From True Selves, Brown & Rounsley, pp 6-21.

What Is a Transsexual?

Transsexuals are individuals who strongly feel that they are, or ought to be, the opposite sex. The body they were born with does not match their own inner conviction and mental image of who they are or want to be. Nor are they comfortable with the gender role society expects them to play based on that body. This dilemma causes them intense emotional distress and anxiety and often interferes with their day-to-day functioning.

Transsexuals frequently report that they feel trapped—destined to live out their lives "imprisoned in the wrong body" unless they correct the situation with hormones or sex reassignment surgery (SRS), formerly referred to as a "sex change operation." Most of my transsexual patients were painfully aware of their gender incongruity from early childhood, although some did not fully acknowledge it until they reached puberty or adulthood. This incongruity between mind and body is referred to in medical literature as transsexualism, gender dysphoria, and also more recently as gender identity disorder (GID).

Intersexed Individuals

Intersexed individuals (formerly referred to as "hermaphrodites") are born with both ovarian and testicular tissue (either fully or partially developed). Some also have some obvious physical abnormality or ambiguity at the time of birth involving the external sex organs. Parents or physicians are often placed in the difficult position of having to make an arbitrary decision as to the sex of the infant. Sometimes parents elect to have the ambiguity corrected by genital surgery. In cases where either the "assigned" sex or the surgically corrected genitalia do not match the child's gender identity, the individual will likely be gender dysphoric and, like transsexuals, will often seek sex reassignment surgery.

Transvestites

Transvestites, or cross-dressers, are individuals who wear clothing of the opposite gender primarily for erotic arousal or sexual gratification, although some do so for emotional or psychological reasons as well, especially as they get older. Because the overwhelming majority of transvestites are men, we'll focus on them first.

Typically, transvestites are heterosexual, married, and well educated males. Some of them may have sexual fantasies about being female (and a few may even take small doses of estrogen for feminization), but transvestites have a male gender identity, enjoy their male bodies, including their genitals, and have no desire to change their sex.

Cross-dressing typically begins at puberty and may continue throughout a transvestite's lifetime. During puberty and the teen years, cross-dressing for males has a strong sexual component. Such boys generally become sexually aroused by wearing one or more articles of women's clothing (which they usually "borrow" from their mother, a sister, or any other female who happens to live in the household) and typically masturbate while wearing these garments.

For some, the sexual component to cross-dressing remains firmly fixed throughout their lives. For others, the sexual arousal disappears as they get older or becomes secondary to a sense of comfort, relaxation, or well-being when they cross-dress. Some transvestites report that cross-dressing allows them to express a more feminine side, a "second self," or a softer, more emotional side. While some say that cross-dressing is calming and releases them from the pressures inherent in society's rigid stereotypical expectations about the male role, others report that it makes them feel exhilarated or "more alive."

The extent, frequency, and visibility of cross-dressing differs widely. Some males wear only one item of female clothing (for example, panties or hosiery) either in a fetishistic way (that is, because it brings on sexual arousal) or as a garment under their male clothes, while others dress from head to toe in female clothing, including makeup and wigs.

Transvestism can run the gamut from mere dabbling to full-time preoccupation. Whereas some transvestites cross-dress only occasionally, others do so on a daily basis and adopt a female name and persona. Many transvestites are able to compartmentalize their "female side" so successfully that they exhibit no hint of femininity while in the male role.

Some transvestites cross-dress only in the privacy of their home or a hotel room, while others enjoy a very public, exhibitionistic cross-dressing life. Transvestites are often narcissistic and revel in drawing attention to themselves, being seen, preening in front of the mirror, and having their picture taken.

Transvestism is far less prevalent among women than men— some researchers believe that there are thousands of male transvestites to every one female transvestite—but the reasons for this disparity are not entirely clear. Because of their scarce numbers, there has been far less research done on female transvestites and less information compiled about them than about their male counterparts. It has been speculated that women may have less reason to cross-dress. Because society is far less rigid about female clothing standards, women can wear masculine-looking clothes or actual male attire without attracting much attention.

Female transvestites may wear one item of male clothing (for example, undershorts) or may don an entirely male outfit. Although they enjoy wearing male attire, they have a female gender identity and, like their male counterparts, have no desire to change their sex.

The major difference between male and female transvestites is the underlying motivation for cross-dressing. Whereas male crossdressing is generally associated with fetishism—sexual arousal elicited by an inanimate object such as lingerie or shoes—this is not the case for female cross-dressing. Experts believe that because women almost never have fetishistic tendencies, there is little or no erotic component to cross-dressing for female transvestites. Instead, according to the female cross-dressers I've worked with, their crossdressing emanates from a desire to embrace and experience male power and status and what is perceived to be male privilege.

It is also possible that female transvestites, like female transsexuals, may be underreported. Much more research is necessary regarding female transvestism before we can draw more conclusive answers.

Transvestite is sometimes abbreviated TV, and transvestites sometimes refer to themselves as "TVs."

Homosexuals and Lesbians

Homosexual men (who often refer to themselves as "gay") and lesbian women are individuals who are sexually and emotionally attracted to members of their own anatomical sex. Homosexuality, like heterosexuality, is a sexual orientation and should not be confused with a gender identity disorder like transsexualism. Although homosexuality has long been regarded by the general public as a sexual "preference" or "choice," more and more experts are beginning to believe that, as with transsexualism, a genetic component is involved.

Some gay males are effeminate in appearance, dress, and mannerisms. These individuals are sometimes referred to as "queens." And some lesbians who are very masculine in their appearance, dress, and mannerisms are sometimes referred to as "butch lesbians."

However, homosexual men self-identify as male, and lesbians self-identify as female. Both view their bodies as being appropriate to their gender identity and do not wish to have surgery to change their sex.

Drag Queens

Drag queens are homosexual cross-dressers who don female clothing for their own erotic and sexual pleasure or for that of partners who are attracted to female presentation in a male. Drag queens don't aspire to be females, and their partners don't want anatomical females—both value their own and their partner's maleness. Drag queens self-identify as male, view their bodies as appropriate to their gender identity, and do not wish to have sex reassignment surgery.

Drag queens generally take a more theatrical or "camp" approach to cross-dressing than transvestites, often affecting exaggerated and pronounced female patterns of speech, movement, gestures, and attire. They cross-dress primarily for show, enjoy being seen in their role, and relish the effect their presentation has on others. Many drag queens dress androgynously during the day (or lean only slightly toward the feminine side) but enjoy the nightlife circuit dressed in full drag regalia.

Although some experts believe that drag queens make up only 5 percent of the total gay population, their flamboyance often makes them more visible than other members of the gay community, thereby precipitating the common misconception that all gay men like to wear female clothing. This is, of course, not true.

The usage of the word drag dates back to early theater days when women were not permitted to perform on stage.

A female impersonator may be a homosexual male, a bisexual male, or a heterosexual male. Most are drag queens, some are transvestites (who may or may not cross-dress offstage), and only a few are transsexuals. Only female impersonators who are also preoperative transsexuals desire sex reassignment surgery.

This type of cross-dressing is primarily an acting job, a stage performance that dates back to the early days of theater in Greece, Rome, England, China, Japan, and other parts of the world.

There are also male impersonators. In Japan, for example, female theater stars called otoko-yaku sing, dance, and perform in male roles to sellout crowds. These women are said by some to be among the most beautiful, elegant, and romantic "men" in Japan, even though they are really women.

Gender Benders

Gender benders are males or females who challenge and cross traditional gender boundaries, often in outrageous ways. They dress and behave to surprise or shock. An example is men who wear dresses but have full beards. Some male and female rock stars are gender benders, at least while they are performing.

Gender bending is usually done to entertain, for dramatic effect, to get attention, or simply to break away from the limits of traditional clothing and demeanor. Some gender benders consider cross-dressing and cross-gender behavior an act of rebellion or a political statement—their way of telling society that they refuse to be governed by stereotypical clothing, presentation, or gender roles. Gender benders do not, however, desire surgery to change their sex.

Transgendered Individuals

There are two common definitions for the term transgendered. The first refers to transsexuals who choose to live in the world as the opposite gender on a full-time basis but do not wish to undergo sex reassignment surgery. The second and more general definition (the one we will use in this book) is as an umbrella term used to describe the full range of individuals who have a conflict with or question about their gender. This includes everyone from transsexuals who desire surgery, those who have no desire to have surgery, and postoperative transsexuals to male and female transvestites, drag queens, female impersonators, male impersonators, gender benders, and people who are experiencing gender confusion but don't know exactly where they fall along the gender spectrum.

The Motivation for Cross-Dressing

You have probably noticed by now that except for cross-dressing, transsexuals have little in common with any of the other transgendered individuals. Even though transsexual men and women dress in clothing traditionally associated with the other gender, their motivation is distinctly different from that of the other cross-dressers.

For transsexuals, cross-dressing is not about playfulness, eroticism, fetishism, exhibitionism, or show business. Nor is it about power and status. Transsexuals do not cross-dress as a form of rebellion or to make a political statement, nor do they do so to get attention or attract partners or, as was assumed in the medical literature of past decades, as a form of denial of a homosexual orientation.

Transsexuals dress in the attire of the other gender solely as an outward expression of their core identity. Male-to-female transsexuals feel female and therefore find that dressing in women's garments feels natural, comfortable, and gender-appropriate. The same is true for female-to-male transsexuals who wear men's clothing.

It's Not About Sexual Orientation

A common misconception about transsexuality is that it is one and the same as homosexuality (particularly in the case of MTFs). Perhaps confusion exists because some gay males exhibit effeminate behaviors (or wear female clothing, as in the case of drag queens), and there is a tendency to confuse effeminacy with femaleness. A similar misconception exists around FTMs and butch lesbians.

Though there may be similarities between homosexual and transsexual individuals in outward presentation, the distinguishing characteristic is that transsexuals' inner self-identification does not match their physical body, whereas gay individuals are attracted to sex partners with the same anatomy as their own. What we are dealing with here are two separate constructs: transsexuality concerns gender identity and homosexuality concerns sexual orientation.

Our sexual orientation is defined by the sex of the individuals to whom we are erotically and emotionally attracted. There are only three possible sexual orientations: heterosexual, homosexual, and bisexual. This is true for every human being—transsexual as well as non transsexual. If we are attracted to members of the opposite sex, our sexual orientation is heterosexual; if we are attracted to members of the same sex, our sexual orientation is homosexual; and if we are attracted to members of both sexes, our sexual orientation is bisexual. Even individuals who are asexual or celibate have (or have had) sexual fantasies about members of the opposite sex, the same sex, or both.

It is important to distinguish further between sexual orientation, sexual behavior, and sexual fantasies. Whereas sexual orientation refers to which sex one is attracted, sexual behavior refers to the sexual activities or acts in which one engages. Kissing, masturbation, and oral sex are three examples in the wide range of possibilities for individuals of all sexual orientations. Furthermore, a person may choose a sexual partner who does not necessarily match his or her sexual fantasies. For example, a woman may be married to a man even though all of her sexual fantasies are about other women.

It's Not About Sex

The terms sex and gender are typically used interchangeably in our culture today and in this book, but it's important to keep in mind that there are distinguishing characteristics between the two. Sex refers to the biological classification of being either male or female and is usually determined by the external genitalia. Gender refers to the culturally determined behavioral, social, and psychological traits that are typically associated with being male or female.

In the United States, as in most other countries, we live in a culture in which our sex—whether we are male or female—is presumed to be an absolute. When an infant is born, the doctor and parents look at the external genitalia and proclaim, "It's a boy" or "It's a girl," depending on whether they see a penis and scrotum or a vulva. From that moment on, the infant is treated in the culturally prescribed manner for a male or a female, as if genital anatomy were the sole indicator of sex. But determining an individual's sex is not that clear-cut.

From a sexological point of view, there are at least eight factors—five biological and three social and psychological—to be considered in determining sex. The biological determinants are chromosomes, hormones, gonads (glands that produce sex hormones), internal sexual and reproductive organs, and external sex organs. The social and psychological determinants are gender of rearing, gender role, and gender identity.

For most people, all eight factors are in perfect agreement. For example, someone born with male genitalia will have the chromosomal and hormonal makeup of a male and the gonads and internal sex organs that are consistent with male anatomy. Moreover, such persons will be reared as males, play the roles typical of males in our society, and self-identify as male.

For transsexuals, however, the eight factors are not in perfect agreement. The eighth, gender identity, is out of sync with the others. This is the crux of the transsexual dilemma.

It's About Gender Identity

Transsexualism is not about sex, sexual behavior, or sexual orientation—it's about gender or, more specifically, gender identity.

Gender

As indicated earlier, gender is a social construct used to distinguish between male and female, masculine and feminine. When we are born, our external genitalia determine whether we are male or female. As we grow up, we learn how to move, speak, dress, and behave in the way our culture deems appropriate for a male or a female (that is, we learn our gender role). Thus, when we meet a stranger we mentally attribute a gender to the person based on a variety of arbitrary bodily and behavioral cues. These things are all part of the way society defines gender, and they can vary from one culture to another.

Gender Identity

Gender identity, or psychological self-identification, by contrast, cannot be attributed by others. It is our own deeply held conviction and deeply felt inner awareness that we belong to one gender or the other. This awareness is firmly in place by the time we are five years old.

Gender identity is private and internal. It is felt, not seen. It is the only one of the eight factors that is totally subjective. It cannot be deduced from how a person looks, moves, dresses, or behaves, nor can it be determined by medical or psychological testing. The only way to know a person's gender identity is if he or she tells you.

For the overwhelming majority of people, their gender identity matches their body, but transsexuals are not so fortunate. Despite all physical evidence to the contrary, they do not perceive themselves as a member of their anatomical sex. Their mind and body are in opposition; one says female, the other says male. Much of this book will focus on describing the complex ramifications this vast incongruity has on the lives of transsexuals and the people around them.

Theories About Causation

Naturally, there has been much speculation about what causes transsexualism. Are transsexuals born that way? Does the answer lie with biology—chromosomes, hormones, physiology—or do social and cultural factors play the dominant role?