Before embarking on a detailed discussion of transsexualism, it is important to define some terms; Sex and Gender are two important and different concepts that are frequently confused.
Sex refers to someone's anatomical sex --- in other words, which type of genitals they possess. Except in very rare cases of hermaphroditism, anatomical sex is well-defined and easy to interpret.
Gender is rather more subtle, and refers to the person's own self-identity as a male, female or something else. The overwhelming majority of the population have a gender that accords with their anatomical sex, which is why few people understand that the two are different. Gender is less clearly defined than anatomical sex, and does not necessarily represent a simple binary choice: some people have a gender identity that is neither clearly female nor clearly male.
Gender consists of two related aspects: Gender Identity , which is the person's internal perception and experience of their gender, and Gender Role , which is the way that the person lives in society and interacts with others, based on their gender identity.
Gender Dysphoria is an umbrella term covering a feeling of unhappiness and incongruity concerning one's physical sex and/or gender role. This covers a range of feelings, from a general sense of discontentment with the socially expected role, through certain forms of gender-motivated transvestism (dressing as the 'opposite' sex to alleviate this dysphoria), through to full-scale transsexualism (with an overwhelming desire to change one's body and genitals, and to actually become, as far as medically possible, the other sex).
There are several other possible human conditions that are commonly confused with transsexualism, but are quite distinct. These are described briefly here to eliminate them from this discussion:
Gender-Motivated transvestites are usually unremarkably masculine, heterosexual men, who construct a female alter ego to allow themselves to express the 'feminine' character attributes such as sensitivity and emotionality that they deny themselves in their male role. The female persona is kept totally separate, and the transvestite, when in his male mode, will often refer to his female persona as if she was a totally different person. Gender-Motivated transvestites may or may not be gender dysphoric: some cross-dress to escape from a feeling of unhappiness with the male social role, many simply because they enjoy playing at being (their idea of) female. The former type would probably be regarded as being mildly gender dysphoric, the latter would certainly not. Nevertheless, transvestites are emphatically different from transsexuals: the transvestite always has a core male identity, even if he occasionally likes to escape into a female alter ego , while the (male-to-female) transsexual always has a core female identity.
Fetishistic transvestites cross-dress to obtain some form of sexual pleasure or stimulation. They are almost universally heterosexual, and are not regarded as gender dysphoric.
Transvestites generally regard themselves as fundamentally male, and most would be appalled by the idea of actually changing their sex. However, it is not uncommon for transsexuals to go through a phase of seeing themselves as (or perhaps trying to convince themselves that they are) merely transvestites, before they come to fully accept their true condition. Conversely, a few transvestites carry their fantasy 'female self' too far and delude themselves into thinking that they are transsexual. Rigorous psychiatric screening is used before allowing 'sex-change' treatment to minimise the possibility of such people embarking on a course of action that they would come to regret.
Transvestites are relatively common: some estimates would have
several percent of the male population showing some degree of
Homosexuality and bisexuality are very common; some statistics
even suggest that people exhibiting some degree of bisexual or
gay attraction could outnumber pure heterosexuals. At the
minimum, homosexuals and bisexuals represent a large
Many milder intersex conditions exist, often resulting in varying degrees of malformation or dysfunction of the genitals. Such conditions do appear to be significantly more common among transsexuals than among the general population, though the majority of transsexuals are not obviously physically intersexed.
The incidence of true hermaphroditism is reportedly somewhere around the one-in-a-million mark, although milder physical intersex conditions are very much more common. As many as 1 in 200 live births exhibit some degree of physical ambiguity, and as many as 1 in 400 people have a chromosome configuration that does not match either the standard male (XY) or standard female (XX) karyotypes.
Transsexualism is the most pronounced form of Gender Dysphoria. A typical medical definition of transsexualism would be along these lines:
A transsexual is someone who experiences a deep and long-lasting discomfort with their anatomical (genital) sex, and wishes to change their physical characteristics, including genitals, to the opposite of those usually associated with their anatomical sex, and to live permanently in the gender role opposite to that normally associated with their anatomical sex.
The medical definition is usually hedged around to exclude conditions such as hermaphroditism and various forms of psychosis which may lead to patients thinking they are transsexual without really being so. Some transsexuals also exhibit a degree of physical androgyny (which supports the view that transsexualism stems from an endocrine disorder, like hermaphroditism) but this is not part of the required conditions for diagnosis.
Transsexualism is still thought by many people to be a psychiatric condition, even though most transsexuals are perfectly sane and rational and recent research has shown that the condition has a physical basis --- that the 'female brain in a male body' is a biological reality. Nevertheless, in most countries the person in overall charge of a gender reassignment ('sex-change') will be a consultant psychiatrist. The psychiatrist's role is to ensure that the patient is sane, really is transsexual, and is mentally stable enough to make the necessary adaptation to the new gender role.
Most transsexuals dislike the typical medical description, as it still tends to suggest a psychiatric, rather than physical, origin for the condition, in spite of the criterion that one must be sane to be allowed gender reassignment. The present author would like to suggest an alternative, and personal, view of what it means to be transsexual:
I am a woman who, probably due to some endocrine malfunction before birth, was born with male genitals. Since our society assumes that gender and sex always correspond, I was wrongly assigned to the gender pigeon-hole called 'male' by a doctor who looked at my genitals instead of my mind. Throughout my childhood I knew perfectly well that I was really a girl (after all, it's my mind, not my genitals, that make me the person that I am), but because my body seemed to insist otherwise, I was forced to try to fit in to the gender role of a boy. This produced intense unhappiness and almost totally ruined my life until I accepted the reality of my situation and underwent gender reassignment as an adult. I now live in the gender role called 'female' that matches my gender identity; the medical profession labels me as a 'post-operative true primary male-to-female transsexual', but I regard myself as a perfectly normal, well-adjusted and happy woman.
Bearing in mind the definitions of 'sex' and 'gender', some transsexuals are uncomfortable with the accepted medical term 'gender reassignment' to cover what is popularly known as 'a sex change'. While many medics would adopt the reductionist viewpoint that sex is properly determined by chromosomes and not by genitals, and that there can therefore be no true change of sex, it is not really a change of gender either. It is a change of gender role , to bring it into conformity with the person's gender identity , with hormonal and surgical reconstruction, as far as possible, of the body's sexual characteristics.
Many specialists draw a distinction between primary and secondary transsexuals, although in reality there is probably a spectrum rather than a black-and-white division. Primary transsexuals exhibit cross-gender identity and severe gender dysphoria from an early age, and are unable ever to function satisfactorily in their natal sex role. Secondary transsexuals arrive at their cross-gender identification later in life, often after being fully functional in their natal sex role for some time, perhaps having even married and raised families. It seems likely that primary transsexuals are the true 'female brain in male body' case, with extensive feminisation of the brain, while secondary transsexuals represent a less severe version of the condition, with only partial feminisation of the brain. This view has been borne out by psychometric tests that aim to quantify 'masculine' and 'feminine' personality traits.
Transsexualism is a fairly rare condition. About one person per thousand is gender dysphoric to some extent, although true primary transsexuals are far fewer. Recent estimates would suggest that around one person per 25,000 is a true primary transsexual, with perhaps ten times that number of secondary transsexuals.
After reassignment most, but by no means all, transsexuals are heterosexual. Among the transsexual population, the usual spectrum of human sexuality can be found. Gender identity and sexual preference are not very strongly connected. Interestingly, it appears that primary transsexuals exhibit a similar incidence of sexual preferences to the natural-born female population, while secondary transsexuals demonstrate a much higher incidence of lesbianism or bisexuality.
There is also an increasing number of people who label themselves as 'transgenderists'. They typically wish to live as members of the opposite sex, but without undergoing genital surgery. This could be regarded as a kind of mid-point between the Gender-Motivated transvestite and the transsexual. While this unquestionably another manifestation of Gender Dysphoria, it is debatable whether such people are transsexual in the true sense.