our transsexual member of the family or friend at a time when
they need it most.
My daughter is now 36. The surgery was performed 3-1/2 years ago. Electrology,
hormonal treatment and psychotherapy were also part of the transitional process.
She is a productive, successful person in her career and at peace with herself
personally. All of this would have been extremely difficult, if not impossible,
without the love and support of her family and friends.
Mrs. Jeanne Ebner
TRANSSEXUALISM: WHAT IS IT?
Introduction
When a member of the family of a transsexual asks this question, his interest in
the answer is neither general nor academic. His concern is a practical one. He
is asking: how did my son or daughter come to be as he or she is; is his
condition reversible; if not, what professional help is available to him, and
how may I help? The aim of this pamphlet is to provide you, in simple terms,
with specific information, derived from the latest medical research, which will
be useful to you. But it is important for you to understand that professional
help is only one ingredient in the successful rehabilitation of the transsexual.
The other, which only you can supply, is the love, concern and acceptance that
are manifested by those people who are important to him.
When we say that man's gender identity is psychosexual in essence, we refer not
merely to his physical characteristics, but to an intricate, variable complex of
mental traits and tendencies, subtle and emphatic. For most of us, these
qualities and characteristics resolve themselves into a harmony that declares
itself as predominately masculine or feminine. This psychosexual identity which
we present to the world satisfies our cultural definitions, and many comfortably
be taken for granted by us and by
those around us.
Not so for the transsexual. For him, the apparent sexual balance, as expressed
in the primary sex characteristics--i.e. the genitalia, is deceptive. It does
not reflect, indeed it contradicts, the inner balance he strongly feels, and
which to him represents his true psychosexual identity. In some instances of
transsexualism, where the secondary sex characteristics--i.e. heavy facial or
body hair in the male, feminine hips and pronounced breast development in the
female--shade into those of the opposite sex, the body itself has already begun
to bear out this inner conviction. But physical ambiguities are by no means
general in every instance in which an individual's powerful, intimate sense of
self contradicts his sex as recorded at birth.
There are other gender identity disturbances which are sometimes confused with
transsexualism, but which are distinct from it. The homosexual and the
transvestite experience some conflict between sex and gender. But neither of
these has any desire to change his anatomy. The transsexual, on the other hand,
feels that he has been trapped in the body of the wrong sex and he seeks help to
be freed from this predicament.
How Did It Happen? Is It Reversible?
The best efforts of skilled, dedicated professionals in the physical and
psychological sciences have so far failed to uncover the origins of the
transsexual condition. The most impressive hypotheses put forward to date, based
upon careful and open-minded clinical studies, indicate that several possible
elements should be considered together: functioning of the brain and of the
endocrine glands, neurological mechanisms, cultural and other environmental
factors.
Most, if not all, specialists in gender identity are agreed that the transsexual
condition establishes itself very early, before the child is capable of elective
choice in the matter, probably in the first two years of life. Others believe it
is set even earlier, before birth during the fetal period.
These findings indicate that the transsexual has not made a choice to be as he
is, but rather that the "choice" has been made for him through many causes
preceding birth and beyond his control. When you fully understand that the
condition is confirmed so early in life, and that no individual can a make a
conscious decision to be a transsexual, this comprehension should allay some of
your anxieties and help you to deal with the transsexual with greater sympathy.
It will become clear, too, why psychotherapy is rarely, if ever, successful
after early childhood. Yet, some sort of treatment is urgently indicated, for in
many instances the transsexual's suffering is so intense that suicide and
self-mutilation are not uncommon. Therefore, many professionals have come to
share the view of the distinguished doctor who said: "If the mind cannot be
changed to fit the body, then perhaps we should consider changing the body to
fit the mind." Thus scientists, through painstaking clinical processes, have
arrived at the same conclusion to which the transsexual's suffering led him as
he desperately sought a remedy for his daily sense of dissonance between his
mind and body.
Physicians and psychiatrists have been deeply impressed with the fortitude with
which many of their transsexual patients confront physical pain, economic
sacrifice, and complicated social and emotional adjustments in their commitment
to the liberating process of sex reassignment. Medical specialists who maintain
a careful, long-term follow-up on their transsexual patients have reported that,
where other efforts at treatment have failed, corrective surgery has produced
"subjective and objective improvement in life adjustment in a majority of
cases." The keys to success are: 1) proper screening, 2) counseling, and 3)
family support before, during, and after surgery.
Is it reversible? The vast majority of medical practitioners seriously concerned
with problems of gender identity in the adult have answered "No", not in the
"true" transsexual. But to this negative answer they have mercifully added
positive suggestions for treatment which offer relief and hope to the
transsexual: counseling, hormone therapy and surgery.
Highly qualified doctors of physical and psychological medicine all over the
world, working singly or in teams, are increasingly concerning themselves with
investigations into the causes and treatment of transsexualism. Evidence as to
causes, and data as to effects of treatment, are accumulating, encouraging the
hope that earlier diagnosis and more effective preventive and ameliorative
procedures, as well as education of the general public, will successfully reduce
this source of human suffering.
But it cannot be too strongly stated that question "why" is the scientist's
proper job, his alone. It is harmful, and even destructive for the family of a
transsexual to look back for the causes of his difficulties. Such a search based
on one case only and biased by emotional involvement may easily mask an
assignment of guilt either to yourself or to your child. It would be better to
look instead to the present, and share this present with him, fulfilling his
need for your love, understanding, and acceptance.
Acceptance
Earlier it was stated that each individual embodies in himself a balance of
contrary qualities, masculine and feminine. Philosophy, religion and science are
also agreed in this conclusion: that each individual forms a constellation with
every other, that we are all members of the same body. If the fate of each
influences the fate of all, surely this is so to a heightened degree for those
whom circumstance has brought together in one intimate familial environment and
by one bloodline. It should then be evident that what nature has united we may
sunder only at great personal cost.
One may regard a problem such as a transsexual child as something to be pushed
aside and forgotten; but in fact, by confronting such a problem one finds
opportunities for growth, a chance to learn about and appreciate qualities in
one's child which seemed undesirable when "out of context" in his male body, but
which not appear lovely. A difficulty avoided inevitably returns to challenge us
in a more acute form. So do not turn from a loved one at the time of his
greatest need.
No parent of an adult transsexual is wholly prepared for the revelation of his
condition. There have generally been numerous clues, usually from early
childhood and always from adolescence, when the psychosomatic crises of that
period produce distress signals that are often most dramatic. You may have no
doubt shared in his embarrassments and traumas, when, since his natural behavior
was inappropriate to his genetic sex, he was rejected by his peers, looked at
askance in public, and finally retreated into a painful isolation. Remembering
your own discomfort on his behalf, recognize that the primary and more intense
suffering was his alone; just as it is he who now bears the heaviest burdens of
readjustment to a new life. Now that he has finally found a way to correct those
conditions that created painful experiences for you as well as for him, it
should bring a sense of relief to you, too.
Almost any biologically complementary couple may participate in procreation. You
are called upon to assist at a re-creation; your child's second birth. Mistakes
are remedied so that he can begin to fulfill himself personally and as a happily
contributing member of society. Through your vitally important, loving support,
you can be a participant in his adventure, sharing in the release and liberation
of his new life.
RESEARCH ON TRANSSEXUALISM
Although the causes of the transsexual condition are not yet understood,
extensive research in recent years has indicated some possible biological and
psychological factors which might render one individual more vulnerable than
another to develop in this way.
Experiments with animals suggest that the altering of hormone balances, during
certain limited, critical prenatal periods, will affect those areas of the brain
that regulate masculine and feminine behavior. Other medications administered to
the pregnant mother (barbiturates for example) may also have an effect on the
development of the unborn child, as may certain intrauterine viral infections.
Transsexual symptoms need not develop under such circumstances, and of course,
usually do not. Predetermining circumstances may simply make the individual more
susceptible to the development of transsexualism. The postnatal determinants of
gender-identity--the child's relationships with those who form his early social
environment--may then supply the deciding factor, if these relationships are
seriously disturbed during the critical postnatal period of gender identity
formation.
Research over the past 30-plus years has shown that pre-surgical transsexuals as
a group are among the most miserable of people, often exhibiting extreme
unhappiness which frequently brings them to the verge of suicide or
self-mutilation. The transsexual's problems are further complicated by a near
consistent trend towards rejection by both family and friends, harassment and/or
discrimination in varying degrees by most of society, and more often than not, a
refusal by many in the legal and medical professionals to render services;
either by reason of questioning the validity of such a diagnosis, or fear of
potential peer and/or community sanctions.
TREATMENT
Ineffective Modes of Treatment
If gender identity is set at an age that precedes the child's ability to make a
conscious choice, it is clear that he is without responsibility for his
disturbance in gender identity. To try to coerce the child into behavior that
conforms with his anatomy, whether by threats, physical force, or the
withholding of love, must be seen to be barbarous, as well as ineffective. It
could be fatal.
In medicine, this attitude has its counterpart in therapies such as
electro-shock and aversion therapies, with results that are sometimes brutally
harmful but which never "cure" transsexualism.
It is generally agreed that an adult transsexual will not benefit from
psychotherapy designed to change his identity. Whether a child who shows signs
of gender identity disturbance will or not is not known, but it is usually
advised so that all avenues of help may be explored.
How Patients Are Chosen
The first step for an adult transsexual who seeks treatment should be a
consultation with a psychiatrist who has had previous experience in working with
transsexuals and adheres to the "Standards of Care" developed by the Harry
Benjamin International Gender Dysphoria Association (HBIGDA). A practitioner who
is unfamiliar with the theory and practice of medical therapy for transsexuals
may flatly refuse help or blunder in the help he offers. Thus it is of critical
importance to begin with a professional who has the necessary qualifications and
experience.
Gender identity clinics are usually associated with a university and are engaged
in a variety of research projects in the field of gender identity. If the
individual applying does not meet the precise requirements of the work in
progress at the clinic of his choice, he may be refused treatment there solely
on these grounds. This does not necessarily mean that he is not a good candidate
for sex reassignment, and should not discourage him from applying to another
clinic where help may be available to him.
Apart from the special restrictions of their research programs, most gender
identity clinics agree on certain criteria for accepting the transsexual who is
over twenty-one for diagnosis and treatment leading to surgery. These
requirements are designed to eliminate candidates whose judgment is impaired or
who are otherwise too severely disturbed to benefit from sex reassignment; those
who are not clearly decided on this course and who might later regret their
decision; and those who, in the opinion of the consulting staff might not, for a
variety of reasons, make a successful adjustment to the new role.
Major gender identity programs are located in San Juan Capistrano, San
Francisco, and Palo Alto, California, Minneapolis, Minnesota, Galveston, Texas,
Denver, Colorado, and Charlottesville, Virginia. Additionally, an increasing
number of physicians and surgeons in private practice, are now providing
treating.
In addition to the interviews, physical and psychological tests and therapies,
and electrolysis of the beard for the male transsexual, there is one further
essential element in the total program of sex reassignment. After the patient is
accepted as a possible candidate for surgery, and while he is receiving hormone
therapy, both gender identity clinics and physicians in private practice require
that he dress, live and work in the new gender role for a period of twelve
months to two years. The patient then may better judge, through direct
experience, whether he will be able to live comfortably, and without attracting
undue notice, in the new role. His physician will observe the degree of his
social and emotional adjustment, and estimate how convincing an appearance he
presents. This testing period is of prime importance in assisting them both to
make a final decision to proceed, or not, with surgery.
Clinical Treatment of the Transsexual
Surgery is not the first, but rather the last major step in the remedial
program. The wisdom of this may readily be seen. The results of surgery cannot
be reserved, the original anatomy can never be restored. For better or worse,
the individual must live with his "new" body. On the other hand, hormone
therapy, with which treatment begins, produces physical changes which are
generally reversed, restoring the original appearance, after hormones are
discontinued.
Hormone therapy is beneficial in several respects. His gradually altered
appearance relieves the transsexual of some of his conflicts and gives him a new
sense of confidence. In addition to the physical changes, hormones produce a
tranquilizing effect in most cases.
It is usually required that the male transsexual complete at least half of a
course of electrolysis of the beard (usually requiring a total of from one to
two years) before surgery is undertaken. If he fails to do this, he will risk
radical confusion as to his gender identity following surgery, with possibly
serious consequences.
During this preoperative phase, it is important for the transsexual to discuss
his social and economic plans in order to gain a practical basis for the new
life he is preparing. Professional counseling may prove helpful in supporting
him through this delicate transitional period. When the physician is satisfied
that the way has been well prepared in all respects, the patient is ready for
surgery.
Gender identity clinics will ask the transsexual to cooperate in periodic
meetings for some time after treatment has been completed. This is for the
purpose of studying and helping with his social, emotional, sexual and economic
adjustments to his new role. By participating in these follow-up studies, the
transsexual makes an important contribution to the better understanding and
treatment of transsexualism. And if further therapy is indicated, his physicians
will be helpful to him in this regard.
Other Steps On The Way
The transsexual making the change from male to female, and to a lesser degree
his female counterpart, will need to study the grooming and clothes of the
chosen sex. His mirror and his friends and family may supply all the help he
needs. Or the male transsexual may decide to apply to a charm school for expert
instruction. For the transsexual whose field of work will not permit him to
retain his old job, vocational training is essential so that he may be fully
self-supporting.
There will be legal adjustments to be made: The securing of identification
papers and other documents in his new name, and, in the case of an individual
who is married, a decree of divorce. All gender identity clinics require that a
divorce be obtained before they accept a patient for surgery.
It may be advisable for the transsexual to relocate to one of the urban areas
where the necessary professional help is readily available. Relocation may
eventually be advisable in any case to spare the patient the embarrassments of
working out his new identity under the public eye. After the final steps in the
transition are completed, he may decide to return home.
The financial burdens of sex reassignment, the cost of surgery and other
surgery, the loss of income during the period of recuperation, may present the
transsexual with a difficult or insurmountable problem. If members of his family
are able to share this burden, hopefully the help will be received with
gratitude.
A Final Word
Imagine that you, the father of a transsexual, awakened one morning, looked into
the mirror, and saw an unfamiliar reflection returning your glance; that of a
woman. Imagine your shock and dismay. Your feelings were no different from what
they had always been; and yet you, with your masculine sense of self, were now
trapped in a body that contradicted all that you know yourself to be. If you are
a woman, perform this experiment in reverse.
Now you have a slight notion of what your son or daughter has been experiencing
daily, probably since earliest childhood. Furthermore, he has been under
constant pressure to keep up the masquerade at school, in his social relations,
in his job, and perhaps even at home; in his total way of life. One day, the
strain began to be overwhelming. He felt that he could not sustain this
deception, this contradiction, for another moment. In his desperation, he may
have tried suicide. Or he may have realized that skilled and understanding help
is available to him, and set out to find it.
It is little wonder that the adult transsexual who finds himself in this impasse
is determined to free himself from it. Once he has decided on the course of sex
reassignment, he probably will never look back. If qualified doctors accept him
for treatment, the chances are that nothing will dissuade him, not even the
disapproval or entreaties of those he loves. When you have clearly understood
and felt the reasons for his determination to find help, let him do so fortified
by your support and love.
This article is
Published on TGGuide.com with express
permission of the Author. All rights are reserved by the original
author. Any reproduction without permission is prohibited.
ARTICLE SUBMISSIONS:
TGGuide is seeking writers for articles of interest to the
transgender community. We will include information about the
author along with links back to your web site. Please submit
your articles to
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