Most people think gender is fixed and immutable and that everyone is either a man or a woman, male or female. Yet, gender and gender identity is far more complex than merely the description of a person's genitalia. Gender identity is determined by many factors, the most important of which is considered by some to be psychological, even spiritual, rather than physical...
Gender Identity 101: A
Transgender Primer
By Alexander John Goodrum Copyright 1998-2002. All rights reserved. Contact the Southern Arizona Gender
Alliance at
for
permission to use or reprint.
Most people think gender is fixed and immutable and that everyone is either a
man or a woman, male or female. Yet, gender and gender identity is far more
complex than merely the description of a person's genitalia. Gender identity is
determined by many factors, the most important of which is considered by some to
be psychological, even spiritual, rather than physical. As transgender people
"come out of the closet" of rigid gender roles and identities, both the general
public and professionals within the health care and social service professions
find themselves lacking even a basic understanding of transgenderism,
transsexuality and gender identity.
I have often been asked ãWhy are there so many transgender people nowadays?
Where were they 10, or 20, 30 years ago?ä The recent appearance of transsexual
and transgender people is due to several factors. One of the most important is
the increased availability of surgical procedures that enable people to
transition (physically go from one gender to another) fully. Many of these
techniques were unheard of just a couple of decades ago.
Another factor in the increased visibility of transgender people is perhaps a
direct result of both the womenâs movement and the gay and lesbian movement.
Both have given our country a legacy, and a blueprint for activism and advocacy.
Indeed, many (but by no means all) transgender people came of age in the gay
and lesbian rights movement.
It is my hope that this information will provide the reader with a basic
understanding of the transgender community and the issues faced by those
within it, as well as an opportunity to learn more about this vibrant and
diverse community. It is not intended to be the final word in this multi-faceted
and ever expanding story - there are many voices within the transgender
community that reflect our rich diversity and some of them contradict, and even
conflict, with each other.
I hope the information presented here will be just the beginning of your
education about the issues and needs of the transgender community and I invite
you to learn more about us. For additional information on this complex subject,
please see the resource list and recommended reading at the end of this
document.
Gender Identity refers to a person's actual or perceived sex, and includes a
person's identity, appearance, or behavior, whether or not that identity,
appearance, or behavior is different from that traditionally associated with the
person's sex at birth. People who are transgender (TG or Trans) are people
whose anatomies and/or appearances do not conform to those considered
appropriate for culturally predominant gender roles. They have physical and/or
behavioral characteristics that readily identify them as having a non-conforming
gender identity. In other words, TG people, to varying degrees, "transgress"
cultural norms as to what a man or a woman "should be."
Of course, not all people who transgress cultural norms in regards to gender
are, or should be, considered TG as we are discussing here. In that case, that
would include a woman who works as a pipe fitter or a male nurse. However, when
transgender is used in the case of a "sexual minority", we are generally
referring to one of the following five categories:
Transsexuals were born into one gender but identify psychologically and
emotionally as the other. Transsexuals are generally thought to have a condition
called gender dysphoria (also called Gender Identity Disorder). Those who are
born physically male but are emotionally and psychologically female are called
Male to Female or MTF's. Those who are born female but are emotionally and
psychologically male are called Female to Male or FTM's. There is some
disagreement as to whether gender dysphoria is a physical condition, a
psychological condition or both. Some scientists believe that gender dysphoria
occurs when the developing fetus is in the womb and that a chemical imbalance
occurs their development, that affects sexual difference.
The primary way transsexuals differ from other TG people is that in almost all
cases, they seek to modify their bodies through hormones, SRS (Sexual
Reassignment Surgery) or both. This process (which may take several months or
many years) is called Transition, where transsexuals will make major life
changes in order to bring their physical appearance in line with their gender
identity. Some of those changes include changing their name and gender
designation on legal documents such as birth certificates, driver's licenses and
social security records. However it is achieved, the ultimate goal of transition
is to enable the transsexual to live completely as the gender with which they
identify.
It is extremely important to remember that male to female transsexuals are
women, just as female to male transsexuals are men and should be referred to and
treated as such.
Intersexed people were born exhibiting some combination of both male and female
genitalia (usually determined by the doctor to be either a clitoris that is "too
large" or a penis that is "too small.") As one can imagine, such a diagnosis is
entirely subjective. At birth, the attending physician or parents or both
"choose" which gender to raise the child, necessitating surgery and/or hormonal
treatment that must be continued throughout the child's life. Many intersexed
people, now adults, are advocating for an end to the way intersexed children are
seen as "damaged goods" needing to be fixed.
Crossdressers (previously known as transvestites) identify as, and are
completely comfortable with, their physical gender at birth, but will
occasionally dress and take on the mannerisms of the opposite gender. Of course,
cross-dressing is more onerous on men, since our culture accepts the idea of a
woman wearing pants, but not a man wearing a skirt. Most cross-dressers are
heterosexual men. The term transvestite is now considered offensive and should
not be used because it is associated with negative images of sexual fetishism.
Drag Performers include people like Ru Paul, or Elvis Herselvis (a well known
lesbian Elvis impersonator). Drag performers are precisely that - performers.
They dress and act like the "opposite" sex for the entertainment of an audience.
For them, drag is a job - not an identity. Some are gay - some are not. Some
identify as transgender - most do not. It is important to be aware of the fact
that some people, including many drag performers themselves, do not consider
drag performers to be members of the transgender community.
Gender blenders, bi-gendered, androgynes and others - Not all
transgender
people fit neatly into the above categories. For some, such characterizations of
gender and gender identity are more constraining than liberating. Gender
blenders may or may not identify as one or the other in a binary gender system
(i.e. either/or, male/female) and many times will assume a mixture of male and
female dress and characteristics, combining elements of both.
There is a great deal of unnecessary confusion about this. To put it simply,
Gender Identity is who you are; Sexual Orientation refers to whom you love or
have sex with. Some view them as two completely separate concepts. For others,
the two are intricately entwined. Either way, what is most important to remember
is that a certain gender identity does not necessarily mean a certain sexual
orientation. A person who is TG may be gay, lesbian, bisexual or straight.
Additionally, there are MTFs who identify as lesbian and FTMs who identity as
gay men.
For some transgender people, hormonal and/or surgical modifications are not
necessary in order for them to express their gender identity. Some TG people
find that the financial costs are prohibitive or they may have a physical
condition that precludes their being able to take advantage of the procedures.
And still others may object to hormonal and/or surgical modifications for
personal, spiritual or political reasons.
Of those who do choose to physically modify their bodies, two methods are used -
hormones and Sexual Reassignment Surgery or SRS. Hormones are controlled
substances (either a pill, injected by syringe or even in patches) and must be
prescribed by a medical doctor. Both MTF's and FTM's use hormones to change
their physical characteristics. For MTF's, estrogen is taken feminize facial and
bodily characteristics. Their body fat redistributes itself to a more womanly
shape. Breast size increases, and body hair decreases. Estrogen does not affect
facial hair, however, and MTF's must use painful and expensive electrolysis
treatments to remove their mustaches and beards. Taking estrogen also results in
the shrinking of the penis and testicles. Male to female transsexuals do not
have menstrual periods, nor can they give birth.
The hormone testosterone is taken by female to male transsexuals, which results
in the growth of facial and body hair, the lowering of the voice, increase in
sex drive, and the cessation of menstruation. FTM's on testosterone are also
subject to male pattern baldness and sometimes increased cholesterol levels.
The most common type of sex reassignment surgery for female to male transsexuals
involves the removal or reduction of the breasts, depending on breast size. Some
FTM's also choose to have some sort of genital reconstructive surgery, either a
metaoidioplasty (which is the freeing of the clitoris to make it longer and more
sensitive) or the more complex phalloplasty. Phalloplastic surgery involves the
removal of tissue, usually from the forearm, to construct a penis. While there
have been marked improvements in phalloplastic surgeries in recent years, the
successes of the procedure remains mixed. In addition, some FTM's may also have
vaginectomies or hysterectomies, either electively or as a response to some
medical necessity. Rarely do FTM's require cosmetic surgery to increase or
augment masculine features.
For male to female transsexuals, the results of SRS surgical procedures are far
more successful. A process called vaginoplasty entails the removal of the testes
with the scrotal tissue used to create labia. The penis is inverted to create a
vagina. Many MTF's also have cosmetic surgery to feminize their facial features,
to reduce the size of their Adam's apple, and many receive breast implants as
well.
In order for a transsexual to receive hormones and SRS, they must, in most
cases, go through stringent reviews by medical doctors and psychologists. Most
medical professionals use a set of guidelines called The Standards of Care for
Gender Identity Disorders developed by the Harry Benjamin International Gender
Dysphoria Association. These standards define the criteria, which determine if
someone is indeed transsexual and if they are emotionally and psychologically
suited for sexual reassignment. Any medical doctor or psychiatrist can prescribe
hormones once they determine their patient is suitable. However, SRS requires
highly specialized surgical expertise and should be done only by those
experienced in such procedures.
Of the fifty states, only Minnesota protects TG people from job and housing
discrimination. Even when legal protections for gay men and lesbians exist, they
do generally not cover TG people because very few communities (currently only 17
cities) explicitly state "gender identity" or "gender expression" in their
protection ordinances. (Source: National Transgender Advocacy Coalition)
Violence against TG people can be particularly brutal. In 1997, in Washington
D.C. a pre-operative transsexual woman named Tyra Hunter was fatally injured in
an auto accident. Paramedics at first refused to treat her after they discovered
she had male genitalia, laughing and mocking her as she lay dying. In December
1993, an FTM named Brandon Teena was raped by two men who discovered he was born
female. Brandon reported the rape to the local sheriff who refused to
investigate, dismissing him with the derisive comment "What are you, anyway?"
Later, the same two men whom the sheriff refused to arrest for the rape murdered
Brandon and two of his friends. For more information about the ultimate cost of
anti-TG violence, please visit the "Remembering Our Dead" at
www.gender.org/remember, an online memorial to those TG men and women whose
lives have been brutally cut short.
Most insurance companies, employee health plans and HMOs specifically exempt
coverage for sex reassignment surgery, hormones, counseling and electrolysis.
This decision, according to the insurance companies, is based on their
designation of Sexual Reassignment Surgery or SRS, as purely cosmetic - like a
chin tuck or an eyelid lift - and therefore, not medically necessary. Today,
this decision stands in spite of the fact that the medical necessity of SRS for
transsexuals is well documented by the leading medical professionals in the
field. Thus, most transsexuals must cover the entire expense of hormone
treatment and SRS out of their own pocket (the cost of surgery can run anywhere
from $3,500 to well over $100,000, depending upon the procedure).
Prejudice against transgender individuals is pervasive. There is a long-held
view on the part of U.S. medical providers and researchers, as well as the
public at large, that transgenderism is pathological. This, in itself,
constitutes one of the most significant barriers to care. As a result of this
labeling, transgender individuals have under-utilized public health and social
services. A survey of transgender men and women in San Francisco reported that
many in the population are chronically underserved with regard to basic medical
and psychological support services. Few resources exist that address their
special needs or provide necessary consumer education and regular medical
follow-up (Source: Asian AIDS Project, 1995; San Francisco Human Rights
Commission, 1994).
Social and economic marginalization frequently accompanies the transgender
experience. Rejected by family and community, with reduced educational and
employment opportunities because of the harassment faced in both settings,
transgender men and women are commonly subject to discrimination, homelessness,
unemployment, and poverty. Many are unable to afford basic medical and mental
health services. Furthermore, a disproportionate number of these individuals are
people of color, HIV-positive, and/or youth, thereby increasing the likelihood
they are socially and medically underserved (Source: Israel & Tarver, 1997).
As with the general population, transgender persons of color are more likely to
be economically disadvantaged and face disproportionately higher rates of
victimization, unemployment, substance abuse, HIV infection, prostitution, and
other difficulties. Transgender persons of color also report a loss of community
identity when their gender identity becomes known. In African American, Asian,
Pacific Islander, or Latin American contexts, for example, heterosexual males
and females commonly stereotype gay males and lesbians as no longer a part of
their ethnic community because they assume that all people of color are or
should be heterosexual. This ostracism carries over to transgender individuals
(Source: Israel & Tarver, 1997).
It is extremely important to refer to a TG person by the pronoun appropriate
to their presented gender. In other words, if someone identifies as female, then
refer to them as she; if they identify as male, refer to them as he. If you are
not sure, ASK them what they want. Once you know, be as consistent as possible.
It's okay if you forget or slip up once in a while. Nevertheless, it is very
important to make the effort. Never use the word "it" when referring to someone
who is transgender, either in their presence or to others when they are not
present. To do so is incredibly insulting and disrespectful.
When someoneâs transgender status comes to your attention, do not assume that
it is a fad or trend - something that will be discarded when it is no longer
fashionable. While public discussion about transgenderism and transsexuality is
a relatively recent phenomenon, most TG people, particularly transsexuals have
dealt with their gender issues for many years - many times at great personal and
professional cost. It is important to trust that their decision to present
themselves in a gender different from their birth gender is not one made lightly
or without due consideration.
Do NOT "out" someone (tell others that they are TG) without his or her
permission. Also, do not assume that everyone knows. Some TG people "pass" very
well and the only way someone would know would be if they were told. The
decision to tell someone about their gender issues should be left to the TG
person themselves.
Never ask a TG person how he or she has sex or what their genitals look like.
That is inappropriate in every situation.
Do NOT assume a TG person is straight. Do not assume they are gay, lesbian or
bisexual, either.
The Harry Benjamin International Gender Dysphoria Association, Inc. (HBIGDA) -
Professional organization devoted to the understanding and treatment of gender
identity disorders. Developer of The Standards of Care for Gender Identity
Disorders. The Program in Human Sexuality. 1300 S. 2nd St. - Suite 180,
Minneapolis, MN 55454. (612) 625-1500. (http://www.hbigda.org/)
Center for Gender Sanity - Provides consulting, education, and training services
on TG issues, particularly those in the workplace. Publishes the extraordinary
books on TG workplace issues, Transsexual Workers: An Employer's Guide and
Working with a Transsexual: A Guide for Coworkers. Center for Gender Sanity PO
Box 451427 Westchester, CA 90045 310-670-2222.
(http://www.gendersanity.com/index.shtml).
GenderTalk - the leading radio program on issues of gender and transgenderism.
Hosted and produced by transgender people, GenderTalk broadcasts locally out of
the Boston, MA area on WMBR, 88.1 FM and has an online archive of over 180
programs. (http://www.gendertalk.com//)
The GLBT Health Access Project - Original developer of the Standards of Practice
for Health Care for GLBT clients. 100 Boylston Street - Suite # 860, Boston, MA
02116. (617) 988-2605. (http://www.glbthealth.org)
The International Journal of Transgenderism (IJT) - Multicultural, peer-reviewed
journal of scholarly work in the area of transgenderism. Excellent source of
medical, social, psychological documentation of the transgender issues.
(http://www.symposion.com/ijt/ )
PFLAG (Parents and Friends of Lesbians and Gays) - Provides support and
resources to the parents, families, and friends of GLBT people. Has chapters in
most states and cities. 1726 M Street, NW, Suite 400, Washington, DC 20036.
(202) 467-8180. (http://www.pflag.org)
TransGender San Francisco - Initially formed as ETVC, or Educational TV Channel,
in 1982, TGSF was established to provide support services for transgender people
and educational materials to the TG community and to the general public in the
bay area and beyond. Excellent website and resources. PO Box 426486, San
Francisco, CA 94142-6486. (415) 839-9448. (http://www.tgsf.org/)
Gender Education and Advocacy (GEA) - National educational resource on gender
diversity, focused on the needs, issues and concerns of gender variant people.
Also home of the renowned "Remembering Our Dead" pages. (http://www.gender.org/)
National Gay and Lesbian Task Force - The national progressive organization
working for the civil rights of gay, lesbian, bisexual and transgender people.
NGLTF's vision and commitment to social change is building a powerful political
movement in the fifty states and the District of Columbia. 1700 Kalorama Road
NW, Washington, DC 20009-2624. (202) 332-6483. (http://www.ngltf.org)
National Transgender Advocacy Coalition - NTAC works for the advancement of
understanding and the attainment of full civil rights for all transgender,
intersexed and gender variant people in every aspect of society and actively
opposes discriminatory acts by all means legally available. The only national
transgender civil rights organization. P.O. Box 123 Free Union, VA 22940.
(http://www.ntac.org)
Intersex Society of North America - Provides education, advocacy, and peer
support organization which works to create a world free of shame, secrecy, and
unwanted surgery for intersex people. P.O. Box 3070, Ann Arbor MI, 48106-3070.
(http://www.isna.org/)
The Gender Identity Center of Colorado - Provides support and educational
resources to people who cross-dress, are transsexual, or are nontraditional in
their gender identity or expression. 1401 Saulsbury St. #G-9 Lakewood, CO
80214-4755. (303) 202-6466.
.
(http://www.gicofcolo.orgl)
The International Conference On Transgender Law And Employment Policy -Deals
with legal aspects of gender identity, generally on the national level. P.O.
Drawer 1010, Cooperstown, NY 13326. (607) 547-4118.
(http://www.abmall.com/ictlep)
Transgender Forum - Predominately MTF resources and information. Has both paid
and free content. 3D Communications, Inc. PO Box 80588, Valley Forge PA
19484-0588. (http://www.tgforum.com)
FTM International - One of the best FTM resources around, this group publishes a
wonderful newsletter that is well worth the subscription price. Also sponsors
several Bay-area support groups and assists others in presenting conferences or
developing programs. 1360 Mission St., Ste. 200, San Francisco CA 94103. (415)
553-5987. (http://www.ftm-intl.org)
American Boyz - A support and social group for people who were born female but
who feel that is not a complete or accurate assessment of who they are (FTMâs)
and our significant others, friends, families and allies (SOFFAS). Also
organizer of the annual True Spirit FTM conference. 212A South Bridge Street,
PMB 131, Elkton, MD, 21921. (410) 392-3640. (http://www.amboyz.org)
GenderPAC - National organization working to guarantee every American's civil
right to express their gender orientation free of stereotypes, discrimination
and violence. 274 West 11th Street, Suite 4R, New York, NY 10014.
(http://www.gpac.org/).
Transgender Care: Recommended Guidelines, Practical Information and Personal
Accounts. Gianna E. Israel and Donald E. Tarvel II, M.D. (1997). Temple
University Press. Temple University Press, University Services 083-42 ,1601 N.
Broad St., Philadelphia PA, 19122-6099. (215) 204-8787.
Physician's Guide to Transgendered Medicine. Dr. Sheila Kirk, MD - (1996).
Together Lifeworks. PO Box 93, Watertown MA, 02272-0093
Our Trans Children. Xavier, J., Sharp, N., & Boenke, M. (1988). PFLAG:
Parents, Families, and Friends of Lesbians and Gays. See contact info above.
Recommendations for treatment: Intersex infants and children. (Pamphlet)
Intersex Society of North America. See contact info above.
Medical, Legal and Workplace Issues for the Transsexual. Sheila Kirk, MD and
Martine Aliana Rothblatt, JD - (1996). Together Lifeworks. PO Box 93, Watertown
MA, 02272-0093
Transsexual Workers: An Employerâs Guide. Janis Walworth, MS ö (1998). Center
for Gender Sanity, PO Box 451427, Westchester, CA 90045.
Gay / Lesbian / Bisexual /Transgender Public Policy Issues: A Citizen's and
Administrator's Guide to the New Cultural Struggle. Wallace K. Swan, DPA, Editor
ö (1997). Haworth Press. 10 Alice St., Binghamton, NY 13904-1580. 1-800-HAWORTH.
Gender Outlaw: On men, women, and the rest of us. Kate Bornstein - (1994). Routledge Press. 7625 Empire Drive, Florence, KY 41042. 1-800-634-7064
Body Alchemy: Transsexual portraits. (Photography) Loren Cameron ö (1996). Cleis Press. P.O. Box 14684, San Francisco, CA 94114 . (415) 575-4700 or (800)
780-2279.
Transgender Warriors: Making history from Joan of Arc to Ru Paul. Leslie
Feinberg - (1996). Beacon Press. 25 Beacon St., Boston, MA 02108. (617)
742-2110.
Coping with Crossdressing. JoAnn Roberts (Ed.) - (1992). Creative Design
Services. CDS, PO Box 61263, King of Prussia, PA 1940. (610) 640-9449
Transsexuals: Candid Answers to Private Questions. Gerald Ramsey, Ph.D. ö
(1996). The Crossing Press. PO Box 1048, Freedom, CA 95019. (800) 777-1048
The Uninvited Dilemma : A Question of Gender. Kim Elizabeth Stuart - (1991)
Metamorphous Press. P.O. Box 10616, Portland, OR 97296-0616. 800-937-7771
Resources / Referrals 
