Transgender Voice Therapy and Treatment

For the male to female transsexual acquiring a female voice which is convincing, even over the telephone, can be one of the most difficult aspects of changing gender role. Speech therapy is a very important part of the gender reassignment package and may or may not be available through medical referral. This information sheet does not make any recommendations or comments on the relative benefits of different ways of changing the voice such as surgery and re-education through speech therapy. The following three articles report on different approaches to the subject.

1) Voice Surgery for Male to Female Transsexuals by Selina of Newcastle upon Tyne (575). First Published in GEMSNEWS No. 24

This is an area of treatment which is sadly neglected and lacking in the UK and about which there is very little reliable information even amongst professional advisers. I am very surprised that so little priority and importance is placed on having a really acceptable female voice. I have found that whilst I can be accepted as female in personal contact (people generally accept what they see) the telephone is the big problem. As I use the phone a great deal for my business, it is a thorough nuisance having to correct wrong gender assumption umpteen times every day.

After much research I discovered two places where the procedure known as “cricothyroid approximation” is undertaken. One is in Beverly Hills, California, USA and the other is Amsterdam, Holland. I know people who have been to both places. The biggest problem with California is the expense both of the treatment and of travel, hotels, etc. Dr Toby Mayer who does this work has been doing it for a considerable number of years and is thus very experienced. I was quoted $7,000 (approx £4,600) for the surgery which included a reduction of the thyroid cartilage (Adam’s Apple). In Amsterdam a consultation with Prof. H.F. Mahieu to see if surgery was feasible cost approx 200 Guilders (£180) and surgery about 3,000 guilders (£1,200). Having decided on this route and having undergone surgery there, I am in a position to describe what happened to me.

”The initial consultation took most of one day and included meeting with Prof. Mahieu to find out about the procedure and for him to find out about me. He told me that it was an inexact science and that everyone responded differently. Very much in my favour was that I have never smoked and I drink very little. On the deficit side was my age but Prof Mahieu said that I seemed very good for my years and so this was hopefully not a problem. In laymen’s terms what is done is that the hard sections of cartilage, which are separated by soft tissue, are pulled together with stitches thereby putting extra tension on the vocal chords and producing a higher pitch than before.

This causes the thyroid cartilage (Adam’s Apple) to become more prominent and therefore necessitates its reduction, known as a tracheal shave. This is still done at the same time as the pitch raising surgery. Physical examination of ears and throat was followed by photographs of throat, X-ray of throat, blood tests (both for blood group and to check for HIV). Also a phonetogram was taken to record my vocal pitch prior to treatment. It was explained to me that patients must have completed their gender re-assignment before voice surgery can be considered. I was then given an appointment for surgery some months ahead of the consultation date. This interval is usually about six months. The surgery is done on an out-patient basis with return for check-up two days later and again at three months and one year later to monitor results. If at check up it is found that insufficient pitch rise has been maintained, apparently a11 is not lost.

There is a second stage procedure and even a third stage which can be applied should it be deemed necessary. The second stage consists of an endoscopical laryngeal procedure creating a web in the anterior or front part of the glottis. This procedure results in a reduction of the length over which the vocal folds can vibrate so the vocal folds form the web. Negative side effects such as hoarseness and breathiness are said to be possible in patients with a laryngeal web. The stage three procedure which is regarded as only to be undertaken as an absolute last resort consists of scarification and mass reduction of the vocal fold mucosa by CO2 laser vaporisation. This can result in a deterioration of the voice quality which is why it is a last resort.

Before describing the actual treatment I received, let me say that there is nothing to be afraid of. Dr Mahieu and his staff were extremely efficient and kind using most impressive up-to-date facilities. I really suffered nothing that I would describe as pain – only discomfort and no hint of sickness. At this point, I should say perhape that I seem to have a fairly high pain threshold; my GRS surgery was not a problem to me and I never have injections at the dentist. Half an hour before surgery I was given a jab of morphine and atropine in my thigh to dull the senses and give a dry mouth so that I would not want to keep swallowing. Immediately prior to surgery I was given a local anaesthetic to the anterior side of my neck with xylocaine and adrenaline.

My view of what took place was most effectively hidden by a blue plastic sheet which was draped over a bar running horizontally 12″ above my face and the plastic was securely taped around my jawline. From then on I had to lie very still and could hear (but not feel) various sounds from the tools used. From time to time there were scratching, clipping and sizzling sounds and a slight smell of hot flesh as, I assume, various things were cauterised.

After about half an hour Dr Mahieu told me that my cartilage had calcified to a certain extent and that he could not push a needle through (not unexpected) and he would have to drill holes for the thread to pass through. This was done with a dentist’s type drill. The nylon thread was then inserted and initially tightened. I was asked to make an extended ee… sound whicb to my amazement was really high pitched. As Dr Mahieu released the tension my pitch dropped back down to its former level. He said that he was very satisfied and would now pull it up again and tie it off permanently. When he had finished his work he inspected it internally by pushing an endoscope up my nose and down my throat to see that no stitches were visible and that the vocal folds were as they shou1d be. Again he said that it looked fine and he would now reduce what he called “the notch” (Adam’s Apple) with a rotary burr. He then handed over to his aasistant to stitch up the incision in my throat.

The endoscopy was probably the worst part as it made me feel I was choking but it was only quite brief. I was actually on the operating table for one and three quarter hours in total and was then put to bed far a couple of hours to recover. I was brought some light lunch (somewhat late in the day at 2.30pm} and then allowed to leave by taxi for my nearby hotel.

1 was told that I must not try to speak or even whisper for two days and then return to hospital far a check-up. If all was well, which fortunately it was, I could then go home to the UK. On the day of surgery I had great difficulty in swallowing but, nevertheless, managed some soup, a hot cross bun with jam and a dish of ice cream. I slept well and next morning was able to eat a good breakfast with swallowing much improved. I kept my neck covered with a chiffon scarf to avoid frightening Joe Public with the initially rather angry looking bruising and swelling: the bruising faded quite quickly although I still have some swelling.

The stitches came out after eight days at the hands of my own GP’s nurse. It was actually one continuous thread and I was told that it had to be mobilised by pulling at alternate ends and then withdrawn in one piece. The suture came out quite easily and painlessly and the scar is neat and unobtrusive. At this time it gives every indication that it will fade very quickly and hopefully be virtually invisible.

The average male frequency range is quoted by Dr Mahieu as being approx 98 to 131 Hz and the average female range 196 to 262 Hz. Prior to surgery my rnean pitch was measured at 133 Hz which is at the top of the male range. I am writing this article only ten days after surgery while it is still fresh in my mind. It is early days yet for me to know how my voice will be at the three months checkup. For two days following surgery I communicated with masses of little notes and on the third day I tried out my new voice. That is actually too exotic a description for the croaky frog noises that I could make. It sounded like the worst case of laryngitis ever recorded. However, I had fortunately been forewarned what to expect so it came as no real shock, (at least to me!)

In the intervening few days the voice has gradually grown stronger but at this time of writing is still a miserable monotone. I was told that anything from three to twelve months is usually needed for full recovery. I am under no illusions about the surgery being a magic wand and I know that patience and further speech therapy will be needed.

2) Voice Therapy in the Case of a Transsexual

By Meryle Kalra. First published in GEMSNEWS Number 8

This paper was designed to present and evaluate a therapeutic approach to the vocal rehabilitation of a transsexual. It was presented at the International Congress on Sexology, University of Quebec, Montreal, Canada, October 27-31, 1976. The goal was to raise the voice pitch of a 27 year old morphological male who became a female.

The male voice is about one octave lower than that of the female. The average normal range of the male voice lies between 100 Hz and 132 while the habitual pitch levels in normal females reported from study samples range between 142-256 Hz.

No specific data on the incidence of transsexualism have been compiled in Canada or the USA. However, the Erickson Foundation of New York estimates that 2000 people in the US have had sexual conversion up until 1975. Gender alteration male to female is four times more frequent than female to male. Hoenig and Kenna, (1973) found the incidence in England and Wales to be 1.51 transsexuals per 100,000 population. Approximately 1 male per 40,000 population and 1 female per 154,000 population, the male to female ratio being 3.41:1

Materials and methods

The subject, BL was a normally developed physiological male whose sexual identity at age 32 was altered to become that of a female. BL, the second son of 11 children, described herself as being close to her mother, having a strict, controlling father, she remembers feeling sensitive and expressing continuously the wish and desire to become a girl. After successive experiences as a homosexual, a female impersonator and transvestite, BL decided at 29 years to seek sexual identity change and become a female. In 1969 hormone therapy was commenced while several months later sexual reassignment surgery was performed. At the time of her referral for voice therapy BL appeared feminine; however, the distinct male quality to the voice was the most likely characteristic to betray her masculinity. BL complained of being mistaken for a male over the telephone. At the time of her referral her vocal characteristics were judged subjectively to be: 1) male vocal quality; 2) poorly controlled pitch levels; 3) clavicular and shallow breathing patterns; 4) laryngeal tension; 5) absence of vocal resonance; 6) poorly controlled loudness which was associated with irregular pitch use. Without professional guidance the client had obvious difficulty in adjusting the male larynx to the functioning requirements of female larynx. At present no precise histological date describe the effects of oestrogen on the intrinsic muscle mass of the human larynx.

Therapeutic procedures

Voice therapy was administered over a three month period, once a week for approximately 45 minutes each session. Optimum pitch at this time was in the area of D sharp well below middle C at approximately 150Hz. Treatment was directed toward controlling intercostal and diaphragmatic muscle activity to reduce clavicular breathing patterns and lessening pharyngeal tension. Elevation of the optimum pitch to more appropriate and desirable pitch levels was achieved through exercises which reinforced resonance and maintained a balance between the vocal generator and supraglottal resonators. As new pitch levels were acquired, Foeschels’ chewing method was used to increase anterior oral resonance. The first pitch level above optimum pitch was F below middle C at approximately 170Hz. Gradually the fundamental frequency of the voice was moved up the musical scale to G below middle C or approximately 220Hz and the therapeutic procedures were repeated. Analysis of data collected throughout the therapeutic process consisted of both subjective and objective measures.

Results

Subjective data contained a condensed therapy log as well as laryngological examinations during and after therapy to determine whether any structural changes had occurred to the client’s vocal mechanism as a result of therapeutic procedures. Laryngological examination during the course of therapy described the normal configuration of the male larynx in size and appearance and indicated improved function of the crico-thyroid muscle two years post-therapy. No vocal strain or pathology had been induced by raising the client’s original male pitch level to within a low average female pitch range. Optimum pitch had been obtained with maximum comfort for the client’s laryngeal mechanism and integrated into the client’s spontaneous speech patterns. Objective data was demonstrated using a KAY sonograph to determine the fundamental frequency through spectrographic print-outs of voice samples using narrow band widths (45Hz) and wide band widths analysis (300HZ).

Discussion and conclusion

The goal of this study was a) to prescribe a therapeutic model for altering the vocal pitch of a male transsexual, thereby creating a vocal quality more appropriate for a female, and b) to assess the efficacy of this model. Results indicate that in the initial period of therapy the subject exceeded the provided model on imitative speech tasks. At this time excessive laryngeal tension was evident and repeatedly the clinician had to re-establish correct breathing patterns and improve supraglottal resonance through chewing practice.

In the second recording, although laryngeal tension had been reduced, the client ‘was unable to achieve a model of 193Hz introduced on imitative speech tasks. Although an increase in the habitual pitch between the first two recordings could be demonstrated, spontaneous speech deviated from the model by minus 25Hz. Carry over into imitative tasks or transfer to spontaneous speech was not occurring.

For a period of four weeks therapy concentrated on improving carryover from imitative speech work at 193Hz to spontaneous speech. Spectrographic measures for spontaneous speech in the third recording showed the client had increased her habitual pitch to a level close to the stated mode. Her speech had become more functional and stabilized in everyday use. Laryngeal tension was less apparent during spontaneous speech, demonstrating an overall increase in the complementary use of the vocal generator and oral resonator. Improvement in vocal resonance appeared to be directly connected to accentuated anterior oral resonance which best accommodated this higher vocal pitch. The therapeutic success in this case appeared to be an important and significant factor contributing greatly to the improvement of the self-image of the patient. She now perceives herself more completely as a woman, and is perceived by others as a woman, which serves to enhance her self-image and reinforce her new gender identity.

3) Feminine Voice Techniques

A collection of practical suggestions and ideas for self help in the feminisation of the voice, developed by a group of male-to-female transsexuals within the Looking Glass Society. First published in 1997 and reproduced here with thanks to the Looking Glass Society.

Neither hormones nor genital surgery will ‘un-break’ a male voice, and voice-changing surgery is widely regarded as inadvisable, in addition to being at best only a partial solution. Thus, speech training is necessary in order to produce a satisfactory ‘female’’ voice. At first, it may seem hard to concentrate on all the different facets of producing a feminine voice, and lapses will happen. The only solution is to practice and practice again until it gradually becomes second nature.

The Methods

1. Sing! To loosen-up the voice box, extend your pitch range, and help develop good control, it can be very helpful to choose a female vocalist who you like, preferably one with a relatively deep voice, and sing along. The musically-minded may also wish to perform singing exercises, such as singing scales.

2. Raise the position of the laryngeal cartilage. This raises your voice pitch and decreases the characteristic male resonance. (The laryngeal cartilage is the ‘movable’ piece of cartilage that you can feel rising if you place a hand on your throat and sing a rising scale ( doh, re, mi, fa, sol, lah, ti, doh ). The point of this is to try to gain a higher ‘baseline’ pitch than you have previously used, and then increase the pitch further when placing emphasis. For example you might decide that if you pitch the “doh” as your baseline male pitch raising your basic pitch to about “fa” or “so” would be sufficient. But do not overdo the pitch-raising: a squeaky, falsetto voice sounds very inappropriate on an adult woman. The pitch adjustment is a compromise – for the technically-minded you should aim for above 16OHz; if you have access to a musical instrument that’s about the G below middle C. Of course, everyone starts out with a different original voice and some will be able to raise it more than others without sounding squeaky. You might find it slightly tiring on your voice-box at first, as you are unused to speaking in that register, but it should become comfortable with a little practice. If it does not, then you are probably trying to force your pitch up too high.

3. Partially open the glottis when speaking. The position of the glottis controls how much air passes over the vocal cords. When breathing rather than speaking, when whispering , or when producing an ‘unvoiced’ sound where the vocal cords do not vibrate, like ‘hhh’ or ‘sss’ ), the glottis is full open and all the air bypasses the vocal cords. With the glottis firmly closed, all the air is forced over the vocal cords, producing a fully-voiced and typically male voiced sound. You need to try to find a ‘semi-whispering’ position that eliminates the fully-voiced sound with heavy resonance in the chest, and imparts a breathy quality to the voice. You can hear the difference between voiced and unvoiced sounds by comparing S and Z sounds (say ‘sss’ and ‘zzz’ , and feel how your vocal cords vibrate on the Z but not the S). You’re trying to find a midpoint between an unvoiced (whispered) sound, and a fully-voiced ‘male’ sound. Try saying the word ‘hay’, and pay attention to how you change between the unvoiced H sound and the voiced A sound: say it very slowly ( ‘hhhhhaaaay’ and feel the change in the vocal cords as your voice slides from the unvoiced hhh sound to the voiced ‘aaa’ vowel sound. Then try to stop before you reach the full voiced point, and you should be producing a soft, breathy feminine) ‘aaa’ sound. Then try to learn to always use that half-open position for all voiced sounds. This is simply a matter of practice.

4. Place emphasis with pitch not volume : Upward intonation places emphasis. Men place emphasis in their speech by varying the loudness, but keep their pitch within a very narrow range; on the other hand women tend to keep their loudness much more constant but vary their pitch a great deal to express emphasis.

5. Speak slowly, enunciate clearly especially consonants at the beginning and end of words. Don’t mumble; clear voice requires fat big lip movements. On the whole, women enunciate much more clearly and precisely than men.

6. Pace your speech carefully. Start and end sentences slowly and gently; do not sound clipped. Do not swallow pronouns, articles or other little words at the beginning or end of sentences. Male speech tends to be characterised by what speech therapists call ‘hard attack’ – the first syllable is pronounced very hard, and quickly. Women usually start a sentence more softly.

7. Use appropriate content. Men and women tend to talk about the same things in different ways; what you say contains gender cues, just as much as how you say it. Women tend to concentrate more on thoughts and feelings, while men concentrate on objects and actions. Men generally use more ‘short cuts’, colloquialisms and bad language, too. A simple illustration is to imagine someone asking a friend if they are going to go for a drink after work. A male might say something like ‘Coming down the pub?’ rather abrupt, using the minimum of words and concentrating on the desired action in a rather impersonal way. A woman might say ‘Do you feel like going for a drink tonight?’ : concentrating on her friend’s feelings and desires, personal, and not abbreviated.

8. Pay attention to tongue position. The tongue is higher and flatter for female than for male. This gives ‘dental’ sounds (ones that involve the teeth, like T and D) a softer, breathier, almost sibilant quality in the female. Say ‘tttt’ in male mode then ‘ssss’; find the halfway position, that is the female position for the letters T and D; likewise for a TH sound, etc. Use plenty of air to get a breathy sound.

9. Hold your mouth in the right shape. A slight smile helps, and is the ‘resting’ facial expression for a woman anyway. Rounder lips (a slight pout), and good lip movement, help produce a clearly enunciated voice.

10. Develop head resonance . One of the biggest problems facing TS women is, after learning to produce a soft, feminine voice, to then learn how to speak loudly when necessary without the voice returning to a masculine sound. Women gain loudness by using the cavities inside the head as a ‘sounding box’ whereas men use the chest. To gain a louder feminine voice, develop head resonance rather than chest resonance – open your mouth a little more, use more air, and ‘push’ your voice up into your head.

11. Use Feedback. Record samples of your voice and listen to yourself. Read a passage of text, listen to yourself and keep practising. It can be helpful to actually read these notes aloud, practising each point as you read it. Then listen to yourself and successfully refine your voice.This information sheet is distributed by the Gender Trust and is intended as a basis for information only. The Gender Trust does not accept responsibility for the accuracy of any information contained in this sheet.

Gender Trust – 2003, This information sheet is distributed by the Gender Trust and is intended as a basis for information only. The Gender Trust does not accept responsibility for the accuracy of any information contained in this sheet.

Transgender Theory

To understand the history of transgender people, one must also understand how both transgendered people themselves, and non-transgendered people explained the presence of such apparent misfits in the otherwise neat binary sex/gender social fabric. One can understand how law, medicine, and society in general treated transgendered people only within the context in which the transgendered person fit into a theoretic framework. If transsexuals were a medical entity, one still needs to know if it is a psychiatrically pathological entity, or a developmentally intersexed entity. If the former, one would expect that “cures” would be attempted, if the latter, then compassionate, though not always welcome, medical treatments might be applied. The law could see the transgendered person as a civil indentity question, a criminal pervert, or as a medical entity. The law’s treatment very much depends on the explanitory world view surrounding the transgendered in society.

Judeo-Christian-Moslem culture, drawing on a single verse in one old testament book, Deuteronomy 22-5, held that cross-dressing was an “abomination in the sight of the Lord”. Some biblical scholars hold that this line refers to a prohibition of the Hebrew people from participating in religious practices of the neighboring cultures, which included the followers of Cybele whose priestesses were post-operative male to female transsexuals. This single edict, surrounded by edicts that are seldom if ever followed today, save for the Ultra-Orthodox Jews, is sometimes quoted as sanctioning the worst transphobic treatment of transgendered people. Other old testament laws detail the status of “eunuchs”, males whose genitals have been surgically removed. Primarily these laws prescribe a second class status to the eunuch, since they are no longer “men”, they do not have male privileges, including the right to “testify” in court… since they no longer have the required equipment, testicles. (This is not a pun, but literally the origin of the words… one needed testicles to testify… and the old testament really does refer to the story, or testimony, of patriarchy.) Thus, built into Judeo-Christian-Moslem is the assumption that MTF transgendered people are untrustworthy abominations. This explains why Judeo-Christian-Moslem cultures have mistreated transgendered people while other cultures have either tolerated, or sometimes, venerated transgendered people, why Joan d’Arc was burned at the stake for wearing men’s vestments as well as armor, while the hijra of India have houses that have been in existence for hundreds of years.

Early in this century, as the United States population moved to the cities, transgender people, though extremely rare, started finding each other, just as they had in other city cultures in more populated countries as China and India. These gatherings of transgendered people were noted by their neighbors. These good people, educated in Christian values, complained to the civil authorities, who duly passed ordinances outlawing transgender expression, society, and existence. It was the cities who passed the laws against transgendered people. It must be noted that these laws were passed in the same climate and time that produced laws prohibiting citizens of African descent from owning property in the city limits, or of Catholics to operate schools. It should be noted that while the cities passed ordinances against transgendered people, the States were concerned with criminalizing homosexual conduct. City police, when they wanted to harrass homosexuals, used the ordinances against the transgendered as more visible targets. Thus, the Stonewall riots of 1969, naturally began with the standard sweeping arrests of transgendered people. The ordinances began to be repealed in the 1970s. It is perhaps fitting that the first governmental bodies to atone for past discrimination by passing anti-discrimination measures in the 1990s should be the very cities that once had laws designed to expose them to criminal sanction.

Laws criminalizing homosexuality were also used to incarcerate or force medical treatment on the transgendered. In the name of eugenics, homosexual and transgendered people were sterilized against their wills. Later, when hormones became available, various medical treatments were devised. Some sought to reduce the libido by suppressing natural hormones, others sought to replace putatively low hormones. These actions were done under the theory of enlightened criminologists that many lawbreakers were rehabilitable using modern medicine. It was rarely questioned in law enforcement that the law itself was in need of rehabilitation. But there were movements to do just that, lead by social reforming physicians such as Magnus Hirschfeld in Germany.

There were times, when the transgendered person came to the attention of the courts through the medical establishment, rather than the police, when compassionate justice prevailed. Until the mid to late century, the prevailing mechanism for transgendered people to gain protective legal status was to seek a change of sex status through correction of birth certificates or registry in the same manner as was done in cases of intersex, where physicians provide for a ‘second opinion’ as to a person’s sex later in life. The law literally saw transsexuals as a form of intersex and helpfully corrected sex designations when asked. It was not until the popular press created the myth of “sex change” that the law began to see transsexuals as separate from intersexed people. Only after this change in perception was it neccessary for specific statutes needed to secure a mechanism for transsexuls to change birth certificates and indentification cards. Even then it was done as an extension of the intersex theory, a reaffirmation, to counter the “sex change” paradigm.

At the turn of the century, the concepts of sexual orientation and gender identity were conflated. One was either a normal man or woman, or one was an abnormal psychosexual invert. In some respects this concept is closer to the modern concept of the classic transsexual in that it was conceptualized as a person who both identified with and shared the same sexual object as a normal member of the opposite sex. Only through education by the homophile community and open minded sexologists such as Evelyn Hooker and Alfred Kinsey was the homosexual person viewed as having a congruent gender identity, merely finding one’s own sex to be the chief object of amorous affections. This left the concept of gender identity separable from sexual attraction, opening the door to conceptualizing the catagories of the lesbian identified male to female and the gay male identified female to male transsexual. Still, it took the work of FTM transman Lou Sullivan in the late ‘70s, early ‘80s, to get the medical establishment to recognize the distinction.

There are three main currents of thought on the origin of gender identity in humans, Essentialism, Social Constructionism, and PsychoSocialism. In academic circles these differing theories are hotly debated. But in the lives of ordinary people, especially transgendered people, the model that is applied by the medical, educational, legal, and even parental authorities that transgendered people interact, as individuals and as a class, deeply influence the interaction and the outcomes.

PsychoSocial Theories

Though Sigmond Freud was from Austria originally, his work influenced North American thought to a greater degree than European. His thoughts on the developing sexual identity and sexuality of infants and children profoundly influenced how transgendered people would be viewed in North America. Freud felt that gender identity was mediated by the existance or absence of a penis, directly. In the case of the owner of a penis the discovery that not all humans have one occasions deep anxiety lest that delightful organ of pleasure might be removed. This “Castration Anxiety” led to a distancing of the owner of the penis from the caretaker who did not own one… presumably because that person might want to steal it. While simultaneously, the owner of the penis wishes to emulate the other caretaker who by good fortune still owns a penis. Thus the owner of a penis learns to be a boy. Meanwhile, the infant who does not own a penis discovers that there are individuals who do own one. This occasions extreme jealousy. This “Penis Envy” leads one to court, and compete for, the affections of the caretaker who owns this marvelous appendage, while simultaneously emulating the caretaker who does not own a penis, who demonstrates ways of successfully courting the affections of the owner of a penis. Thus the one who lacks a penis learns to be a girl.

The existance of transgendered people brought the theory a serious challenge. How to explain people who end up having the exact opposite reaction to the presence or absence of a penis? The first answer of any theorist to such a challenge is denial, “transgendered people are psychotic”, likening the transsexual to a delusional man who believes himself to be Napolean. This glib answer sufficed for those who had never actually spoken at length with transgendered people. But the diagnosis of psychosis failed to hold up apon examination. The challenge remained.

For FTM transgendered people the failure to resolve “Penis Envy” was enough explaination. But MTF trangendered people were still a mystery. The psychoanalytic theorists response was to posit a family constellation involving an overly close mother, who kept her son wrapped up in her emotional world, and a distant or absent father. The son could not make the emotional and subsequent identity break with his mother. Perhaps we can call this theory “Castration Envy”? This seemed at first glance to hold up well, since such family histories were indeed present in MTF transgendered people. Except it didn’t explain all of the cases since many profoundly transsexual MTF individuals had extremely good relationships with their fathers. The theory further broke down when comparing the statistics with non transgendered people. The were many families with an absent or emotionally distant father, the vast majority of single mothers, whose sons did not show signs of being transgendered. Though it remained popular to blame mothers, especially single mothers for all sorts of society’s woes, transgenderism was not able to hold up as being caused by family dynamics when tested statistically.

Still the psychoanalytic model held for most of the 20th Century, inspite of repeated failures of psychoanalytic therapy to dissuade transgendered people to abandon their gender identity. It is probably responsible for the prevailing attitude that Gender Identity Disorder is a psychiatric illness as defined by the American Psychiatric Association’s Diagnostic and Statistic Manual.

Toward the middle of the 20th Century, as the psychoanalytic model for all mental illness began to be cast into doubt, a new model of gender identity came into vogue, “Imprinting”. One the chief proponents of the theory was John Money, Ph.D. Observing that intersex infants with the same physical features at birth who had been assigned to different sexes both seemed to adjust equally well, Money theorized that there was a critical period in the infant’s early life when the parents’ sexually dimorphic treatment imprinted apon the child a congruent gender identity. The notion of imprinting comes from observation that some animals imprint the image of a caretaker in infancy. The popular image is that of gosslings first sight of a farmer’s child, who subsequently is followed around as “mother”. This lead to the standard procedure of early genital surgery for intersexed infants to unambiguously assign a sex, any sex, to child so that an unambiguous gender identity will be imprinted by parents and family who “know” the childs sex. It lead to a medical ethic of misinforming even the parents as to the intersexed nature of the child. It also resulted in sterilization of thousands of male children, who born with a phallus too small to be comfortably described as a penis were reassigned as female.

Transgender people were explained by the imprinting theory simularly to the psychoanalytic model, blaming the mother. Again, an overly emotionally close mother, and sometimes the father as well, coset and pamper a male child in a manner that the hapless male child gets the message that it is female. Sometimes it was noted that the feminine male child was “physically beautiful”, that is, like a pretty girl child, illiciting a response from adults in a manner that reinforces the mistaken identity as a female child. Similarly, a physically adventurous female child might illicit masculinizing responces.

Money’s hypothesis and recommendations lead directly to the tragedy and “experiment of opportunity” of John Theissen, a man who’s penis was accidentally destroyed during circumcision. Mr. Thessien was later surgically reassigned as female. His parents then proceeded to raise him as their daughter, while his identical twin brother served as “control”. When the children we several years old the clinics declared that the reassigned child was accepting “her” gender as a girl. The case became known as that of John/Joan. Money published this case as proof of his hypothesis. Unfortunately, John Theissen as a teen refused to continue the program, insisting that he was a boy… he grew to be a man, obtained phalloplasty, married, and is raising three children from his wife’s prior relationships. It can be said that his is a case of surgically created transsexuality, as his personal gender identity was at odds with his sex assignment as an infant. Mr. Theissen’s story was published in Rolling Stone magazine in the mid ‘90s after a scientic paper was published by Milton Diamond, a proponent of pre- and neonatal hormonal brain sex differentiation.

Social Constructionism:

As the Second Wave of Feminism grew in strength, critism of discrimination against women led to a reaction to prescribed restrictive societal roles for the sexes. “Biology is not destiny” became a rallying cry. What started out as a critism of socially constructed roles developed into a theory of gender which denied Essentialism in every form, stating instead that society took the biological differences of procreation, and instilled in them an artificial behavioral difference. The theory, thus expanded, denies that there is any natural basis for gender identity. Thus it denies to transgender people any rational cause… while at the same time, presenting no reason why not.

To some authors this meant that transgender people were free to express themselves in any manner they chose since all gender expression is as valid as any other. Only societal convention stands in the way of such freedom. Such conventions can be modified by the society as is deemed desirable. To some, all such restrictions are to be avoided, in a live and let live ethos.

Other authors, Janice Ramond and Germain Greer being notable examples, saw MTF transgender people as exploitive of women, aping the forms of femininity, supporting the artificial sexist forms that oppress women. It is interesting that in this regard they exhibit a hidden Essentialism, one that focusses on the genitalia as defining classes of human beings. They decried the restrictions on one class, while dispising those of the other class when they break those very restrictions.

Still the existence of transgender people poses a challenge to the social constructionist theory. One must explain both why gender identity exists, how it is perpetuated, enforced, and why some rare individuals “chose” to express a gender identity at odds with societally prescibed gender expression norms.

Performance Theory has it that we are taught to Perform Gender, to act it out, in the same way that we learn to act out social roles like teacher, student, friendly store clerk, police officer, etc. One is said to “do gender” rather than “have a gender”. This is very similar in basics to the psychosocial theory of imprinting, save that there is no instinctual basis for having the ability to absorb a particular gender identity. We are taught a set of gender behaviors that become so ingrained as habit that we forget that we are merely acting them out.

Transgender people are explained by this as having been improperly instructed. Even among those inclined toward psychosocial models as one would expect physicians to be, one finds this theory in currency. It is the model used in justifying Behavioral Modification Therapy to treat Gender Identity Disorder in children. Under the assumption that even though gender identity is arbitrarily socially constucted and taught to children, one should not allow children to express gender behavior different than the norm. Some rationize it on the basis of wanting the children to fit in, experience less rejection and bullying, a ‘blame the victim’ mentality. Others are simply moralists that insist that God has ordained that we should all behave in a certain prescribed manner.

One Post-Modern philosophical theory, one that has a striking resemblance to the psychosocial theory that transgendered people are simply crazy, has it that transgendered people are suffering under a “false consiousness”. That they are not really experiencing a gender at all… but an alienation from their social and biological reality. This theory is perhap the most transphobic of all theories in that it denies what is called in Post-Modern cant, “agency”, the characteristic of experiencing and expressing their existence and very real psychic pain.

Oppression Theory starts from the assumption that transgendered people are very much in command of their faculties and have made a rational decision to avoid societal restrictions on desires they experience. The usual script is that an ambitious woman noting that she is unable to succeed “in a man’s world”, dons mens clothes, assumes a fictious identity as a man, in order to achieve career success. These “passing women” are the darlings of the feminist historian because they are reveared as daring pioneers for women’s liberation, or they are held as examples, proof, of how horrible conditions were in some past epoch. To the feminist historian, modern FTM transsexuals are an embarrassing disproof of the theory. Similarly, Oppression theory is used to explain modern MTF transgendered people as being examples of internalized homophobia in gay men, too ashamed to live openly, and so have to “pretend” to be women in order to express their desire for same sex relations. To such gay male chauvenists, the fact that half of transgendered people identify as lesbian or gay male after transition, are an equally ebarrassing disproof of the theory.

Social Constructionist theories fail to note that ethnobiological studies of sexually dimorphic behavior in animals is not socially constructed for non-humans. Nor does it explain the cross cultural similarity and temporal stability of core gender identity throughout history around the world.

Essentialism:

Essentialism posits that men and woman are “made that way”. It is a deceptively self-evident fact that most everyone accepts since for over 99% of the population there is a clear cut correlation between genital morphology and gender identity. It is easy to for the average person to ignore the disquieting cases of intersex that cast doubt on the simplistic assumption of binary sex assignment. The question of which sex an intersex person “really is” demonstrates the esentiallist bias through much of Western Society for the past two centuries. Historically, Essentialism divided on which of two somatic characteristics was indicative of the “real sex” of an individual, genitalia or gonads. For most people the genitalia, the presence or absence of a penis was the overriding feature. As medical science grew more sophisticated in the 19th century, the gonads came to be the indicative feature. But early in the 20th Century the newly discovered chromosomes, specifically the presence or absence of the “Y” chromosome, became the newly crowned final arbiter of “real” sex. The faith in microscopic examination to “scientifically” determine one’s sex was unquestioned.

In 1968 the International Olympic Committee instituted chromosomal karyotyping for all female athletes. Any that did not have the required 46,XX chromosome karyotype were disqualified from competition, informed that, scientifically speaking, they were not women. The demonstrable fact that they had female genitalia, had lived as female all of their lives not knowing that they did not have the officially approved karyotype for women, did not enter into the unfeeling officials minds. Reductionist Essentialism had no room for intersexed people. They were counselled to fake an injury, slink away into silence to keep their shame of being “not female” from becoming known.

In 1970, the Corbet vs Corbet decision to nullify the marriage of a MTF transsexual to a non-transsexual man used karyotyping as the “scientific” marker for sex and gender that the law was henseforth to follow in the United Kingdom, throwing the legal status of transsexual and many intersexed people into limbo, neither male nor female.

Although essentialism has often been used as a philosophy to ‘prove’ that transsexuals and transgendered people do not have a valid claim to their identity, Essentialism still has explanitory power. If the locus of gender is found, not in the genitals or chromosomes, but elsewhere, transsexuals could be rationally described as “men trapped in women’s’ bodies” or “women trapped in mens’ bodies”. There are several loci that are, or have been proposed as the Essential Seat of Gender, but they come down to two main catagories, “Brain Sex”, and “The Soul”.

Many religions have a concept of an essential self, separable from the body. In Judeo-Christian-Moslem belief systems one’s soul separates from the body after death. This soul retains the sense of self, including gender indentity. Some religious thought includes the concept of the soul entering the body at some point in becoming a living being… and therefor must become, or always have been a gendered self. For religions that included the concept of reincarnation, the notion that a being always returns to the same sex body suggested an explanation for transgendered identity. Once in a while, a soul finds itself in the wrong sexed body. This idea was openly discussed in newsletters published in the ‘60s and ‘70s by the Erickson Education Foundation, as this was the personal belief of Reed Erickson, the Foundations benefactor. The Church of Latterday Saints (Mormon) debated the issue of pre-born souls finding themselves in the wrong body with Kristi Independence Kelly in 1980 at her excommunication. The Church held that, though the pre-born souls did have a gender before birth, God did not make mistakes: “There is no such thing as a man in a woman’s body or a woman in a man’s body” was declared, ex-cathedra by the leader fo the Mormon faith. Apparently, intersexed people must have also intersexed souls?

Some non-Judeo-Christian-Moslem cultures held that transgendered people were indeed gendered souls in the wrong body. Some believed that this juxtaposition have the transgendered person a special status with the spirits of nature or the powers. In ancient times in the mediteranean culture, MTF transsexual women became priestesses, Galla, of the goddess, Cebele. The Hopi Nation held that a transgendered spirit, or katchina, sent visions to transgendered people. In India, the hijra, transgendered and intersexed people are both reviled and revered, given varying circumstances. Mystical Essentialism has played an important role in various cultures, including our own.

The early 20th Century european researchers and medical practitioners believed that gender and sexual behavior in general are the result of a sexually dimorphic brain. That is to say that the brain itself has a sex. This sex usually conforms with the chromosomal and the genital sex. However, just as there can be chromosomal and genital >intersex conditions, the brain might also exhibit intersex morphology leading to behavior and that elusive personal experience, gender identity, at odds with either somatic or chromosomal sex. Magnus Hirschfeld, a leading early researcher described the entire spectrum of what today we would call Queer expression, gay, lesbian, bisexual, transgender, transsexual, as forms of “Sexual Intermediates”, or intersex. This was not a metaphor or a rationalization. Instead it was an earnest theory, based on careful observation and scientific generalization, understanding the then current lack of neurological science. Hirschfeld and his colleague, Harry Benjamin believed that as our understanding of the brain grew we would discover just where and how the brain was organized to produce sexual orientation and gender identity. For Hirschfeld, there was no major divide between non-conforming sexual orientation and gender identity, they were simply different forms that intersex could take. Thus for Hirschfeld, the late 20th century division between the concepts of gender identity and sexual orientation, the great political divide between the gay & lesbians and the transgender community would be meaningless. To Hirschfeld, we are all transgendered, gay and transsexual alike.

In the first decades of the century, experiments with cross sex gonadal implants in animals suggested that there was a connection between hormones and gender specific behavior. This lead to horrific experiments in humans during the NAZI era and beyond as hormones became available as a common pharmaceutical. Testosterone was administered to gay men and MTF transgendered people in an attempt to ‘cure’ them. The hormone treatments had no effect on the sexuality or gender identity of the experiments. No lasting harm was done to the gay men. But the supermasculinizing effects on the transgendered victims was severely traumatizing.

In the later decades of the century, neuroscientists found significant sexual dimorphism in microstructures in the brains of animals and humans. Experiments on rats indicated that hormone levels during a period in late gestation and early post-natal development to be critical to the development of these structures and subsequent behavior. Gorby was able to create what he described as a laboratory model of transsexuality in rats. He demonstrated this in both MTF and FTM cases. When he introduced them to each other, the FTM rats mounted the receptive MTF rats.

Using human children to explore gender identity and sexual orientation would be extremely unethical in the laboratory, but science often uses “experiments of opportunity”. Simon La Vey used autopsy material from straight and gay men who had died from aids to find that a small microstructure of the brain differed in the two populations, suggestive of a sexual orientation controlling microstructure. The same technique of using autopsy was performed by Swaab to discover a different structure associated with gender identity. Shaffer, in an as yet unpublished study, used MRI data from a large pool of controls, MTF and FTM transsexuals to demonstrate that the corpus collosum showed sexually dimorphic structures that, on a statistical basis, correlated with gender identity. Both Swaab’s and Shaffer’s work ruled out effects of hormones in adulthood.

The early data is tantalizing, and agrees with laboritory findings using animals. However, it is also known that experience can shape the brain. Lack of sensory stimulus and a chance to work out problems leads to dramaticly less brain development in infantile rats. In humans there is a suggestion that early musical training affects the shape of the corpus collosum, building greater connectivity between the two hemispheres of the brain. These early experiences suggest that early gender experiences could also lead to sexual dimorphism in the human brain by a similar mechanism. This would agree with Dr. Money’s imprinting hypothesis… But would be at odds with Gorby’s work with rats, and the results of the case of “John/Joan”.

Science could very well demonstrate that the seat of sexual orientation and gender identity is located in the brain. How that arises developmentally is still open for further research.

transhistory.org/history/TH_Theory.html – 2003

Transgender History: Timeline of Significant Events

1907 Harry Benjamin Meets Magnus Hirschfeld
1910 Magnus Hirschfeld coins the term “transvestite”
1919 Magnus Hirschfeld founds the Institute for Sexology in Berlin, Germany, which becomes the first clinic to serve transgendered people on a regular basis.
1920 Jonathan Gilbert publishes “Homosexuality and Its Treatment” the story of “H”, Dr. Alan Hart’s 1917 FTM transition
1923 Magnus Hirschfeld coins the term “transsexual”
1931 “Genital Reassignment of Two Male Transvestites”, is published by Felix Abraham, M.D.
1932 Harry Benjamin arranges a speaking tour for Magnus Hirschfeld in the United States.
1932 Man Into Woman, the story of Lili Elbe’s life, MTF transition, and Sex Reassignment Surgery is published.
1933 The Institute for Sexology is raided, shut down, and its records destroyed by the Nazis. Physicians and researchers involved in the clinic flee Germany. Some, unable to escape, commit suicide in the coming years. Magnus Hirschfeld dies in 1935, an exile in Paris.
1938 Di-Ethyl Stilbesterol (DES) is introduced into chicken feed as a means of increasing meat production. Later the drug is marketed to pregnant women to prevent miscarriage, a claim that was never substantiated. The drug causes serious heath problems in the children whose mother’s took the drug while pregnant; endometrioses, cancer, infertility, intersex and possibly transsexuality. (The drug is still available but no longer recommended for pregnant women.)
1941 Premarin®, conjugated estrogens collected from pregnant mares is first marketed in Canada. Two years later it is marketed in the United States.
1949 Harry Benjamin begins to treat transsexuals in San Francisco and New York with hormones.
1952 Christine Jorgensen is “outed” in the American press. She begins a life long effort to educate the public about transsexual people.
1966 Harry Benjamin publishes The Transsexual Phenomenon..
1968 Olympic Commmittee begins chromosome testing of female athletes, effectively banning transsexuals and some intersexed individuals (some of whom were fertile as female, with children) from competition.
1968 Universities begin opening clinics for treating transsexuals; First surgeries performed on non-intersexed transsexuals.
1969 Sylvia Rivera throws a bottle at cops harrassing queers at a local bar… The Stonewall Riots in New York galvanize the Gay & Lesbian community… Transgender people are in the heart of the riot and the organizing that followed.
1970 April Corbet’s (neé Ashley) marriage is annulled and declared to be legally still a man inspite of a legal sex reassignment, leaving United Kingdom post-operative transsexuals in legal limbo, unable to marry as either sex.
1973 Beth Elliott, aka: “Mustang Sally,” becomes vice-president of the Daughters of Bilitis. Soon after, she is ‘outed’ as transsexual and hounded out of the organization by transphobic lesbian separatists.
1973 New York TransActivist Silvia Rivera is followed at a Gay Pride Rally by Jean O’Leary who denounces transgendered people as female impersonators profiting from derision and oppression of women.
1974 Jan Morris publishes Conundrum
1976 Reneé Richards is ‘outed’ and barred from competition when she attempts to enter a womens’ tennis tournement. Her subsequent legal battle establishes that transsexuals are fully, legally, recognized in their new identity after sex reassignment, in the United States.
1976 Jonathan Ned Katz publishes the connection between Gilbert’s “H” and Alan Hart. He also incorrectly characterizes Dr. Hart as a “lesbian,” effectively stealing transgender history.
1977 Sandy Stone is ‘outed’ while working for Olivia Records as a recording engineer. Lesbian separatists threaten a boycott of Olivia products and concerts, forcing the record company to ask for Stone’s resignation. Angela Douglas writes a satirical letter to Sister as a protest of the transphobia in the lesbian community in general and the virulent attacks on Sandy Stone in particular.
1979 Janice Raymond publishes The Transsexual Empire, a semi-scholarly transphobic attack. In the book she cites Douglas’ Sister letter out of context as an example of transsexual misogyny and casts Sandy Stone’s involvment in Olivia Records as “devisive” and “patriarchal.”
1980 Joanna Clark organizes the ACLU Transsexual Rights Committee.
1980 Paul Walker organizes the Harry Benjamin International Gender Dysphoria Association to promote standards of care of transsexual and transgendered clients.
1989 Billy Tipton, a minor, but well respected, jazz musician, dies and is discovered to be female… after presenting as a man since 1933.
1992 Jean Burkholter is ejected from the Michigan Womyn’s Music Festival by transphobic festival organizers.
1993 Cheryl Chase founds Intersex Society of North America (ISNA)
1993 “March On Washington” organizers include bisexuals but refuse to include TransGender in the name of the march, angering TG activists that had worked for months to get inclusion
1993 “Camp Trans” is pitched outside of the entrance gate to the Michigan Womyn’s Music Festival to protest the Festival’s newly publicized “Womyn-Born-Womyn Only” anti-transsexual policy. “Camp Trans” is pitched for three years running.
1993 TransActivists working for many years with Gay and Lesbian activists, successfully pass an anti-discrimination law in the State of Minnesota protecting transsexual and transgendered people along with Gays and Lesbians.
1994 TranGender activists protest exclusion from Stonewall 25 celebrations and the Gay Games in New York City. The Gay Games recinds rules that require “documented completion of sex change” before allowing transgendered individuals to compete.
1994 Several cities on the west coast of the U.S. pass anti-discrimination statutes protecting transsexual and transgendered people.
1995 Transsexual activists protest the stealing of TS/TG History by the Gay & Lesbian community. Efforts by the Ad Hoc Committee to Recognize Alan Hart successfully pressure Oregon’s Right to Privacy (RTP, now known as “Right to Pride”) political action committee to cease using Alan Hart’s old name as an award given out to Gay & Lesbian rights activists.
1996 JoAnna McNamara of It’s Time Oregon successfully convinces Oregon’s Bureau of Labor and Industry (BOLI) that transsexuals are protected under existing Oregon labor law dealing with discrimination of people with disabilities and medical conditions. This made Oregon the third state to extend employment protection to transgendered people, following Minnesota and Nebraska.
1998 TranGender activists protest exclusion from the Gay Games in Amsterdam. The Gay Games reinstates rules that require “documented completion of sex change or two years of hormones” before allowing transgendered individuals to compete. Loren Cameron, FTM transman, expected to compete, drops out of competion in protest. However, European singer and transsexual, Dana International performs at the Games’ festivities.
1998 Japan allows first legal Sex Reassignment Surgery to be performed on a FTM.
1999 “Camp Trans” is revived to protest at the the Michigan Womyn’s Music Festival. Post-op MTF transsexuals are allowed to attend the festival, but confrontations with transphobic lesbian separatists occur.
1999 In a Texas court, In Littleton vs. Prang, Christine Littleton, a post-op MTF transexual loses her case against the doctor who she contended neglegently allowed her husband to die, when the doctors’ defence lawyers argue that she was never married to her late husband since her Texas birth certificate, though now amended to read female, originally read male, and thus could not be the widow as the law does not allow “same sex marriage.” Her appeal to a higher court fell on bigoted ears, she was declared to be still male inspite of having taken all of the proper medical and legal steps. Thus, transsexual citizens of the United States joined those of the United Kindom in finding that their legal status is in legal limbo.

transhistory.org/history/TH_Timeline.html – 2003

The Gay, Lesbian, and Feminist Backlash

The modern era of the gay & lesbian rights movement is usually marked as starting on a hot July evening at the Stonewall Inn in New York City’s Greenwich Village. The New York police, as many city police departments across the United States did, made period raids on sexual minority bars to harass and arrest the patrons. On this particular night, transgendered woman, Sylvia Rivera, resisted arrest, touching off a riot that continued for three nights running.

In the next year, three transgendered people, Sylvia Rivera, Marsha P. Johnson, and Angela Keyes Douglas would play pivotal roles in organizing the emergent Gay Liberation Front and the Gay Activists Alliance. The goal of the Gay Liberation Front was complete acceptance of sexual diversity and expression. But by 1971 the gay men’s community had returned to the assimilationist strategy as the lesbians, in 1973, turned to separatism and radical feminism. There seemed to be no room for transgendered people in either camp.

In 1971, the GAA wrote and introduced a bill to the New York City Council that was the first omnibus anti-discrimination bill to protect homosexual people. However, inspite of early and avid support of the GAA by transgendered people the bill completely ignored transgendered people. Silvia Rivera, disgusted by the batrayal, said to the leaders of the GAA, “It’s not us that they are afraid of — its you! Get rid of us. Sell us out. Make us expendable. Then you’re at the front lines. Don’t you understand that?” This marked the first serious batrayal, but certainly not the last.

Disillusioned by the GAA’s betrayal of transgendered people, Angela Douglas formed the Transsexual Activist Organization along the same lines as the GAA, with some of the loftier ideals of the GLF. She began publishing MoonShadow, a quirky newsletter for and about transgendered people and the struggle for legal rights.

In early 1970’s, Beth Elliott was active in a number of organizations including the Alice B. Toklas Gay Democratic Club, which she co-founded, the Board of Directors of the California Committee for Sexual Law Reform working to repeal California’s anti-sodomy laws, and the Daughters of Bilitus. The Daughters of Bilitus had been a pioneering lesbian organization during the 1950s and ‘60s, but was losing membership in the ‘70s as the lesbian community turned to more radical organizing. In ‘73 Ms. Elliott was asked to stand for election as the Vice-President of the San Francisco chapter of the Daughters of Bilitus. Late in her term of office her transgender status became a point of contention at the West Coast Lesbian Conference, where she was outed and vilified for being a MTF transsexual. The complaint was that Beth Elliott had insinuated herself into a position of power over women as a patriarchal man, a propagandist ploy that was to become common when attacking other transgendered people . At the conference she was forced to stop her music concert due to the catcalls from the audience by women that knew nothing more about her than that she was transsexual. She was required to sit through a popular vote of the attendees to determine whether they would let her finish her set. In the weeks and months to follow she was further vilified and even betrayed by women who had once called her friend. The treatment she received led her to become “stealth” for many years after.

In July of 1973, during a “Gay is Good” rally, Sylvia Rivera was followed on the stage by lesbian separatist Jean O’Leary. She denounced transgender people as men who, by “impersonating women”, were exploiting women for profit. It was the beginning of a series of such high profile transphobic attacts from the lesbian community.

In 1977, at the height of the Right Wing / Anita Bryant anti-gay rights backlash, the lesbian feminist separatist movement was busy attacking an even smaller community that only wanted to work within the lesbian community, lesbian identified transsexual women. Central to the conflict in ‘77 was transsexual recording engineer, Sandy Stone, working at Olivia Records.

Sandy Stone was a recording engineer for A&M Records before her transition. Olivia Records needed a recording engineer with skills and experience to help their fledgling all women’s recording studio. They found it in Sandy Stone. She recorded a number of their early albums, training other women on proper recording and mixing technique. When word got around that Olivia had a transsexual in the company, lesbian separatists threatened a boycott of Olivia products and concerts. Olivia Records was on the edge of profitability. A boycott would destroy them. Olivia supported Stone at first but eventually crumpled beneath the separatists demands, asking for Sandy’s resignation.

Angela Douglas became upset at the vitriolic, absurd, and transphobic comments broadcast on listener sponsored station KPFA in Berkeley, California and letters published in the feminist journal Sister. She wrote a very tongue-in-cheek satirical letter to the editor of Sister, the night before the 1977 San Francisco Gay Pride Parade.

The next day, at the Parade, a “gender bending” MTF individual handed out fliers that was written in protest of the Parade Committee’s policy of exclusion of “Drag Queens, Transvestites, and Transsexuals” . The policy was formulated in the hope of heading off the media which tended to focus on the flamboyant, instead of the very serious issues of Gay & Lesbian community pride and efforts to fight homophobia in society. However, transphobia had operated in the Parade Committee to equate transgendered people with “flamboyant” social unacceptability and political liability.

After the parade, Angela Douglas wrote a short essay with photos for the Berkeley Barb, in which she decried the efforts to exclude transgendered people. She asked if there shouldn’t be a counter parade by transgendered people, to be held on Halloween, a day that one is supposed to be flamboyant!

Two years later Janice Raymond in The Transsexual Empire, wrote of the events of 1977, casting Ms. Stone as an agent of the “Patriarchy” and “divisive”. The letter that Angela Douglas wrote as satire was quoted out of context, as an example of transsexual hatred of women, by Raymond. Her quoting out of context a letter written by Douglas was tantamount to intellectual dishonesty, with scholarly repercussions.

Janice Raymond was a professor at the University of Massachusetts. She is infamous for having written her doctoral thesis attacking transsexuality, denying its medical reality, and for viciously attacking individual transsexuals, notably Sandy Stone and Angela Keyes Douglas in her book, based on her dissertation. The book uses insensitive and transphobic language throughout, while vilifying feminine MTF transsexuals as tools of patriarchy for upholding stereotypes of women, and vilifying androgynous lesbian identified MTF transsexuals for being tools of patriarchy, fifth columnists infiltrating womens’ space and “raping womens’ bodies”, a typical ‘damned if you do, damned if you don’t’ trap. She dismisses FTM transsexuals as deluded and misguided lesbians, afraid of the label “homosexual”. Her thesis rests entirely on arguments that sex/gender identity are fixed within the genitals at birth, an essentialist theory that excludes the possibility of transsexuals being a form of intersex, a topic which Raymond never addresses.

The book, while it did not create the transphobic attitude in the lesbian community, did tap into and ‘validated’, at least for the transphobes themselves, the discrimination they practiced. Thus, what began in the ‘70s, occasional attacks on individual transsexual women, became institutionalized discrimination against all transsexuals in the ‘80s.

The Transsexual Empire, was not the most damaging writing that Raymond penned. Far worse was a United States federal government commissioned study in the early 1980’s on the topic of federal aid for transsexual people seeking rehabilitation and health services. This paper, not well publicized, effectively eliminated federal and some states aid for indigent and imprisoned transsexuals. It had a further impact on private health insurance which followed the federal government’s lead in disallowing services to transsexual patients for any treatment remotely related to being transsexual, including breast cancer or genital cancer, as that was deemed to be a consequence of treatment for transsexuality.

Ms. Raymond is closely associated with another noted transphobic writer, Mary Daly, who described transsexuals as “Frankenstien’s Monsters” in her book GynEcology.

Transgender participation continued to be controversial in the Gay & Lesbian Community. Transsexuals taking leadership positions in the community were especially subject to attack.

Ms. Carol Katz was on the Christopher Street West Gay Pride Parade and Festival Committee, serving as Security Coordinator from ‘79 through ‘81. However her position on the board was a controversial one as many gays and especially lesbians objected to the presence of a transsexual. She recruited a number of transgendered people, both FTM and FTM to work as volunteer parade monitors and festival security each year . Her background in law enforcement facilitated greater cooperation between the Committee and local law enforcement organizations, LAPD and the LA County Sheriff’s Department.

In 1980 Ms. Katz was asked to serve as Security Co-ordinator for the “Women Take Back The Night March” in Hollywood. She agreed to help. However… lesbian feminist separatists threatened to boycott the march. Carol offered to step down in the interests of the larger community, with some private bitterness. The Committee accepted her resignation. But at the very last minute, due to overwhelming details in doing the job without her… and perhaps a realization that it was wrong to push her out of her participation… the committee asked her to take back the job the very day of the march. The controversy over Ms. Katz’es leadership role lead to the effective banning of broad transgender community participation in event planning and execution, though transgendered people did march that night .

It should be noted that the memory of the gay & lesbian community is short, as demonstrated by the efforts of the transgender community in Los Angeles to win inclusion in the Parade and Festival in 1995; Transman, Jacob Hale faced a Festival committee that believed transgendered people had never been participants before. The work of the transgendered community in ‘79-’81 had been completely forgotten, erased by the silence of the 1980’s.

In 1991 Nancy Burkholter was ejected from the Michigan Wymyns’ Music Festival at 1:00am by security staff suspicious that she was transsexual. She had done nothing to warrant eviction. She was forced to find transportation back to town to fly home, a holiday trip ruined by transphobia.

Unknown to the transsexuals who had been quietly attending the festival for years was an unpublished policy of the festival organizers that transsexuals were not welcome “on the land”. The policy was written out in the material for the next year that only “Wymyn Born Wymyn” may attend. The language was clearly designed to exclude transsexuals while avoiding debates regarding whether MTF transsexuals were “Wymyn”.

The next year, in 1992 TransActivist Anne Ogborn began organizing a protest to be held at the Festival, unable to go herself, she enlisted Davina Anne Gabrielle to attend. Davina and non-transsexual woman, Janis Hollingsworth handed-out buttons to women reading “I might be transsexual” at a table to enlist festival attendees in a dialog over the transsexual inclusion. Davina was ejected from “the land” in accordance with the written policy.

In 1993, the transgender community pitched CampTrans outside the main entrance. Jessica Xavier, Leslie Feinberg, among others attended to protest the Festivals’ “Wymyn Born Wymyn Only” policy. “Woman Born Transsexual” read a new button worn by CampTrans inmates. At the camp, workshops and concerts were presented as an alternative to the Festival. A number of women came out of the festival to participate in discussions. Notable was the participation of younger lesbians, especially members of The Lesbian Avengers. TransActivist volunteers stood outside the gate taking a poll of the festival attendees attitudes toward transsexual inclusion at the festival. The poll revealed division on the issue, but the majority of the women attending indicated that they would welcome transsexual women.

Participation in CampTrans energized the transgender community to become active once again, after the community’s silent withdrawal from the larger gay & lesbian community the previous decade.

National and local transgender activist worked for months to gain inclusion in the 1993 March On Washington. Transgender volunteers aiding in organizing the March, notably Jessica Xavier, worked with March organizers for months trying to gain inclusion in the name of the March. There was a ‘divide and conquer’ politicking by transphobic gays & lesbians that pitted bisexuals against transgenders. They told the bisexual community members who were also working toward official inclusion that it was either transgender or bisexual, but not both. To their credit the bisexual members did not buy into the ploy. However, the issue of inclusion was still couched in such terms by the foes of transgender inclusion. When the issue was put to a vote by the organizing committee the bisexuals won inclusion easily. The vote for inclusion of transgender was divided. There were actual cheers from the gay and lesbian community when the committee announced their decision to exclude transgender which deeply dismayed the transgender community volunteers.

A new pattern emerged in the mid 1990’s. The generation that had grown up since Stonewall welcomed transgender people without reservation, perhaps even with a tinge of adulation for their contribution to the struggle for Queer Rights. The older generation, those who had struggled just after stonewall, those who had read The Transsexual Empire when it was new, had not changed their minds significantly. Those that had been accepting during the 1970s remained so, those that had been sitting on the fence now came down on transgender inclusion. But those who had adamantly opposed trans-inclusion in the ‘70s still fought against it in the ‘90s. In 1994 The Transsexual Empire was reprinted and used as a textbook in feminist classes once again.

In 1994 CampTrans was pitched again with Riki Anne Wilchins taking a leading role. The turn out was smaller than expected. It was not due to a feeling of failure, but rather a feeling that the issue of transgender inclusion in “wymyn only space” was being by-passed by larger and more important issues.

Also occurring in 1994 was the Gay Games. When transgendered people wished to participate they discovered similar transphobic attitudes that the International Olympic Committee held . The Games organizers refused to allow transgendered people to participate except under very restrictive rules, namely that had to prove that they had had surgery or at least lived two years full time, with hormones, in their gender of identity. Bi-gendered individuals were completely excluded. This reliance on rules that on the surface seem to come direct from the HBIGDA Standards of Care, offended the transgendered community.

Transsexual Menace of New York organized to protest the restrictive and discriminatory rules. In street protests the group held up a banner that read, “Gay Games to transgendered: DROP DEAD!!” The uproar and embarrassment forced the organizers to drop the rules and allow unrestricted participation.

Some gay columnists were calling the events the “transgender Stonewall”, comparing 1994’s protests to ‘the gay riots of 1969’, totally ignoring the historic irony that Stonewall itself was started and fought by transgendered people. This lack of historic recognition sparked another protest in New York, demanding inclusion in planned events to mark 25 years since Stonewall.

In 1994 the issue of discrimination against sexual minorities became the biggest issue. The gay & lesbian community was working towards passing a bill in Congress, the Employment Non-Discrimination Act (ENDA);. Transgender activists worked with the gay & lesbian community and the bill’s sponsors in Congress on inclusive language for the bill, only to discover that the language was removed before the bill was introduced. When the issue was researched by Phyllis Frye, she discovered that the Human Rights Campaign (HRC) had objected to the language. Once again transphobia in the gay community had resurfaced as betrayal.

The betrayal of the HRC was echoed at the local level. In 1995, transactivists in Oregon worked with gay & lesbian activist with the Right To Privacy Political Action Committee (RTP) for a state version of ENDA. Once again language was changed at the last minute, behind the back of the transgender community. Later, RTP board members denied this fact when charged by transactivists. However, transsexual law student and legislative intern, JoAnna McNamara was in the meetings that were held with RTP and the bill’s sponcors. RTP representitives did not know that Ms. McNamara was transsexual, who later provided information to the local gay press regarding the betrayal.

The transgender community lobbied the HRC and other organizations to amend the language to include transgender and gender variant gay & lesbian protection. Each year saw organizations that had previously supported the bill, drop its support. Each year of the second half of the ‘90s saw organizations officially add transgender to their mission statement. Each year saw what started as inclusive lip service become real support.

In 1998. the Gay Games was held in the Nederlands. Ironically, while transsexual pop singing star Dana International performed at the opening festivities, the transgender community protested the re-instatement of the same restrictive rules that had excluded some transgendered people in New York four years earlier. However, European officials of the Games were unmoved.

In 1999, five years after the disagreement between the HRC and the transgender community over inclusion in ENDA surfaced the controversy continued, one of the bill’s Congressional sponsors, openly gay Representative, Barney Frank, played the “Bathroom Card”, saying that employers will not accept transgender people as employees since they won’t be able to convince their other employees to tolerate transgender people in the restrooms. This was quickly denounced by transgender activists as truly expressing transphobia, though Frank had earlier voiced his concern regarding violence and discrimination against transgender people in the wake of the death of Tyra Hunter, pointing out the irony as the “Shower Card” was used against the gay & lesbian community in its fight to gain the right to serve in the armed forces earlier in the decade .

In 1999, at the close of the 20th Century, the gay & lesbian community was still divided over transgender inclusion. Camp Trans was once again pitched in front of the gate of the Michigan Wimmins’ Music Festival. This time post operative male to female transsexuals were allowed ‘on the land’, but pre-operative MTF women and post-operative FTM men were not. The issue had now come down to possession of a penis. Although they were now allowed on the land, vocal transphobic lesbian separatists menaced transsexual women, while members of The Lesbian Avengers supported them.

At the end of the 20th Century, the Transgender Question in the gay and lesbian community was still unsettled, and unsettling for the majority.

transhistory.org/history/TH_Backlash.html – 2003

Transsexualism: A Guide for Employers

Transsexualism is the most pronounced form of Gender Dysphoria, in which a person experiences such a deep conflict between their physical sex and their mental gender that they have no choice but to embark upon the process of Gender Reassignment. Persons with this condition are likely to have been under a great deal of stress for many years prior to embarking upon treatment. The treatment has a very high success rate (over 97%} in alleviating the person’s suffering and helping them to function better both in society and at work.

The process of Transition (switching into living full-time in the desired gender role) and Gender Reassignment (medical and surgical treatment to alter the body) can be stressful for the person involved, and sympathetic treatment by their employers and colleagues will contribute greatly to successful outcome.

It is common for transsexuals to be diligent and highly motivated employees. Prior to transition, many take refuge from their emotional pain in being ‘workaholics’; after transition a good employee is likely to be better: the process of changing gender role alleviates the stress and pain, but the motivation remains. Gender reassignment does not change the inner person, and there is no need for it to adversely affect workplace relationships.

The Law

This is an area that is currently in a state of change. Historically, transsexuals have had no employment rights and there have been numerous cases of transsexuals being dismissed merely because of their condition. This changed in the spring of 1996 when the European Court of Human Rights ruled, in a test case, that such dismissal constituted a breach of human rights, and thus effectively extended the scope of the Sex Discrimination Act to include discrimination against someone for changing sex within the meaning of discrimination on grounds of sex. The outgoing UK government did not actually amend statute law to reflect this ruling, however Industrial Tribunals began enforcing it (such EC rulings automatically supervene over national law). The Sex Discrimination Act has now been updated by the present government with effect from 1st May 1999, including employment protection for transsexual people — and the government has made a commitment to examining the whole issue of legal rights for transsexuals.

The Transition Process

Before being officially diagnosed, a transsexual will usually have gone through a period of profound introspection, possibly denial, and certainly much emotional torment. The medical diagnosis confirms what the patient has felt, and treatment then commences. The diagnosis is made by a Consultant Psychiatrist with special knowledge of the subject — this Psychiatrist will also oversee the entire reassignment process. This does not mean that transsexualism is a mental illness or a delusion: in fact, quite the opposite. The psychiatrist’s role is to ensure that the patient is sane and really is transsexual, and that they really will be helped by a change of gender role. Recent research has proved that the ‘female brain in a male body’ (or vice- versa for female-to-male transsexuals) is a biological reality, not a fanciful metaphor. Some transsexuals will require a period of counselling before, or in parallel with, the medical treatment – in many cases they will have experienced much emotional pain from their years trapped in the wrong gender role and the wrong physical sex.

Given a reasonably certain diagnosis by the psychiatrist, the patient will commence Hormone Replacement Therapy (HRT). This involves the administration of high doses of hormones appropriate to the target gender: female hormones for male-to-female (MtF) and male hormones for female-to-male (FtM) transsexuals. These cause the body to start changing: MtFs develop breasts, lose muscle mass and body hair and start to look feminine facially, while FtMs become muscular, hairy and masculine and the voice breaks. As well as starting the process of physical change, HRT has a diagnostic function: a person who is not truly transsexual will feel strange and unhappy under the effects of HRT, while a true transsexual will show a marked increase in emotional well-being. This confirms the diagnosis of transsexualism. Once this confirmation takes place, most MtFs commence antiandrogen drugs, which wipe out male hormonal and genital function; as an alternative, some undergo orchidectomy (castration) at this stage or later.

MtF transsexuals also require electrolysis treatment to remove facial hair as HRT does not do this. Neither HRT nor genital surgery will ‘un-break’ a male voice, so speech therapy is often required. During this period the person is likely to start living more and more in their desired gender role, as their appearance changes towards that of their true gender. Once the transsexual and their psychiatrist feel that they are ready, they will ‘transition’ – that is to say, legally change their name and official documents to match the target gender, and start to live and work full-time m that gender role. At this point the person is on ‘Real Life Test’ (RLT); this is a period of at least a year in which the person must demonstrate that they can successfully live in the target gender role before Gender Reassignment Surgery takes place.

Good Practice for Management

There is every reason to believe that a transsexual who has been a good employee before transition will continue to be a good (and usually better) employee afterwards; in many cases the Company will have made a substantial investment in an employee in the form of training and job experience, and hence it is desirable to manage the person’s transition in such a way as to preserve good working relationships all round and to continue to reap the benefits of the person’s work.

The attitudes of the person’s colleagues and management is vitally important. It has been found in many companies that it is worthwhile to convene a meeting to explain to all employees having contact with the transsexual person what is happening and why. Good, accurate information on the condition, presented carefully, can go a long way towards dispelling prejudice and possible hostility in the workplace. Many companies have benefited from calling in a professional or voluntary counsellor with special training in this area, to give a presentation and answer questions. It should be emphasised that it is a medical condition that has been properly diagnosed by a specialist doctor and that the person’s change of gender role at work is a recognised and medically necessary part of their treatment. Having informed the person’s colleagues and chain of management about the situation, it should be made clear that the Company recognises that the transsexual employee has a genuine medical condition and that the Company is fully supporting the employee in their transition. It should be made clear that harassment or discrimination against the person will not be tolerated, and colleagues are expected to treat them with the same respect and courtesy as any other employee of the Company. Once the person has officially transitioned at work, they should always be referred to by their new name and by pronouns appropriate to their new gender role; to wilfully use the old name or pronouns (occasional slips are inevitable at first of course) is very hurtful to the transsexual and should be treated as harassment.

Sympathetic treatment by management is also vital. The person will have to spend much time undergoing various treatments (especially electrolysis for MtFs, which may take hundreds of hours in total), and while an employer cannot realistically be expected to grant paid leave for all of this, a sympathetic approach (such as allowing some degree of flexible-hours working, or perhaps unpaid leave) will be beneficial. Of course for strictly medical treatments such as checkup visits and surgery, the patient should be granted sick leave and sick pay under the same rules as for any other medical condition.

The timing of the transition will be as nominated by the employee in consultation with the medical specialist(s) supervising their treatment. Provided that reasonable notice is given, the employer should not attempt to block or delay the transition, as that can be positively harmful to the transsexual. A reasonable period of notice will allow the company to change records and inform other staff of the impending change before it actually happens.

The Company should provide appropriate recognition of the legal name change, when the transition at work occurs, in the form of changing payroll records, computer logins, staff lists and so on to reflect the new name. The person should always be referred to by pronouns appropriate to the new gender (i.e. ‘she’ for an MtF).

No guide to transsexualism in the workplace would be complete without a discussion on the issue of toilets. There is absolutely no reason why a transsexual employee should not use the toilets appropriate to their new gender, once official transition has occurred – in other words, prior to surgery. To force a pre-operative MtF to use the male toilets despite living as, and looking like, a woman is cruel and discriminatory. Of course it would be wise to reassure the female employees that the person is, psychologically speaking, a woman, and that as a result of the hormone treatment could not possibly pose a hazard of sexual impropriety. The fact that she still has male genitals is not relevant as they would only be exposed inside a toilet cubicle.

It goes without saying, of course, that in return for sympathetic treatment of the transsexual employee, the employer has a right to expect the employee to continue to work to the best of their ability and to conduct themselves with appropriate professionalism and dignity, and to dress and present themselves in an appropriate manner for their job – and not to wilfully do anything that might cause unnecessary embarrassment to the Company.

It should perhaps be pointed out at this point that MtF transsexuals undergoing electrolysis for the removal of facial hair will have to grow some ‘stubble’ for one to three days prior to each treatment. If the employee is not in a public-facing role, then this should simply be recognised as a necessary part of the treatment (and not as untidiness or wilful gender-mixing). If the employee is in a public-facing role then it might be necessary for her to restrict her electrolysis to Monday mornings so that the stubble only appears at the weekend, or maybe to delay transition until the facial hair is less obvious. In such cases the situation should be discussed with the employee’s counsellor or psychiatrist: it is not acceptable for a company to attempt to delay or prevent a medically necessary gender transition, and usually an acceptable compromise can be found. In some cases, transsexual staff have been temporarily transferred to less public-facing roles (with their consent of course) until their physical presentation is more ‘passable’. Counsellors and Psychiatrists treating transsexual patients are generally very willing to provide guidance and advice to employers, as well as specific advice regarding individual situations (subject, of course, to the patient’s consent to being discussed).

The following is a suggested draft Company Policy which embodies the recommended ‘best practice’ set out in this document and may be adopted ‘as it stands’ or used as a basis for the Company’s own policy towards transsexualism in the workplace.

Company Policy on Transsexual Employees

The Company recognises that Transsexualism (a form of Gender Dysphoria) is a genuine medical condition. Staff with this condition will be afforded the same treatment and support by the Company as if they suffered from any other treatable medical condition.

Transsexual staff are entitled to be treated with respect and permitted to perform their ,jobs free from harassment and discrimination. The Company views harassment or discrimination against any employee, on any grounds, as a serious disciplinary offence.

The Company recognises the right of the transsexual employee to work, and to present themselves at work, as a member of their new gender as soon as the official transition and legal name-change occur.

Once official transition to the new gender role has taken place, the Company expects all its staff to treat the transsexual employee in a manner appropriate to their new gender and to address them, and refer to them, by their new name and appropriate pronouns.

Once official transition has taken place, the transsexual employee will be permitted to use the lavatory facilities appropriate to their new gender.

The Company will provide appropriate recognition of the legal name change, when the transition at work occurs, in the form of changing payroll records, computer logins, staff lists and so on to reflect the new name and gender.

This information sheet is based on the paper Transsexualism : Notes for Employers published by The Looking Glass Society in June 1997.

This information sheet is distributed by the Gender Trust, with thanks to The Looking Glass Society, and is intended as a basis for information only. The Gender Trust does not accept responsibility for the accuracy of any information contained in this sheet.

The Gender Trust publishes a book Transsexuality in the Workplace – A Guide for Employers by Julie Denning available priced £2.50.

Gender Trust – 2003, This information sheet is distributed by the Gender Trust and is intended as a basis for information only. The Gender Trust does not accept responsibility for the accuracy of any information contained in this sheet.

The Rights of Man, Woman and Transsexual

The authors are in the employment department at Bates Wells & Braithwaite. Copyright 2001 Times Newspapers Ltd. 30th January 2001

Employers are disturbingly ignorant of sex change issues, say . With 5,000 transsexuals in Britain, issues about gender reassignment are arising within the workplace with increasing regularity. Several employers have sought advice from us in the past year about the treatment of employees undergoing gender reassignment. Although few cases about transsexuals have been reported, it is clear from the output of the Equal Opportunities Commission that many cases are being brought, and often settled. But there appears to be a disturbing ignorance among employers about the legal protection of transsexuals and good equal opportunities practice.

In 1996 the European Court of Justice held, in the case of P v S and Cornwall County Council, that the dismissal of an employee because she was starting gender reassignment was unfair and contrary to the European Equal Treatment Directive. As a result, the Sex Discrimination (Gender Reassignment) Regulations 1999 were brought into force. They amended the Sex Discrimination Act 1975 to extend protection in employment and vocational training to anyone who ‘intends to undergo, is undergoing or has undergone gender reassignment’.

Gender reassignment is defined as ‘a process undertaken under medical supervision for the purpose of reassigning a person_s sex by changing physiological or other characteristics of sex and includes any part of such a process’. There is no definition of ‘intends’ within the regulations but clearly more than cross-dressing is envisaged (although individual freedom of expression by way of dress is now to some extent protected by the Human Rights Act 1998). The category of individuals protected is wide, with no differentiation between pre and post-operative transsexuals.

Less favourable treatment of a transsexual is permissible in limited circumstances: where the job requires performance of intimate physical searches or doing work or living in a private home where objection may reasonably be taken by the individual to this degree of intimacy and contact. These genuine occupational qualifications are applicable at all stages of the gender reassignment process.

There are two further exceptional circumstances: where it is necessary for the employee to live in shared accommodation, or where personal services are being provided to vulnerable individuals ‘and in the reasonable view of the employer those services cannot be effectively provided by a person whilst that person is undergoing gender reassignment’. However, these two genuine occupational qualifications do not apply to individuals who have undergone gender reassignment.

There is thus, evidently, potential for difficulty with, for example, a care worker who has completed the process of changing but by whom an elderly client does not wish to be cared because the client is aware of the transsexuality. A refusal to provide work would amount to discrimination. Employers and prospective employers should bear in mind that tribunals are able to draw the inference of discrimination from the very fact of less favourable treatment.

It is often practical issues that cause difficulties at work. In particular, there is the question of which lavatory a transsexual should use. The answer is straightforward: whichever he or she prefers to use. If this preference causes embarrassment among staff, the employer must attempt to inculcate a more enlightened attitude. A last resort may be to agree with the transsexual that a lavatory be designated as unisex (this should preferably not be the same as the disabled facility).

This course of action was approved by an employment tribunal in the 1999 case of Bourne v Roberts & the Post Office. Equally, employers are often concerned about when other employees should be informed about a change of gender. All that is required is agreement on a timescale and to be flexible. Again, it should be borne in mind that the legislation encompasses the whole process from the stage of intention onwards. Personnel records should be updated at an appropriate point, and any references to previous gender removed (save if required for specific and legitimate purposes, such as insurance or pension records). It is an anomaly at present that transsexuals are unable to alter their birth certificates to reflect a change in sex.

The regulations do not address the question of discrimination in areas other than employment, such as education and access to goods, facilities and services. However, it is recognised that domestic legislation is inadequate and is likely to be expanded. Last May a case brought by a transsexual, Lisa Jones, against a landlord who asked her to stay away from his pub in Honley, near Huddersfield, settled for £1,000 compensation plus a £600 contribution towards costs. We can expect more such cases in future.

By Lucy McLynn and William Garnett

Gender Trust – 2003, This information sheet is distributed by the Gender Trust and is intended as a basis for information only. The Gender Trust does not accept responsibility for the accuracy of any information contained in this sheet.

Frequently Asked Questions about Transsexuality

Most of us are perfectly comfortable with the fact that we are male or female. In fact we normally never give it a thought. But there are a very few people who feel they were born with the wrong body – men who feel they should have been born women and vice versa. These people suffer from a recognised medical condition known as gender dysphoria and are generally referred to as transsexual.

Because transsexual people are born with bodies that seem perfectly normal to other people, we may suspect that the source of these deep seated feelings about the body arises from the brain. A report from the Netherlands Institute for Brain Research confirms this theory. In examining the brains of many individuals, including homosexual men, heterosexual men and women and six male-to-female transsexuals, they found that a tiny region known as the central region of the bed nucleus of the stria terininalis (BSTc), which is believed to be responsible for gender identity, was larger in men than in women. The BSTc of the six transsexuals was as small as that of women, thus the brains of the transsexuals seem to coincide with their conviction that they are women.

The rate of occurrence of transsexuality is not accurately known. Because of the social stigma attached to being transsexual, arising from a widespread lack of awareness of the true nature of the condition, it is something that is often kept hidden. Therefore it is only possible to collect statistics on the numbers of declared transsexuals and such figures undoubtedly represent only a proportion of those affected. Not very long ago estimates of the rate of occurrence of male-to-female transsexuality might have been around 1 in 100,000 of the male population. Today, with the greater awareness and openness that exists, some estimates now put the figure at greater than 1 in 10,000. It is known that other chromosomal or intersexed conditions can have rates of occurrence of, or approaching, 1 in 1,000 of the population and it may well be that this is the true order of magnitude of transsexuality.

Rates of occurrence of known female-to-male transsexuals are significantly lower, typically being around 1/3 to 1/4 of the rate for male-to-female transsexuals. However, this rate has varied somewhat with time and between different parts of the world. This suggests that varying cultural factors might play a role in the decision to be open about the condition.

The currently accepted and effective model of treatment for the condition of transsexuality utilises hormone therapy and surgical reconstruction and may include counselling and other psychotherapeutic approaches. Speech therapy and facial surgery may be appropriate for some male to females, and most will need electrolysis to remove beard growth and other body hair. In all cases, the length and kind of treatment provided will depend on the individual needs of the patient. The male to female will take a course of female hormones (oestrogen) similar to those used in the contraceptive pill and HRT, the female to male will take the male hormone testosterone.

At this time they will also be required to carry out the Real Life Test, during which they will be required to legally change their name and all documents to show their new gender identity. All documents including passport, driving licence, medical card, etc can be changed, but at present it is not possible for UK citizens to change their birth certificate. During the Real Life Test they will also be expected to live, work and socialise full time in the new gender role, to deal with any problems which may arise for example at work or within the family, and generally become familiar with the reality of living this way. After a minimum of a year (two years if being treated via the NHS) if the Real Life Test has been successful and the psychiatrist is satisfied with the person’s progress, they can be referred for surgery. After surgery the person will continue to take hormones for the rest of their life, but probably at a reduced dosage.

Because the BSTc is so small none of the non-invasive imaging techniques currently available can measure it, it cannot be detected through scans, X-rays of blood tests. Diagnosis is carried out through lengthy and in-depth assessment by a specialist consultant psychiatrist, however it is important to understand that gender dysphoria is not a psychiatric condition, nor is it a mental disorder.

In a male to female transsexual person, the effects of feminising hormones vary greatly from patient to patient but most patients experience noticeable changes within 2-3 months, with irreversible effects after as little as 6 months.

The main effects of feminising hormones are as follows:

1) Fertility and ‘male’ sex drive drop rapidly, erections become infrequent or unobtainable and this may become permanent after a few months.

2) Breasts develop, the nipples expand and the areolae darken to some extent, but typical final breast size is usually somewhat smaller than that of close female relatives.

3) Body and facial fat is redistributed. The face becomes more typically feminine, with fuller cheeks and less angularity. In the longer term, fat tends to migrate away from the waist and be re-deposited at the hips and buttocks, giving a more feminine figure.

4) Body hair growth often reduces and body hair may lighten in both texture and colour. There is seldom any major effect on facial hair, although if the patient is undergoing electrolysis, hormone treatment does noticeably reduce the strength and amount of re-growth. Scalp hair often improves in texture and thickness, and male pattern baldness generally stops progressing.

5) Many people report sensory and emotional changes: heightened senses of touch and smell are common, along with generally feeling more ’emotional’. Mood swings are common for a while following commencement of hormone therapy or any change in the regime.

In the female to male transsexual, where biological females are prescribed androgens, changes include:

1) A permanent deepening of the voice, this usually occurs within four months and is irreversible.

2) Permanent clitoral enlargement occurs.

3) Some breast atrophy, but at this stage it is usual to bind the breasts.

4) There is cessation of menstruation within three to six months

5) Increased strength and weight gain particularly around the waist and upper body with decreased hip fat. With exercise this can take the form of muscular development. Testosterone will not alter height or bone structure.

6) Growth of facial and body hair is likely to follow the pattern of hair growth inherent in the family, for example if other male members of the patient’s family have a tendency to baldness or if they do not have a great deal of body hair this is what can be expected with hormone treatment.

7) Increased social and sexual interest and arousability may occur and there may also be heightened feelings of aggression.

The most frequent form of surgery for male to female patients is known as penile inversion. When carried out by a skilled and experienced gender surgeon the results look almost indistinguishable from the external genitals of a natal woman. The transsexual women, however, does not have ovaries and a womb, is not able to conceive and does not have monthly periods. During the operation tissue and skin from the penis and scrotum is relocated to form a vagina and clitoris. Following surgery the patient will need to keep the newly formed vagina from closing up by performing regular dilation.

In the female to male, surgery is often carried out in stages, and the first stage is usually removal of the breasts with a bilateral mastectomy during which the nipples are preserved but may need to be reduced in size. The next stage is usually hysterectomy and oophorectomy to remove uterus and ovaries. Both these stages are commonly performed operations and can be carried out by any competent surgeon who does not necessarily need experience of gender reassignment surgery. Further stages are more specialised and involve metaidoioplasty for construction of a microphallus by surgically releasing the enlarged clitoris, or possibly phalloplasty which is construction of a penis. There are various techniques in use for phalloplasty, but as yet there is no method which can produce a totally realistic and fully functioning penis. Scrotoplasty may be carried out at the same time, or separately, to create a scrotum from the labia and silicone implants.

There is no evidence of any genetic link to the condition of gender dysphoria and therefore it is not something that is known to be passed down through generations of the same family. Nobody knows exactly what causes the condition, although there are various theories that consider a possible link between hormone disturbance in the mother during the first weeks of pregnancy or other interruptions to the normal course of pregnancy while the foetus is at a critical point of development.Is this Person a Man or a Woman?

In this example let us look at the male to female transsexual person. Gender dysphoria occurs when the person believes themselves to be a woman, their brain knows them to be a woman, even though their physical body may be that of a man. The only ‘cure’ for gender dysphoria is to change the body to match the brain. Therefore after surgery both brain and body are those of a woman. This person is in all respects a woman, even her passport will show this. It is therefore extremely painful for such a person to be addressed as ‘him’ or ‘Mr’. Having gone through so much to find a sense of inner peace in their true gender role, they should rightly expect to be treated as the woman they know themselves to be.

Even after hormone treatment and surgery, a transsexual male to female, may still retain certain male physical characteristics. These may include a voice that is unusually deep for a woman, or they may be very tall, or have large, hands and feet and heavy bones, particularly in the jaw and brow area of the face. They may have a receding hairline and need to wear a wig. When you meet this person for the first time you may feel shocked, uncomfortable or uncertain how to treat them. Hopefully you will understand that this is a medical condition for which the person is receiving treatment from highly qualified doctors and consultants, that they have been carefully assessed and diagnosed, and in many cases their treatment has been carried out under the National Health Service. If you think of it in this way you will find it easier to accept that this is a genuine and serious situation. If you are willing to accept this person for who they are, you will be helping them to adjust to a very difficult life challenge, and you may find you are making a very good and loyal friend.

What is the Difference Between Transvestite and Transsexual?

The differences are very distinct between a person who cross dresses and someone whose brain is telling them they belong to the opposite gender role. The transvestite may just cross dress occasionally, or may enjoy dressing regularly either in the privacy of their own home or to socialise. Some live full time in female clothes, but they always retain their core identity of themselves as male and will not want to consider gender surgery. Generally TVs who are “out” are sociable and may attract a lot of attention, they may enjoy wearing outrageous or fetish outfits and spend a lot of time involved with their clothes and appearance. It has often been observed that TVs tend to be heterosexual males while drag queens and female impersonators are often gay men. Although transsexual people are often very concerned about their dress and appearance, this is not the driving force behind their cross dressing. For the transsexual person clothes are an expression of their core female identity and many strive to blend in by studying how women of their age and background dress and learning how to tailor their appearance and mannerisms to attract as little attention as possible.

The above is a general guideline, but this is far from being a black and white issue and most cross dressers would place themselves somewhere on a gradient between the outrageous female impersonator at one extreme and the totally integrated post operative transsexual at the other. Many people who later go on to complete full gender reassignment begin the search for their true identity within the transvestite community, perhaps this is the only obvious and safe place where they feel they can cross dress. Also there are very few social groups where transsexual people meet, so those who enjoy socialising may be attracted to transvestite clubs. Many individuals feel very confused about their true gender identity, so how can an outsider be expected to judge whether a person is TV or TS when that person themselves does not know – or cannot accept – where their true identity lies and is therefore not giving out any clear signals about themself.

Long before they begin medical treatment, in fact often long before they even realise what is happening within them, most transsexual people will already show signs of thinking and behaving in ways more usual to the sex opposite to that of their physical appearance. They will frequently recall knowing from childhood that they were in some way “different” and it is usual for a transsexual woman to remember dressing in the clothes of a mother or sister, having a dislike for traditional boys’ toys and games, and feeling more comfortable in the company of girls.

Because of social pressures, particularly on young men, many transsexual people enter a period of denial in their late teens, in which they try to suppress any thoughts or feelings to do with their gender identity. For example it is common for a male to female to take up a typically male profession such as the armed forces, police, engineering, lorry driving, and also to marry and have children. They tell themselves that this proves they cannot possibly be a woman. At this time of their life they may also absorb themselves totally in a career – often becoming very successful – or in some form of sport or hobby which occupies all their spare time. Some may continue to cross dress.

But in time the stress begins to build until the person no longer feels able to keep this thing hidden and they need to seek help and medical treatment. When the gender dysphoria has been suppressed in this way for many years, the person may have developed other problems such as severe depression or a dependence on alcohol or drugs, and this will also need to be dealt with, along with any commitments to family responsibilities. There may be a break with wife, children and siblings, a change of career, loss of home, money and security, so the road to gender transition is an extremely difficult and often painful one.

Transsexual people often reveal themselves to be extremely isolated individuals, some people never make it through transition. Those who do have to find a lot of inner strength and determination to keep going. During transition these people need the support and understanding of friends and family as well as work colleagues and society in general. After surgery it is common for many people to melt away into society, living a normal life and often nobody guesses what they have been through. However the scars created by the pain of living with gender dysphoria for many years may remain and make it difficult for them to settle into an ordinary lifestyle.

Transsexual people are just ordinary people who experience all the challenges and problems that everyone has to deal with. Some are optimistic and cheerful, some slip easily into depression, some are determined, some are fragile, some make friends easily, some find socialising difficult. They are people like everyone else – they also suffer from a condition called gender dysphoria.

Understand what is happening, and accept the person for who they truly are – this is often all a transsexual person wants from you. Try to offer encouragement and support. Imagine how you would feel if it was you – take a moment to try and imagine how you would feel if you woke up tomorrow morning to find your body had become the opposite gender.

After all it could easily have been you who was born with this medical condition, nobody knows exactly what causes it but the dysphoria is believed to occur in an unborn baby during the first three months of the mother’s pregnancy. Someone who has already been through so much does not need to be victimised and taunted, humorous remarks, clever comments and other subtle ways of intimidation can cause intense pain. Also remember it is now against the law to discriminate against someone because they are transsexual.

Gender Trust – 2003

My Facial Feminisation Surgery

Smoakie Bulle Just after midnight on New Year’s Eve 2000, six months or so ago, my friends and myself were invited into a house across the road from where I live to join a party. It was one of those only- on-New-Year’s-Eve-with-a-skinful-occasions, and when I went in I was treated as the bloke across the road in a frock. It was he and him without cease – they just saw me as male, unbelievably, and I began this year deep in yet more of those unending tears back at my flat. Will this never end, I said, is there no way out of this? After all I have done, after living well as a woman for all this time, rarely read, or so I thought, after Sex Reassignment Surgery, after thousands of little white oestrogen pills, with a skin like a baby, a girl at last and happy and well in my world? After all I’ve been through, and it means nothing?

Right, I said to my partner, gritting my teeth yet again, this is it. I’ve had enough, I won’t live with this. I’m going to have my face fixed this year no matter what. You see, I knew what it was these people were seeing, what it was in me that made them see the old maleness; it was in the structures of the bones of my face, and this is what I decided had to be changed. In for a penny, in for a pound, that’s my way. I forgot how to spell kompromize a long time ago. Why stop before the end? Why not the best?

I stumbled on the Anne Lawrence website (annelawrence.com/twr) years ago, and with its links it has led me through many a maze, and it was here that I learned of Facial Feminization Surgery (FFS). Go and look for yourself, and what you will find is a revelation. Once you see it, it’s obvious, and male and female faces are never the same again. It all comes down to hormones again, that demon testosterone and the ravages it had on our bodies and minds.

In late adolescence, boys turn into young men. I’ve watched this happen to my son, who is now eighteen. The bones change, and what makes a man a man, and brings a woman like myself a life behind a mask, is the creation of, from the top down;

The brow ridge, and brow bossing. For me, the most significant of all. Like many results of the work of testosterone, my browridge formed almost a hood over my eyes. The line of the forehead in profile came down, then out just before the eyes, then right in. Oestrogen does not make this happen, and the brow in natal women remains the same as in children, where the line of the forehead comes straight down, leaving the eyes more open and unhooded. As we first look at the eyes when we meet someone, this subconscious marker of gender is highly significant.

The nose in the natal female is often smaller, narrower, less significant; the testosterone nose wider, more powerful a presence.

The prominence of the chin and the line of the jaw. This is more well-known. The female chin comes more to a point, it is rounded and is slighter in profile; it doesn’t stick out so much. The testosterone jaw is often wider, coming to strong angled points below the ears.

Of course, faces come in billions of forms, none of them the same, and masculinity and femininity shows in other ways on the face, but the main markers of maleness and femaleness are consistent. Freud said that the first point of recognition when we meet a person is that of gender; is this a male or a female? The rest of identity follows, is built on this. The subconscious indicators of gender come in the form of dress and body language, ways of moving, ways of dressing, the skin, the voice, the way we speak, the way the person feels to us; on and on. Many of these we can work at and change, but the bone structures of the face, the frame upon which the skin hangs, can only be changed by surgery, and this is what we look at first, this is what sets the tone for all that folows.

If you look on the Net, you will mostly see the work of Dr Ousterhout in San Francisco. The results of this surgery can be astonishing; craggy male faces turned into attractive women’s. For some, a life which would be unbearable becomes a joy.

No wonder so many transsexual women don’t mind what Dr Ousterhout charges; anything to get me out of this! When I contacted some of the women who had put their results up on the Internet, I was told of Ousterhout’s costs, and my heart sank. Around $28,000. Plus two trips to San Franscisco. It comes to around £20,000. A great surgeon, no doubt, but way too expensive for me.

So I looked for alternatives. This was not so easy. What I was looking for specifically was a cranio-maxillary-aesthetic surgeon with experience of transforming the transsexual face at a good price. I needed a surgeon who works with the bone structures of the face, with empathy and understanding of who and what I am, and these guys hardly come on every street corner.

Still, with determination I found one, not advertised at all, tucked off in a corner of Belgium. Dear Dr Noorman van der Dussen. I went to see him in February, loved him, and had extensive facial surgery at the Eeufeestkliniek in Antwerp on April 18th. Not bad, eh? Less than four months from New Year’s Eve and it was all done.

I had my brow ridge removed; Dr Noorman van der Dussen (all of this is his surname, let’s call him Dr NvvD) told me afterwards that he had removed about 1 centimetre of bone from over my eyes. A centimetre! Usually these things are done in millimetres. I had a lot to lose.

My nose, which was always slender, had its upturned, ski-jump end removed. My upper lip was enhanced. My chin was narrowed, taken back, the angle changed, and the jaw line altered to fit. Seven hours on the operating table; not a small thing to do.

I left the clinic the day after surgery and went to a hotel, amazingly, but it was fine. As Dr NvvD said, all you need is comfort to recover, better and cheaper in a hotel. I had two days of great discomfort, but almost no pain at all, thank God. How lovely I looked; bandages over the scalp, right round the jaw, my nose in a plastic cover taped to my face, one eye closed completely and the colour of a red fruit, the other open a crack, gorgeous colours everywhere, looking like a creature from a strange part of the universe in Star Wars.

But recovery was swift. Five days after surgery I was out in the Belgian countryside with the friend who came with me – bless you Jane, where would I be without you? – and a new transsexual friend I made in the hotel, enjoying pancakes and coffee. Avoid the tea; this is not England. I had on so much covering make-up I could hardly lift my head, and there was swelling in plenty which made me look a little odd, but I made it.

Then I was back home less than a week after surgery, feeling tired and full of anaesthetic, but not too bad. No signs of surgery at all. Incisions were made behind the hairline for the forehead, inside the mouth for the chin and jaw. It was like a miracle had happened.

It took a few weeks for the whole thing to settle in properly, but it did, and now I am fine. But the test of the pudding is in the eating, and the test of FFS is not only in the looking, but in how I feel, the most important thing of all. And what I have to tell you is that I am very happy. It’s made all the difference in the world. When my friends look at me, they still see Persia. It’s not as if I have another face; what’s happened is that my own face has been softened and opened. It has been feminized. The work is subtle and very well done, integral, looking so natural that many people have no idea anything has been done at all. You are looking well, Persia, they say, not knowing what they are seeing.

The greatest effect can be seen in profile. All the prominent angles of my face have been removed. The overhanging brow, the ski-jump nose, the angular chin, all replaced with softness. I love it. I now have none of the indicators of the male on my face. I have always felt that the transsexual transition was, for me, a restoration of my own true being, and now I have even restored my own face. It is no longer the face of a brother I never had.

And I feel completely relaxed now. I am seen as a woman now, almost completely, except for on one of those bad days when nothing goes well. I am what I am, a transsexual woman, and there will always be someone somewhere who knows. But so little, so rarely that I no longer care.

The feelings of this cannot be expressed better than in the words of anon (name witheld by request), who underwent FFS at the hands of Dr. DouglasOusterhout in San Francisco, but the same is true of Dr Noorman van der Dussen, and anon expresses my own feelings with a beauty I cannot hope to match.

” When I went out before my surgery, no amount of radiated joy and peace would have kept me from being perceived oddly by some. I’m not talking about passing here, I’m talking about how, as a human being, people saw me. I want people to see *me* clearly, not through the filter of doubt about who I might be. Even as happy and upbeat as I was prior to surgery with Doug, the lines and curves in my face that didn’t belong to me abraded my confidence, were as wrong as a lock of hair that stands away from your scalp that no amount of coaxing can keep down.

I am sure that if Doug’s work did not exist, I would have made the best of it, but I suspect that as much happiness as I would have mined out of life, the difference between who I am and who my face said I was would have eaten away at me. Who knows.

Results aside, it allows me to not simply move through the world and society — the best I could hope for beforehand — but to actively embrace it, to find a peace within myself, or the possibility for it, that others see and perceive. It is a wonderful resonant cycle as the relaxed comfort in my own skin radiates from me to others, who in turn sense my centeredness and reflect happiness back at me.

It’s how I feel too. Undergoing this surgery has let me cross the line into my own womanhood in a way I could not quite manage before, no matter how well I did, how good I looked, and even then I could go to the women only sessions at the swimming pool and feel almost at ease. Now I am completely relaxed, found myself chatting to other women in the showers while we waited for one to be free the other day without me noticing what I was doing – an amazing feat of transformation when I think back to my early days.

There is a form of trasngendered political correctness in the USA these days which states that we should be accepted as we are, no matter how we are, this being our truth, this being one form of human existence the world needs to accept as another normalcy. We should be proud of who we are, no matter how we look.

Very good, but my own truth is that I am just a simple girl from Liverpool who wants to live without problem in this world; more than that, to live here with joy. I was like Dorothy in the Wizard of Oz – but I wanted to come home even more than she did. And I’ve made it, I’m back in Kansas, back in Brighton actually, just living in the world but now with restored exquisite normalcy. I am a very happy and fulfilled person, and my life is opening like a flower. What I have done, despite having no money to speak of, you can do too. Go for it.

The cost of the surgery with Dr Noorman van der Dussen, by the way, came to around £6,500. Not cheap, but a bargain in British or U.S. surgical terms. About a third of the cost here, if you could find the surgeon, and I don’t think he or she exists. I had SRS in Belgium too, under the kind knife of Dr. Seghers, a complete coincidence, so I know about Belgian medicine. It’s very good indeed, recommended.

By Persia West June 2001

Gender Trust – 2003, This information sheet is distributed by the Gender Trust and is intended as a basis for information only. The Gender Trust does not accept responsibility for the accuracy of any information contained in this sheet.

 

Transsexuals’ Children

Continuing contact between transsexual parents and their children has met with significant opposition. Two areas of concern are effects on the gender identity of the children and reactions by the children’s peer group. Eighteen children, 10 boys, 8 girls of 9 transsexual parents, have been evaluated. Their ages range from 5-16 years. All live with or have regular contact with their transsexual parent. No child has gender identity disorder. No child has had extensive conflict with the peer group. All continue positive relationships with their transsexual parent.

Introduction

In 1978 I published a paper on sexually atypical and gender atypical parents and their children (Green 1978). It described 21 children being raised by lesbian mothers and 16 by transsexual parents. Since that paper 20 years ago, none other has been published describing a series of children of transsexuals. This absence explains why that report was cited as a stand alone in the case brought by a female-to-male transsexual in his recent fight for parental status before the European Court of Human Rights (Case of X, Y and Z v United Kingdom, 1997).

Opposition is strong to a transsexual continuing in a parenting role during or after gender transition. It derives in part from concerns that the children will become confused in their own gender identity during critical years of psychosexual development. Although to those concerned about this posited impact no developmental period is safe harbour, the first handful of years are seen as exceptionally vulnerable. This is during the setting of basic gender identity and resolution of the posited Oedipal conflict. Early adolescence when sexual orientation manifests strongly, perhaps reviving earlier Oedipal conflicts, is another arguably vulnerable period. The second focus of concern impacting on the best interests of these children is the reaction of their age mates, the peer group. Will the children be teased, ostracised, bullied in consequence of their parent’s transsexualism?

But, beyond these presumably empirically testable concerns, there is more. There are the feelings of betrayal, abandonment and hostility of the non-transsexual parent. Many are so enraged at the transsexual parent that they defiantly oppose any contact with the child. As custodial parent, some non-transsexual parents instil in the child a distorted, negative image of the absent (or rarely present) transsexual parent, the Parental Alienation Syndrome (Gardner 1978). In time, the child, too, opposes continuing or renewed contact. The concern to courts here is that the conflict and trauma imposed on the child of enforcing contact with one parent when the other is implacably opposed, and perhaps the child too is opposed, is greater than terminating contact.

Are the former noted issues concerning the children’s gender identity and peer group reaction to be considered as independent of the latter consideration of uncompromising parental opposition? They should not be. To the extent research demonstrates the absence of an objective basis for concern for the child’s welfare as a direct effect of the transsexual status of one parent, the other parent’s opposition becomes increasingly irrational. It should be given less legal weight on the scales of justice in judicial determinations.

During the past four years I have interviewed transsexual parents at Charing Cross Hospital in London. Many have not seen their children for years. Several abdicated their parenting role because they feared their transsexualism would be harmful to the child, others because their former spouse had been adamantly opposed to contact and the transsexual believed that a legal fight was hopeless. There have been other families, however, where the transsexual parent has continued to live with child(ren) and spouse during the gender transition of the “Rea.l Life Test” or has maintained frequent parenting contact, though living apart. An outline of these children is drawn here.

There are 18 children. They are from 9 families, with 10 children boys and 8 girls. Six transsexual parents are male-to-female, three are female-to-male. The children’s age range is 5-16 years, with 4 ages 5-7, 6 ages 8-10, 4 ages 11-13 and 4 ages 14-16. The frequency distribution is shown in Table l.

Areas of focus in interviewing these children and parents have been the two typically cited as potentially problematic for the children: their own gender identity and peer group stigma.

Gender Identity

None of the children meet the DSM IV or ICD 10 criteria for “gender identity disorder”. One boy and one girl had thoughts about changing sex briefly when informed of the transsexualism of the parent, but the curiosity did not evolve into a desire to change sex and the curiosity did not continue. No clinically significant cross-gender behaviour is reported.

Peer Group

Three children have been selective in informing peers of the transsexual status of their parent. They informed those whom they thought they could trust with the information and who would not tease or spread it indiscriminately. Three children experienced some teasing; it was transient and resolved. The remainder report no problems.

Understanding the Parent

Three children do not remember their parent in the parent’s birth sex. The others became aware of the transsexual status 1-3 years before my interview. The children have a reasonable understanding of the parent’s gender dysphoria and the treatment process. Some examples of their perceptions of their parents follow:-

Seven year old boy with male-to-female transsexual parent (father):

“Linda. wants to be a woman. Linda wants to start a fresh life. She likes living as a woman. I think that is happy for her. At first (when I was 4’/2) I didn’t quite understand. As I got older, I realized she must be happy living as a woman, so I’ll just accept that.”

Does Linda have a penis?

“She is going to have it taken off.”

What is your worry?

“The thing I worry about is if he gets injections that the wrong amount would be given and something would go wrong… Is there a chance he could die in the operation?”

Nine year old boy with female-to-male transsexual parent (mother):

“She will change into a man with plastic surgery.”

Why?

“My dad (biological mother) reckons that God had made a mistake when he was born.”

Seven year old girl with male-to-female transsexual parent (father):

Why does your daddy dress as a lady?

“It’s a better life.”

Sixteen year oId boy with female-to-male transsezual parent (mother):

“Jim is a bloke. The only thing missing is a dick.”

Ten year old boy with male-to-female transsexual parent (father):

How do you feel about it?

“It’s alright.”

Why is your daddy doing this?

“He does not like being a man.”

Eleven year old sister:

“My dad’s having a sex change. He is turning into a woman.

Why?

“He feels like a woman”

How do you feel about it?

“I feel OK about it.”

Fourteen year old daughter with female-to-male transsexual parent (mother):

“My Mother’s not happy in the body she is in. My mom is a lot happier since starting to live as who she wants to be. When I was 13, my mother said, ‘I want to be a man, do you care?’

I said, no, as long a you are the same person inside and still love me. I don’t care what you are on the outside… It’s like a chocolate bar, It’s got a new wrapper but it’s the same chocolate inside.”

Ten year old brother:

“Jim (mother) is my dad because he is having a sex change. It’s alright with me. If it makes Jim happy, it makes me happy.”

Conclusion

Available evidence does not support concerns that a parent’s transsexualism directly adversely impacts on the children. By contrast, there is extensive clinical experience showing the detriment to children in consequence of terminated contact with a parent after divorce.

Can anything be done to help maintain these families? Courts can be educated regarding clinical or research findings. Transsexual parents may profit from engaging with children in counselling sessions in anticipation of, or during, the gender transition process where concerns and questions can be addressed. Marital counselling early in the transition process could mitigate the hostility of the non-transsexual parent. Hopefully, the non-transsexual parent’s feelings of disappointment, loss and perhaps anger can be placed in perspective to the benefit children derive from contact with two parents. Children can also benefit from counselling, when troubled, after parent sex reassignment (Sales, 1995)

The cases described here and twenty years earlier demonstrate that transsexual parents can remain effective parents and that children can understand and empathise with their transsexual parent. The cases demonstrate that gender identity confusion does not occur and that any teasing is no more a problem than the teasing children get for a myriad of reasons.

Children’s best interests are not served by the bullying tactic of implacable parental opposition by one parent to continuing contact with both parents. Divorce may be inevitable between parent and parent, but divorce need not be inevitable between parent and child.

References

Case of X, Y and Z v United Kingdom (75/1995/581/667), European Court of Human Rights, Strasbourg, 1997.

Gardner, R (1998). The Parental Alienation Syndrome, Second Edition. Cresskill, New Jersey, Creative Therapeutics.

Green,R (1978). Sexual identity of thirty-seven children raised by homosexual or transsexual parents. American Journal of Psychiatry 135: 692-697.

Sales, J. (1995). Children of a transsexual father: a successful intervention. European Child and Adolescent Psychiatry 4:136-139.

Table 1

Transsexual Type | Number of Sons | Ages | Number of Daughters | Ages

M-F | 1 | 7 | – | –

F-M | 1 | 16 | 2 | 14, 12

M-F | – | – | 2 | 5, 7

M-F | 1 | 10 | 1 | 12

F-M | 2 | 8, 10 | – | –

F-M | 1 | 10 | 1 | 14

M-F | 2 | 9, 12 | – | –

M-F | 2 | 10, 13 | 1 | 16

M-F | – | – | 1 | 5

A Research Paper by Professor Richard Green

Gender Trust – 2003, This information sheet is distributed by the Gender Trust and is intended as a basis for information only. The Gender Trust does not accept responsibility for the accuracy of any information contained in this sheet.

Rich Man, Poor Man, Transsexual Woman

Summer 1955 and this child’s fate has already been determined by nature.

A child giggles whilst drinking the bath water from an egg cup. It is 1955 and not long since the national press have reported the story of a Spitfire pilot and racing driver who has “become” a woman through what we now call Gender Reassignment Treatment.

The child’s parents have registered and christened her as a boy. How is anyone to know any different? Within three years “he” will know otherwise though … and the little girl inside will have learned enough about life already not to mention her profound self knowledge to anyone.

In years to come she will learn that people who seek the treatment to release them from this silent hell are labelled as freaks and get hounded by the press. They are shunned by their families and friends. They are treated with less respect than murderers and rapists. Anything they receive from medical specialists or authority is to be regarded as a grudging and contemptuous concession which they don’t really deserve. Not surprisingly, she will seek to bury her terrifying self knowledge deep within herself.

As enlightenment gradually dawns on society, sometime in her thirties, she will wince though when she sees women like her described as having been “born a man”.

A man? Look again at the photograph. You could no more call the child a “man”, than you could label them a “Computer Consultant”, “Conservative” or “Rights Campaigner”. Yet all of these labels are a part of her development potential, just as her innate femininity means she will not rest until she finds her true self-expression within society.

So, eventually, she will come to the agonising choice which confronts all transsexual people in the end … made worse for having deferred it until mid life. She will have to decide how to deal with the partner and family she acquired whilst trying to be what everyone expected of her. She will have to put her career on the line. She will lose her home and tens of thousands of pounds through divorce. She will lose some of her friends. For a while she will wonder if she deserves to keep her own self respect. Yet the choice is between that and suicide. For a life which is a perpetual lie … a life which gets more painful with every passing day of the soul’s denial … is no life at all.

Make believe? No. Increasing research evidence indicates that everything which transsexual people have ever reported about their mysterious juxtaposition of psychological gender and physical sex is true. The more science is inclined to look, the more it finds to substantiate the discovery that children like the little “boy” in the picture above really did already have the brain of a little girl.

Nobody can be blamed for assuming this little girl was a boy. If we have to have a basis for distinguishing how we’re going to differentiate the type of upbringing we’re to give our children then the appearance of their genitals is no more and no less arbitrary than the colour of their skin or the country they were born in. What matters, however, is how we respond when the child is old enough to turn round and say that we got it wrong in their case.

It helps, of course, to be sophisticated enough to be able to accept such an assertion with the respect it deserves. If society attaches such importance to gender then it’s hardly a trivial thing when you know you’ve been dragooned into the wrong one. Transsexuals need help, not hindrance, if they are to manage a transition which affects every single way in which they relate to the world around them.

More than that, however, a compassionate and sensible society will recognise that once such a change has occurred then there is absolutely no benefit to anyone in making it anything less than a 100% change. Society only has two social genders to choose from. Man and Woman. To cripple a man with a legal status which regards him as a woman, or to say that a woman cannot marry a man because of her long-since-removed birth deformity is to erect a deliberate barrier to the otherwise successful functioning of that individual. It is, in short, like breaking a man’s leg because you don’t want to accept that he can walk.

And that is all that we in Press for Change seek from British society. The right to walk. To stand on our own two feet after being forced to crawl for almost thirty years. It’s not a lot, is it?

This information sheet is compiled from an article by Press for Change, the organisation which campaigns for rights for transsexual people. To find out more about Press For Change visit their website at pfc.org.uk or write to them at:- Press For Change, BM Network, London WC1N 3XX

By Christine Burns, April 1997

Gender Trust – 2003, This information sheet is distributed by the Gender Trust and is intended as a basis for information only. The Gender Trust does not accept responsibility for the accuracy of any information contained in this sheet.