Frequently Asked Questions: (click each question to open or close the answer, or use the expand/collapse all button)
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1) What is Sexual Orientation, or Sexual Preference?
Sexual orientation or Sexual Preference refers to an individual’s physical and emotional attraction to the same and/or opposite gender. “Heterosexual,” “bisexual,” and “homosexual” (aka gay or lesbian) are all sexual orientations.
2) What is Gender Expression or Gender Presentation?
Gender Expression or Presentation refers to all external characteristics and behaviors that are socially defined as either masculine or feminine, such as dress, mannerisms, and speech patterns. The way an individual expresses his or her gender identity is frequently called gender expression or presentation, and may or may not conform to social stereotypes associated with a particular gender.
3) What is Gender Identity?
Gender identity refers to an individual's innate, deeply felt and internal sense of being male or female, or somewhere along a spectrum between the two. Gender identity is generally first recognized in the early years of an individual's life, typically age 3 through 5. Neurological research suggests that Gender Identity is associated with distinct physical structural characteristics of the brain and is not primarily learned behavior as was formerly thought. If this internal perceived identity is different from the individual's gender identified at birth from external genitals, it may be referred to as Gender Identity Disorder and may result in increasing psychological and emotional discomfort and pain. These individuals may or may not change their physical or gender characteristics in order to alter or publicly redefine their gender from that defined at birth, to the gender identified internally, a process known as Transition. Gender Identity is completely independent of Sexual Orientation.
4) What is Gender Dysphoria?
Gender Dysphoria is the medical term for the staggering psychic pain and emotional distress that Gender Identity Disorder causes. This pain is almost impossible for anyone without the condition to understand, because they have always taken their perceived gender identity for granted. All transsexuals describe intense emotional and psychic distress from this condition which typically is progressively debilitating over time. If you imagine the intensely pleasurable feelings described by the term “euphoria,” and imagine the opposite intensely dis-pleasurable feelings, you have an idea what dysphoria describes. The pain of gender dysphoria for me became like the pain of a parent who has lost a child, except the lost child is my lost life as the authentic female me. For a parent who loses a child, in time the pain softens and becomes more bearable, but as a transsexual, every year the loss grows, and the pain increases; I would watch girls and women at various life stages and feel the ache of never sharing that experience. First I lost the experiences of being a little girl, then a pre-teen, then an adolescent, then a young woman, and so on. Gradually the balance shifts to more of my life lost forever, and less remaining to potentially experience. Eventually, the remaining life left to live as the authentic female inside me, becomes unbearably short, and pain turns to panic. For many there comes a point where mere survival requires transition.
5) What is Transgender?
Transgender refers to persons who experience and/or express their gender differently from what most others expect – either in terms of expressing a gender that does not match their sex designated sex at birth, or physically changing their sex. It is a broad term that includes people who are transsexual, cross-dressers, or otherwise gender non-conforming. Not all people who consider themselves (or are considered by others as) transgender will undergo a gender transition.
6) What is CIS-Gender?
CIS is the complementary prefix to TRANS. CIS-Gender refers to persons whose gender identity is aligned with their birth gender assignment and their body genitals.
7) What is a Transsexual?
Transsexual refers to transgender individuals who, usually today with the help of medical and psychological professionals, have Transitioned, are in the process of Transitioning, or desire to Transition from one gender presentation to another. This transition facilitates both personal and public recognition of their gender as different from that which they were assigned at birth. The term transsexual does not require or imply any particular surgical procedure, but is purely a function of an innate sense of gender identity that is at odds with the sex identified at birth from external genitals. For FTM individuals there is frequently a strong desire for breast reduction "top surgery", sometimes a hysterectomy, and generally hormone therapy. For MTF individuals, there is generally a desire for HRT, SRS, removal of facial and body hair with electrolysis and/or laser therapy, and often FFS or other cosmetic surgery procedures. In both the case of FTM, and MTF, if financial resources, or other medical conditions, prevent some or all of these desired procedures, it does not change the individual's core identity as transsexual. Any of these desired procedures should be viewed, for a transitioning transsexual, not as "elective surgery", but as medically necessary for healthy survival. (See Transition, MTF, FTM, HRT, SRS, and FFS below)
8) "Trany" offends me!
In the recent past "trany" has had two common usages and it's difficult to be sure which came first; by haters as a slur, and sometimes considered an ironic badge of pride, much like a black person using the "N" word. It has recently become a source of some controversy and increasing condemnation despite it's ongoing common usage among celebrities in the drag queen community, but I and many others in the transgender and transsexual community find the term just as offensive as the "N" word has become. It isn't worth fighting about, but I do hope and expect that it will fall out of favor.
9) What is Transition?
Transition is the process of changing Gender Presentation from the one assigned at birth to the Gender Presentation of choice. By the time transition begins, the transsexual has been dealing with this issue for many years. The current Standards of Care for Transsexuals (SOC, published by the WPATH.ORG, the World Professional Association for Transgendered Health) recommends, and many surgeons require, living full time for one year as a member of the desired gender before irreversible surgical interventions such as Sexual Reassignment Surgery are performed. This necessarily requires that the transsexual begin living and working in his/her new role before transition is complete. This has been called a Real Life Test (RLT) and involves psychological testing and on-going monitoring, throughout the one year trial period to ascertain the level of comfort the person has in the new gender presentation, and to assist the Transsexual with various challenges that may be encountered through the process. This counseling is frequently as much about the relationships with others in society and their attitudes as it is about the internal process and experiences of the Transsexual. The complete transition process can be very complex and typically requires several years to complete. The transsexual will generally seek some of the following medical treatments: Gender Therapy counseling, Hormone Replacement Therapy, laser or electrolysis hair removal, cosmetic surgery to the face and body, and Sexual Reassignment Surgery. These life altering, and even life-saving, therapies can be very expensive and are not always covered by insurance (although there is a strong trend toward full coverage of these vital medical services). Some individuals will not pursue some (or any) of these forms of medical treatment because of their age, medical condition, lack of funds, or other personal circumstances. An individual does not become a Transsexual because of any particular medical intervention they receive, they are transsexual as a result of their perceived gender identity even before, or if no, medical treatment is sought.
10) What is MTF (Male to Female)?
MTF refers to a Transsexual who was assigned male gender at birth but identifies as female and may or may not be transitioning to live as a female.
11) What is FTM (Female to Male)?
FTM refers to a Transsexual who was assigned female gender at birth but identifies as male and may or may not be transitioning to live as a male.
12) What is HRT? (Hormone Replacement Therapy)
Hormone Replacement Therapy refers to the process of replacing the gender specific hormones of the birth gender with the gender specific hormones of the perceived gender. In the case of a Male to Female transsexual, it is typical to begin with an androgen testosterone blocker such as Spironolactone, to drop the testosterone from the level typical for males, to the level typical for females. Then female hormones estrogen and possibly progesterone are added to bring the complete endocrine system in line with the desired gender. HRT results in a wide variety of welcome changes for the MTF transsexual, including ultimately breast growth and other redistribution of body fat to create a more feminine body profile, and thinning finer-grained skin, along with increased sensitivity to heat and cold. Body hair growth is reduced consistent with female characteristics (except that facial hair is too coarse to be reduced and must be eliminated with laser or electrolysis). Skin oiliness and body sweat are reduced greatly and the scent of perspiration changes from a metallic pungent odor to a more subtle sweeter scent. The senses may become refined and experience heightened sensitivity. Emotions will generally be heightened and more sensitive, tears may come much more easily. Some of the first effects experienced are a new sense of calm, reduced aggression, greater patience, and a generally welcome reduction in male libido. Other MTF secondary sexual characteristics that remain unaffected by HRT, and may require other surgeries or interventions, include voice pitch and resonance, overall body height and size, and size of the hands and feet. In the case of FTM transition, Hormones will typically deepen the voice, cause increasing facial and body hair to grow, and frequently results in some degree of male pattern baldness.
13) What is SRS? (aka: GRS, GCS, etc.) (Sex Reassignment Surgery)
SRS (et al) are acronyms for Sexual Reassingment Surgery, Genital Reassignment Surgery, Genital Reconstruction Surgery, Gender Confirmation Surgery, etc., all terms for the complicated MTF genital surgery, a process that has sometimes been euphemistically referred to as "changing an outie to an innie". After decades of development this surgery has become extremely sophisticated, fully functional and sensate female genitals (excluding the uterus and capability for childbirth), to the point that some gynecologists have thought they were examining a CIS-Gendered woman who had a hysterectomy. Fundamentally female genitals and male genitals begin as the same pre-natal cells which will become female genitals by default, or if the intra-uterine bio-chemistry environment dictates, may develop into male genitals. MTF SRS is the process of literally undoing this differentiation with sophisticated cosmetic surgery. Using the existing skin and nerves from the male genitals to construct female genitals. There are several subtley different techniques developed by different surgeons, each with their proponents. This surgery is now available from surgeons in the United States and Canada and numerous foreign countries. I actually prefer the term SRS because to me it best explains what is changed. My gender has always felt female, so I am not reassigning it, but my sexual organs are do not match my perceived gender, so this surgery "reassigns" my sexual plumbing to match the gender I've always been. Like many things, the terminology used is a subject of much debate and difference of opinion. I think the important thing is that we understand what it is, I don't care so much what we call it. SRS for the FTM is much more complex and at this time cannot result in fully functional male genitals, and is therefore frequently not pursued. SRS for the FTM may include a hysterectomy, and breast reduction "top surgery."
14) What is FFS (Facial Feminization Surgery)?
Facial Feminization Surgery is the process of changing a male facial structures including both soft tissue and and bone structures (which cannot be changed by HRT alone) to more nearly approximate a female facial structure. Pre-puberty, the faces of male and female children are nearly identical. During puberty the male face begins to change with new bone growth in the jaw, nose and brow. Soft tissue changes occur as well. FFS is a collection of procedures to undo these effects. In the most complete procedures, the brow and forehead maybe carved back or even broken and re-assembled to reduce and smooth the brow ridge. The upper eye orbits may be expanded and a traditional facelift employed. The nose may be reduced in size and reshaped to a more feminine profile. The corners of the jaw may be rounded and the chin size reduced. The distance from the upper lip to the nose may be shortened. The Adams Apple may reduced in size. These procedures are typically performed by an FFS cosmetic surgery specialist with who has studied the aesthetic differences between male and female facial features. See also a list of surgeons on the "Links" page.
15) Isn't there a therapy that can cure Transsexualism?
No, there is no therapy cure. A few have claimed to have a cure, but these "cures" amount to painful repression which is not helpful. Given that gender identity is believed to reside in brain structures that develop in-utero, these cannot be redeveloped later any more than fetal alcohol syndrome can be cured through therapy.
16) How many people are transgender or transsexual?
For many years an unreasonably low occurrence rate of 1-in-100,000 was frequently quoted within the psychiatric community as the best available estimate, but this estimate seems to have been based on no legitimate research data. Transsexuals tend to hide before, during, and after transition and this early estimate was much too low. In 2001 Dr. Lynn Conway began to realize that this estimate was unrealistically low. Using the actual rate of SRS surgeries, and other data, she and Prof. Femke Olyslager of Ghent University (Belgium) developed a much more accurate estimate traceable to verified data sources. They estimated that the total occurrence of transsexualism to be about 1-in-300. Those who go on to full-time transition may be about 10% of that number. With the recent increase in visibility and acceptance for transgender people, it is likely that we will see these percentages increase as more transgender people feel safe enough to come out of the closet, and a corresponding decrease in those taking their own lives.
17) How old were you when you were first aware of a gender issue in your life?
I have known that I didn’t fit easily into the male role since I was 4 or 5 years old. By the time I was in about the second or third grade I was cross-dressing, and going to bed praying that I would wake up a girl the next day. No one in my life knew I felt that way because I knew they would never accept my feelings, so I hid these feelings and tried to fit in as a boy.
18) What causes transsexualism?
There have been many theories, but there does not seem to be a clear genetic link, and the majority of cases are not associated with any sort of unusual nurture factors which could explain the condition. The best data suggests that it is a birth defect (or a birth "affect" if one objects to the pejorative "defect") which occurs during pregnancy in-utero. There may be many possible causes during a mother's pregnancy; medications, naturally occurring variations in the endocrine balance, extreme mood swings, illness, etc. In my case, a likely collection of causal factors may be associated with the fact that my mother was diagnosed with bipolar disorder, had been on a variety of medications, and experienced extreme mood swings.
19) What does the Bible say about Transsexualism?
As a Christian, I have struggled for years to try to understand what can be God’s will for me and others with this condition. This is a very difficult thing to sort out, and our society has not been much help. In short, I find nothing in scripture that explicitly deals with transsexualism, nor any condemnation of it, but there are some reasons to infer that it is no hindrance to salvation. (For more discussion of this subject, please see the BIBLE" Tab above)
20) Why transition after you've lived so much of your life in the gender role you were born with?
The staggering psychic pain and emotional stress that this condition causes is almost impossible for anyone without the condition to understand, because of course they have always taken their perceived gender identity for granted. All transsexuals describe intense emotional and psychic distress from the condition. These experiences have been given the label “gender dysphoria.” If you imagine the intensely pleasurable feelings described by the term “euphoria,” and imagine the opposite intensely displeasurable feelings, you have an idea what dysphoria describes. The pain of gender dysphoria for me became like the pain of a parent who has lost a child, except the child is my lost life as the authentic female me. For a parent who loses a child, in time the pain softens and becomes more bearable, but as a transsexual, every year the loss grows, and the pain increases; I would watch girls and women at various life stages and feel the ache of never sharing that experience. First I lost the experiences of being a little girl, then a pre-teen, then an adolescent, then a young woman, and so on. Gradually the balance shifts to more of my life lost forever, and less remaining to potentially experience. Eventually, the remaining life left to live as the authentic female inside me, becomes unbearably short, pain turns to panic, and survival requires transition.
21) Transsexuals and suicide?
To get some idea of the intensity of these feelings, pre-operative transsexuals are believed to have the highest rates of suicide of any known condition. It is very difficult to get complete data because the vast majority of transsexuals remain unidentified for much of their lives – as I have been – but most estimates suggest that about half of all pre-operative transsexuals have attempted suicide by their twenties, about twenty percent succeed, and nearly all have thought about it intensely and repeatedly – as I have. It is likely that a significant number of unexplained suicides, where the internal causal condition has been too private to be shared with anyone, may well be transgender related. It has been said that there are only two cures for the pain of gender dysphoria, transition to live in the perceived gender, and death. Also of note is that post-operative transitioned transsexuals experience rates of suicide no higher than population averages. In summary, the only medically recognized treatment for gender identity dysphoria today is physical transition to live in the innately perceived gender.
22) What is the WPATH (World Professional Association for Transgender Health)?
The World Professional Association for Transgender Health (WPATH), formerly known as the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity disorders. WPATH Mission Statement As an international multidisciplinary professional Association the mission of WPATH is to promote evidence based care, education, research, advocacy, public policy and respect in transgender health.
23) What is the WPATH SOC (Standards of Care)?
The World Professional Association for Transgender Health promotes the highest standards of health care for individuals through the articulation of Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People. The SOC are based on the best available science and expert professional consensus. The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. While this is primarily a document for health professionals, the SOC may also be used by individuals, their families, and social institutions to understand how they can assist with promoting optimal health for members of this diverse population.
24) What is the DSM-5 (Diagnostic and Statistical Manual revision V)?
DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process. APA is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treatment, prevention and research of mental illness.
25) What is the HRC (Human Rights Campaign)?
HRC ORG: As the largest civil rights organization working to achieve equality for lesbian, gay, bisexual and transgender Americans, the Human Rights Campaign represents a force of more than 1.5 million members and supporters nationwide — all committed to making HRC's vision a reality. Founded in 1980, HRC advocates on behalf of LGBT Americans, mobilizes grassroots actions in diverse communities, invests strategically to elect fair-minded individuals to office and educates the public about LGBT issues.
26) What is the HRC CEI (Human Rights Campaign - Corporate Equality Index)?
2013 HRC CEI: The Human Rights Campaign’s 2013 Corporate Equality Index is the national benchmarking tool on corporate policies and practices related to LGBT employees.
27) Who is Dr. Harry Benjamin?
Dr. Harry Benjamin (January 12, 1885 – August 24, 1986) was a German-born, American endocrinologist and sexologist, widely known for his ground-breaking clinical work with transsexualism. Widely considered the Father of Transsexualism in the sense that he was the first modern clinician to take the condition seriously and research it conscientiously. He is credited with coining the term Transsexual. "His were the pioneering observations and efforts that called the attention of the medical community to
28) Who is Lana Wachowski?
Lana Wachowski and her brother are the famous directors of the "Matrix" movies, "V is for Vendetta", and "Cloud Atlas". Well known previously as Larry Wachowski, one of the "Wachowski Brothers" when she finally came out of the closet as Lana, the Human Rights Campaign awarded her their "Visibility Award for 2012" You can view her very moving and funny 30 minute acceptance speech here:
29) Who is Jazz?
Jazz is a young transsexual with understanding parents who allowed her to begin transitioning at age 5. She was able to have a complete childhood as the female she was sure she should be. She is just entering puberty and due to begin HRT. Her story was the subject of an excellent three part documentary which can be seen at the links below. (If these links break in the future just Google the full name "I am Jazz - A Family in Transition")
30) Who is Lynn Conway?
Lynn Conway is a computer scientist, and academic, many of whose contributions went unrecognized for many years as she had transitioned and for many years no one knew about her past. She has long been something of a heroic figure to me. I actually took classes from her research partner Carver Mead at Cal Tech. See: