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Transsexualism: A Primer
Second Edition, August 1996
Re-published by The Looking Glass Society by
permission of the original author.
Contents
1 Introduction
2 What
is Transsexualism?
2.1 Sex, Gender and Gender
Dysphoria
2.2 What Transsexualism Is
Not
2.3 What Transsexualism Is
3 The Medical Viewpoint
3.1 What Causes
Transsexualism?
4 Dealing with Being Transsexual
5 Social, Economic and Legal Implications
6 Conclusion
Preface
This
booklet was written as an introduction to the
subject of Transsexualism. It includes a summary
of current medical and scientific opinion about
the condition, as well as observations on how it
feels to actually be a transsexual woman.
The
booklet is based very strongly on the author's
own personal experiences as a transsexual woman,
and therefore some other transsexuals may well
choose to disagree with some of my opinions and
observations. Likewise, the medical part of the
booklet represents my understanding of the 'best
consensus' of current medical and scientific
opinion. Research is ongoing into many aspects
of human gender and sexuality, particularly
regarding genetics and neurophysiology. Contrary
opinions are held by some researchers, and new
information is appearing all the time.
This
booklet deals only with male-to-female
transsexualism. This is in no way meant as a
slight to the female-to-male community, but as I
am a male-to-female transsexual, I do not feel
qualified to write about female-to-male
transsexualism, although it is of course a
closely related phenomenon.
For
more in-depth technical or medical information,
please refer to the considerable existing
literature around the subject. This booklet was
written as a general introduction for those
seeking to understand the condition and its
social and personal consequences, and is not
meant in any way to replace such specialist
material.
I
would like to dedicate this booklet to all the
people, both friends and professionals, who have
helped me through my own gender change. And to
all those who seek to understand and to help
those of us who are transsexual, I offer my
sincere thanks.
This booklet is subject to Copyright (1995/6).
It may be copied unchanged in its entirety and
distributed for any non-commercial purpose
promoting the understanding and well-being of
transsexual people. No part of the booklet may
be copied for any other purpose without the
author's permission.
Transsexualism is a complex and
little-understood condition. Because it involves
very fundamental aspects of human identity, it
attracts considerable misunderstanding, fear and
prejudice. Sensational and inaccurate stories
about 'sex-changes' abound in the popular media,
and contribute to the misunderstanding and
apprehension that many people feel about the
condition.
Put very
simply, a transsexual is a person whose gender
(psychological sex) is opposite to their
physiological sex. Many transsexual women, prior
to gender reassignment, do consider themselves
to be 'women trapped in male bodies'; others
consider this description trite or even
inaccurate.
The
first part of this booklet aims to explain what
transsexualism really is, as well as dispelling
the common confusion between transsexualism,
transvestism and homosexuality (they are three
totally different phenomena). The second part
summarises the current medical viewpoint on the
causation of the condition. The third part
describes how transsexual people deal with the
condition, and briefly describes the process of
gender reassignment ('sex change'). Finally, the
social and legal implications of the condition
are discussed.
Before
embarking on a detailed discussion of
transsexualism, it is important to define some
terms; Sex and Gender are two important and
different concepts that are frequently confused.
Sex refers to
someone's anatomical sex --- in other words,
which type of genitals they possess. Except in
very rare cases of hermaphroditism, anatomical
sex is well-defined and easy to interpret.
Gender is rather
more subtle, and refers to the person's own
self-identity as a male, female or something
else. The overwhelming majority of the
population have a gender that accords with their
anatomical sex, which is why few people
understand that the two are different. Gender is
less clearly defined than anatomical sex, and
does not necessarily represent a simple binary
choice: some people have a gender identity that
is neither clearly female nor clearly male.
Gender
consists of two related aspects: Gender
Identity , which is the person's internal
perception and experience of their gender, and
Gender Role , which is the way that the
person lives in society and interacts with
others, based on their gender identity.
Gender Dysphoria
is an umbrella term covering a feeling of
unhappiness and incongruity concerning one's
physical sex and/or gender role. This covers a
range of feelings, from a general sense of
discontentment with the socially expected role,
through certain forms of gender-motivated
transvestism (dressing as the 'opposite' sex to
alleviate this dysphoria), through to full-scale
transsexualism (with an overwhelming desire to
change one's body and genitals, and to actually
become, as far as medically possible, the other
sex).
There
are several other possible human conditions that
are commonly confused with transsexualism, but
are quite distinct. These are described briefly
here to eliminate them from this discussion:
-
Transvestism.
Very commonly confused with
transsexuals, transvestites lack
the overwhelming need to change
their physical sex
characteristics that
characterises transsexuals.
Transvestites feel a need to
dress as the opposite sex from
time to time, but have no wish
to change sex. There are two
broad types of transvestite,
Gender-Motivated and
Fetishistic, although there may
be some blurring of the
distinction.
Gender-Motivated transvestites
are usually unremarkably
masculine, heterosexual men, who
construct a female alter ego
to allow themselves to express
the 'feminine' character
attributes such as sensitivity
and emotionality that they deny
themselves in their male role.
The female persona is kept
totally separate, and the
transvestite, when in his male
mode, will often refer to his
female persona as if she was a
totally different person.
Gender-Motivated transvestites
may or may not be gender
dysphoric: some cross-dress to
escape from a feeling of
unhappiness with the male social
role, many simply because they
enjoy playing at being (their
idea of) female. The former type
would probably be regarded as
being mildly gender dysphoric,
the latter would certainly not.
Nevertheless, transvestites are
emphatically different from
transsexuals: the transvestite
always has a core male identity,
even if he occasionally likes to
escape into a female alter
ego , while the
(male-to-female) transsexual
always has a core female
identity.
Fetishistic transvestites
cross-dress to obtain some form
of sexual pleasure or
stimulation. They are almost
universally heterosexual, and
are not regarded as gender
dysphoric.
Transvestites generally regard
themselves as fundamentally
male, and most would be appalled
by the idea of actually changing
their sex. However, it is not
uncommon for transsexuals to go
through a phase of seeing
themselves as (or perhaps trying
to convince themselves that they
are) merely transvestites,
before they come to fully accept
their true condition.
Conversely, a few transvestites
carry their fantasy 'female
self' too far and delude
themselves into thinking that
they are transsexual. Rigorous
psychiatric screening is used
before allowing 'sex-change'
treatment to minimise the
possibility of such people
embarking on a course of action
that they would come to regret.
Transvestites are relatively
common: some estimates would
have several percent of the male
population showing some degree
of transvestite behaviour.
-
Homosexuality and Bisexuality.
This has no connection at all
with transsexualism --- gay men
and lesbians are generally
totally happy with their
anatomical sex, and their gender
identity is in accordance with
it. They are merely attracted to
persons of their own anatomical
sex, or to both sexes in the
case of bisexuals. Of course,
there are also gay transvestites
('drag queens'), who cross-dress
from a different motivation:
generally for show or humour, or
perhaps as a political
statement.
Homosexuality and bisexuality
are very common; some statistics
even suggest that people
exhibiting some degree of
bisexual or gay attraction could
outnumber pure heterosexuals. At
the minimum, homosexuals and
bisexuals represent a large
minority.
-
Hermaphroditism and Intersex.
Hermaphroditism is a very rare
condition in which the genitals
are neither clearly male nor
clearly female. There is a
school of thought that maintains
that this is related to
transsexualism, but is a much
more extreme case resulting in a
strongly intersexed body, rather
than the mind/body mismatch that
characterises transsexualism.
Many milder intersex conditions
exist, often resulting in
varying degrees of malformation
or dysfunction of the genitals.
Such conditions do appear to be
significantly more common among
transsexuals than among the
general population, though the
majority of transsexuals are not
obviously physically intersexed.
The incidence of true
hermaphroditism is reportedly
somewhere around the
one-in-a-million mark, although
milder physical intersex
conditions are very much more
common. As many as 1 in 200 live
births exhibit some degree of
physical ambiguity, and as many
as 1 in 400 people have a
chromosome configuration that
does not match either the
standard male (XY) or standard
female (XX) karyotypes.
Transsexualism is the most pronounced form of
Gender Dysphoria. A typical medical definition
of transsexualism would be along these lines:
A
transsexual is someone who experiences a deep
and long-lasting discomfort with their
anatomical (genital) sex, and wishes to change
their physical characteristics, including
genitals, to the opposite of those usually
associated with their anatomical sex, and to
live permanently in the gender role opposite to
that normally associated with their anatomical
sex.
The
medical definition is usually hedged around to
exclude conditions such as hermaphroditism and
various forms of psychosis which may lead to
patients thinking they are transsexual without
really being so. Some transsexuals also exhibit
a degree of physical androgyny (which supports
the view that transsexualism stems from an
endocrine disorder, like hermaphroditism) but
this is not part of the required conditions for
diagnosis.
Transsexualism is still thought by many people
to be a psychiatric condition, even though most
transsexuals are perfectly sane and rational and
recent research has shown that the condition has
a physical basis --- that the 'female brain in a
male body' is a biological reality.
Nevertheless, in most countries the person in
overall charge of a gender reassignment
('sex-change') will be a consultant
psychiatrist. The psychiatrist's role is to
ensure that the patient is sane, really is
transsexual, and is mentally stable enough to
make the necessary adaptation to the new gender
role.
Most
transsexuals dislike the typical medical
description, as it still tends to suggest a
psychiatric, rather than physical, origin for
the condition, in spite of the criterion that
one must be sane to be allowed gender
reassignment. The present author would like to
suggest an alternative, and personal, view of
what it means to be transsexual:
I am
a woman who, probably due to some endocrine
malfunction before birth, was born with male
genitals. Since our society assumes that gender
and sex always correspond, I was wrongly
assigned to the gender pigeon-hole called 'male'
by a doctor who looked at my genitals instead of
my mind. Throughout my childhood I knew
perfectly well that I was really a girl (after
all, it's my mind, not my genitals, that make me
the person that I am), but because my body
seemed to insist otherwise, I was forced to try
to fit in to the gender role of a boy. This
produced intense unhappiness and almost totally
ruined my life until I accepted the reality of
my situation and underwent gender reassignment
as an adult. I now live in the gender role
called 'female' that matches my gender identity;
the medical profession labels me as a
'post-operative true primary male-to-female
transsexual', but I regard myself as a perfectly
normal, well-adjusted and happy woman.
Bearing
in mind the definitions of 'sex' and 'gender',
some transsexuals are uncomfortable with the
accepted medical term 'gender reassignment' to
cover what is popularly known as 'a sex change'.
While many medics would adopt the reductionist
viewpoint that sex is properly determined by
chromosomes and not by genitals, and that there
can therefore be no true change of sex, it is
not really a change of gender either. It is a
change of gender role , to bring it into
conformity with the person's gender identity
, with hormonal and surgical reconstruction, as
far as possible, of the body's sexual
characteristics.
Many
specialists draw a distinction between
primary and secondary transsexuals,
although in reality there is probably a spectrum
rather than a black-and-white division. Primary
transsexuals exhibit cross-gender identity and
severe gender dysphoria from an early age, and
are unable ever to function satisfactorily in
their natal sex role. Secondary transsexuals
arrive at their cross-gender identification
later in life, often after being fully
functional in their natal sex role for some
time, perhaps having even married and raised
families. It seems likely that primary
transsexuals are the true 'female brain in male
body' case, with extensive feminisation of the
brain, while secondary transsexuals represent a
less severe version of the condition, with only
partial feminisation of the brain. This view has
been borne out by psychometric tests that aim to
quantify 'masculine' and 'feminine' personality
traits.
Transsexualism is a fairly rare condition. About
one person per thousand is gender dysphoric to
some extent, although true primary transsexuals
are far fewer. Recent estimates would suggest
that around one person per 25,000 is a true
primary transsexual, with perhaps ten times that
number of secondary transsexuals.
After
reassignment most, but by no means all,
transsexuals are heterosexual. Among the
transsexual population, the usual spectrum of
human sexuality can be found. Gender identity
and sexual preference are not very strongly
connected. Interestingly, it appears that
primary transsexuals exhibit a similar incidence
of sexual preferences to the natural-born female
population, while secondary transsexuals
demonstrate a much higher incidence of
lesbianism or bisexuality.
There is
also an increasing number of people who label
themselves as 'transgenderists'. They typically
wish to live as members of the opposite sex, but
without undergoing genital surgery. This could
be regarded as a kind of mid-point between the
Gender-Motivated transvestite and the
transsexual. While this unquestionably another
manifestation of Gender Dysphoria, it is
debatable whether such people are transsexual in
the true sense.
Transsexualism has been recognised as a distinct
condition for about forty years; before that,
anyone who was convinced that their true sex lay
opposite to that suggested by their genitals was
simply considered psychotic. For many years,
opinion was divided as to whether the origin of
the condition is psychiatric or physiological,
despite the fact that no amount of
psychotherapy, psychoactive drugs, aversion
therapy or any other psychiatric method has ever
'cured' a true transsexual. The only treatment
that seemed to work was gender reassignment, the
use of hormones and surgery to modify the
person's body and bring it into line with their
true gender, and to enable them to live in their
proper gender role.
It is
now accepted by all reputable professionals in
the field that transsexualism stems from a
physiological cause, and is in no way a mental
illness, perversion or 'lifestyle choice'. The
consensus of opinion is that gender identity is
determined before birth and is unchangeable
thereafter:
All
human foetuses start off in a female
configuration, and in the absence of biochemical
instructions to the contrary, will develop into
baby girls --- irrespective of their
chromosomal sex . This 'female by default'
development is overridden in normal male
foetuses by a complex sequence of hormonal
processes. It starts about six weeks after
conception, when the SRY gene on the Y
chromosome causes a weak male hormone precursor
to be secreted. This causes the foetal gonads to
differentiate into testes instead of ovaries.
Some weeks later, the primitive testes start
working, and secrete a large dose of
testosterone (the principal male hormone), which
causes the foetal brain to differentiate into
the male pattern. It is at this point that the
brain structure responsible for gender identity,
as well as all the other well-known (and
measurable) brain differences between men and
women, is laid down.
Transsexualism is caused by that second burst of
hormones failing to happen, or only happening
very weakly (many male-to-female transsexuals do
exhibit some masculine mental tendencies, but
retain the feminine gender identity, suggesting
that the masculinisation of the brain went part
of the way and then failed). In the case of the
most extreme primary transsexuals, with no
detectable brain masculinisation at all, the
second hormone surge is probably entirely
absent. There are a number of possible reasons
for this failure; in some cases, the genitals do
not develop normally, and therefore do not
manage to secrete testosterone on schedule to
alter the brain. This is likely to produce a
certain degree of physical intersex in the
infant as well as transsexualism. Most
transsexuals, however, are not obviously
intersexed, so subtler causes must be involved.
Overall,
the condition seems to have three possible
causes:
-
Chromosomes:
by no means the only cause, but
the easiest possibility to
identify. As many as 1 in 400 of
the population have a karyotype
other than XX (standard female)
or XY (standard male), some of
the other combinations can give
rise to a variety of conditions
including transsexualism and
intersex. A few, but by no means
all, transsexuals have a
non-standard karyotype, leading
to hormonal 'confusion' during
foetal development.
-
Chemicals: some
drugs that were administered to
pregnant women (most notoriously
diethylstilboestrol), or oral
contraceptives unknowingly taken
after conception, frequently
caused transsexual offspring by
disrupting the hormone
processes. There is also
increasing evidence that some
pollutants can have the same
effect --- many man-made
chemicals are known to mimic
oestrogen and/or disrupt
androgen receptors; especially
substances like
polychlorobiphenyls and
dibenzodioxins, which were very
widespread in the 1950's and
1960's, before their hazardous
nature was realised and they
were banned. Polychlorobiphenyls
were even used as ingredients in
makeup in those days --- many
women were exposed to
dangerously high levels of these
chemicals.
-
Random events:
sometimes, the biochemistry
simply fails to work properly
--- things just go wrong for no
very clear reason. Perhaps the
expectant mother is anaemic or
the foetus is undernourished for
some reason, or maybe maternal
hormones cross the placenta in
sufficient quantity to disrupt
foetal development (progesterone
in particular is very good at
blocking the action of
testosterone). The process by
which a fertilised ovum develops
into a complete baby human is so
unimaginably complex that there
is an almost unlimited number of
things that could go wrong.
Some
other causes have been suggested in the past,
but have by and large been discredited. In
particular, all variants of the 'nurture'
explanation (which suggests that the infant was
subject to a 'wrong-gender' upbringing ---
perhaps the parents really wanted a girl, not a
boy) can be discounted, now it is known that
male-to-female transsexuals have physiologically
female brains --- after all, neither upbringing
nor cultural influences can change the pre-natal
wiring of one's brain.
Once the
relevant stage of pregnancy has passed, there is
no way that the foetus's brain-sex (and hence
gender) can be altered: postnatally, hormones
can alter the body, but the brain remains
forever as it was born. This is why it is
impossible to change a transsexual's gender to
match their natal sex. It may seem strange to
change someone's body-sex to match their gender,
but it is the only treatment possible, as the
brain cannot be altered to match the natal
physiological sex. So gender reassignment
('sex-change') is the only successful way of
treating transsexuals.
There
are a number of ways in which transsexuals deal
with their condition, and many transsexuals will
pass through several of these as 'stages' on
their journey to self-fulfilment.
Denial
This is not
a way of dealing with being transsexual, but is
something that all transsexuals probably go
through in the early stages. Trying to convince
themselves that they are not really transsexual,
or will grow out of it, or 'ignoring it and
seeing if it goes away', all characterise the
denial phase. Denial does not usually work for
long, and there is considerable evidence that
transsexuals who fail to escape this stage
frequently commit suicide. Figures suggest that
as many as thirty percent of transsexuals are
not diagnosed and treated soon enough to prevent
them from taking their own lives.
No Action
A few
transsexuals come to a realisation of what they
are, but consciously choose to live with the
discomfort of an inappropriate body and gender
role, perhaps because of religious beliefs or
perhaps for the sake of wife or children. In a
few cases, transsexuals may live in a way more
reminiscent of transvestites, only expressing
their true gender on agreed occasions. This type
of adaptation is nearly always found to be
unsatisfactory for the true transsexual, and
similar problems to those of the Denial phase
then occur.
Social Reassignment
For many
transsexuals, the most pressing need is the need
to alter their gender role and to live in
accordance with their gender identity. This
means, for a male-to-female transsexual, living
completely as a woman. This is usually, but not
always, done as a step in a journey leading to
hormonal and surgical gender reassignment, but
some people choose to stop here (and usually
label themselves as 'transgenderists'), or maybe
even to live a 'mixed-gender' lifestyle --- a
few people with Gender Dysphoria feel that they
are neither truly male nor truly female.
For
male-to-female transsexuals, permanent removal
of facial hair by electrolysis is usually a
necessary step, and is usually done before, or
just after, social reassignment. It is
time-consuming, expensive and painful: two years
of treatment at two or three hours per week is
often required, at a cost that can often exceed
£25 per hour. Many people find the pain barely
tolerable, even with a local anaesthetic. It is
normally impossible to obtain electrolysis from
the NHS, so the transsexual must pay for private
treatment.
Hormonal Reassignment
Most
transsexuals undertake hormone treatment to
bring their body shape and appearance into
closer accord with their gender identity.
Hormone treatment may start before or after
social reassignment: a few transsexuals can
'pass' in their new social role without hormone
treatment, many may require some months of
treatment before undertaking social
reassignment. In Britain, hormones can only be
prescribed by a consultant psychiatrist as part
of a gender reassignment programme.
The initial
hormone treatment is largely reversible if
stopped early, and this is often used as a
safety check to prevent people who are not truly
transsexual (such as confused transvestites who
convince themselves that they are transsexual)
from taking a disastrous course of action. Since
transvestites have male brain structure and core
identity, and their behaviour is mediated by
male sex hormones, their cross-dressing
behaviour stops when female hormones are
administered. This effect is used to 'weed out'
people who are not true transsexuals: a true
transsexual will feel natural and happy under
the effects of female hormones, anyone else will
feel wrong and will stop their apparent
cross-gender behaviour as male hormone function
ceases.
Large doses
of hormones are used to overcome the body's own
sex hormones, which carry some risk of side
effects. After genital surgery, the dosage is
greatly reduced as the body no longer produces
hormones in opposition to the prescribed ones,
but a post-operative transsexual will need to
take a maintenance dose of hormones for life.
Some
transsexuals continue in a pre-operative state
for long periods, taking hormones and living in
their preferred gender role, but perhaps never
having surgery. There is evidence that
continuing the high hormone dosages required for
pre-op transsexuals for long periods may be
harmful.
Male-to-female hormone treatment causes
development of breasts, usually rather small, as
well as redistribution of body fat and a general
feminisation of the figure, hair and skin. Body
hair is often reduced but not removed, and
hormones seldom have any large effect on facial
hair. Hormones will not alter a male voice (nor
will genital surgery), so male-to-female
transsexuals must usually undertake some kind of
speech training, learning to raise and soften
the voice as well as using more feminine
inflection and vocabulary.
Surgical Reassignment
This is
seen by some as the entire purpose of the long
process of gender reassignment, while others
feel that it is more of a final step to achieve
congruity of body and mind after the really hard
work of establishing a life in the proper gender
role has been done.
The
process, for male-to-female transsexuals,
involves removal of the male genitals and the
construction of a set of female genitals
(excluding uterus and ovaries, of course) using
material from the male genitals. Present
state-of-the-art surgical technique produces a
very good approximation to natural female
genitals (even gynaecologists have been known
not to realise that a patient is a post-op
transsexual), with fairly good nervous
sensation, although of course it is dependent on
the skill of the surgeon.
The
operation is a major surgical procedure
(requiring about ten days in hospital, and four
hours or more under anaesthetic), is quite
painful and invariably expensive. Many
transsexuals in Britain opt for private
treatment as it has become very difficult, and
impossible in many areas, to obtain NHS
treatment and the waiting lists are very long.
No
reputable surgeon will perform surgical
reassignment without recommendations from two
psychiatrists. It is normally impossible to
obtain permission for surgery without performing
a 'Real Life Test' --- living and working as a
woman for at least one year.
Transsexuals in Britain face considerable social
and legal obstacles to a successful gender role
change. Widespread social prejudice means that
transsexuals are often harassed, ostracised or
even assaulted if their condition becomes known.
Many transsexuals find themselves forced to
abandon their previous life, job and social
circle altogether and to start a new life 'from
scratch' in a new area where their gender
history is not known. Many transsexuals lose
friends or family due to prejudice and lack of
understanding. All this makes for considerable
additional difficulty for the transsexual during
what is inevitably a stressful and traumatic
part of her life.
The
economic situation also makes life difficult for
the transsexual. Many transsexuals, prior to
reassignment, are unable to function effectively
as productive citizens because their Gender
Dysphoria is so debilitating. After successful
gender reassignment, the vast majority of
transsexual people become fully functional
members of society and contribute to the economy
in full. The biggest difficulty arises at the
'in-between' stage: today it is almost
impossible to obtain gender reassignment with
NHS funding, leaving private treatment as the
only available option for many people. But a
person who is unable to function effectively in
their natal sex role will probably find it
extremely difficult to save enough money for
treatment, and the problem is compounded by the
requirement for the 'real-life test' --- it can
be very difficult to hold down a job while 'in
transition'; it is a difficult time for the
transsexual herself, she may require
considerable time off work for treatment, and if
her transsexual status is discovered (and it can
be very hard to conceal, especially prior to
surgery) she is likely to lose her job. In the
circumstances, it is not surprising that many
transsexuals become suicidal when treatment is
unobtainable, or that some resort to
prostitution as the only way to pay for the
treatment. Privately, gender reassignment costs
a minimum of £10,000 for surgery, psychiatrists'
fees and electrolysis; the cost can easily rise
by thousands of pounds if the patient requires
more than a minimal amount of electrolysis, or
if she requires any cosmetic surgery in order to
'pass' as a woman.
An
untreated transsexual may well be a burden on
the state if she cannot keep a job, she may have
persistent psychological problems such as
depression, and she may well eventually commit
suicide, costing the state a great deal to
'clear up'. After successful treatment, she
would most likely be a fully productive member
of society, and would repay in taxation many
times the cost to the NHS of providing the
reassignment; recent figures show a 97 %
long-term success rate. Denial of NHS treatment
to transsexual people is not only a false
economy for the state, it is an iniquitous
denial of basic rights to a group of citizens
with a genuine and debilitating medical
condition.
If the
social and economic difficulties are bad, the
legal situation is in many ways worse, and acts
to compound the other difficulties. Under
present UK law, a post-treatment transsexual
exists in a kind of legal 'limbo': It is not
difficult to obtain a legal change of name, and
after gender reassignment it is possible to have
much civil documentation re-issued in the new
name and gender --- for example, passport,
driving licence and medical records. The single
biggest problem, however, is that owing to a
25-year-old court ruling based on reasoning that
is now known to be invalid in the light of new
medical knowledge, transsexuals are not
allowed to change their Birth Certificates ,
even after surgery. As a consequence, for many
legal purposes the original natal sex is
considered still to apply. This means, for
example, that a transsexual woman may not marry
a man, and if convicted of a criminal offence
may be sent to a male prison, with dreadful
consequences.
Prior to
that Court ruling, transsexuals in Britain were
allowed to change the gender recorded on their
Birth Certificates after surgery. Today, the UK
and Eire are the only countries in the EU that
deny this fundamental right to their transsexual
citizens, with far-reaching consequences for
those citizens.
Since
the Birth Certificate is the primary form of
identification document in Britain, a
post-treatment transsexual may have to reveal
her history to a prospective employer, which may
well lead to discrimination. Furthermore, the
DSS and Inland Revenue will not recognise the
new gender, so a transsexual woman will not
receive her pension until 65 rather than 60 and
will be treated as male for taxation purposes.
This, and similar anomalies, can all too easily
lead to the person's history being revealed.
(Some
people object to the idea of changing the Birth
Certificate, on the grounds that it 'should'
record the genital sex into which the person was
born --- the problem arises because the Birth
Certificate is used as an identification
document rather than merely as a historical
record. This objection can be addressed by the
method adopted by some states in the USA: a new
certificate, with the new name and gender, is
issued, but the original certificate is sealed
and kept on file, where it can be accessed only
on the order of a Court.)
Furthermore, existing case law in Britain holds
that the Sex Discrimination Act does not apply
to transsexuals, and that an employer may fire
an employee at will merely for being
transsexual. In April 1996, the European Court
of Human Rights ruled, in a test case, that this
was unlawful and thus that the coverage of the
Act should be extended to include transsexuals;
however the present UK government is still
resisting this ruling and the relevant statute
law has not yet been formally amended.
All of
this leads to a significant denial, to the
transsexual, of basic rights and civil liberties
that all other citizens take for granted.
Britain lags significantly behind most other
developed countries in this respect, and change
is long overdue.
Modernising the law to allow post-treatment
transsexuals the same rights and
responsibilities as other members of their
gender would not only offer a significant direct
improvement in quality of life for transsexuals,
but would also send a clear signal to society at
large that transsexual people are to be treated
the same as anybody else. Over a few years, this
could significantly ease the problems of social
discrimination --- at the moment, the fact that
transsexuals are marginalised and oppressed by
the law signals to the public that it is
acceptable to mistreat and discriminate against
transsexuals.
The key
points discussed in this booklet have been as
follows:
-
Transsexualism is the condition
in which a person is born with a
mental gender opposite to their
physical sex.
-
Transsexualism is a rare, but
genuine and debilitating,
medical condition, for which the
only possible treatment is
gender reassignment.
-
Transsexualism is not
transvestism or homosexuality.
-
Transsexualism is not a
perversion or a 'lifestyle
choice'. Transsexuals do not
choose to be the way they are,
they are born that way.
-
Gender Reassignment for
transsexuals enables them to
become fully functional
citizens, and has a very high
success rate.
-
Gender Reassignment is now
almost unobtainable on the NHS.
Private treatment is extremely
expensive, putting it out of the
reach of many transsexuals.
Psychological problems and
suicides frequently result when
treatment is unobtainable.
-
Transsexuals are unjustifiably
stigmatised by society in
general and by UK law in
particular. Transsexuals in
Britain are denied basic rights
and freedoms that all other
citizens take for granted.
-
Britain lags behind most other
developed countries in its
treatment of its transsexual
citizens.
-
Allowing post-treatment
transsexuals to have their Birth
Certificates corrected, and
recognising their new gender
legally, would greatly reduce
the discrimination that they
suffer, and would restore most
of the basic rights and freedoms
that they are denied.
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