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Transgender, Transsexual, Gender Identity Disorder

Abstract: Strong feelings of being born with the wrong gender.

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Transgender, Transsexual, Gender Identity Disorder

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Written by: (partly) Wendy Moelker, psychologist in charge of Emergis, Goes, the Netherlands. This article was mainly copied from Wikipedia, and is available under the terms of the GNU Free Documentation License (see Copyrights for details). The text has been approved by the Web4Health medical experts.
First version: 22 Jul 2008.
Latest revision: 08 Mar 2012.

What is transgender and transsexual? Is it a gender identity disorder?


Transgender is generally used as a catch-all umbrella term for a variety of individuals, behaviours, and groups centered around the full or partial reversal of gender roles ; however, compare other definitions below.


A transgender symbol, a combination of the male and female sign with a third, combined arm representing transgender people.
A transgender symbol, a combination of the male and female sign with a third, combined arm representing transgender people.


The term remains in flux, but the most accepted definition is currently:

People who were assigned a gender, usually at birth and based on their genitals, but who feel that this is a false or incomplete description of themselves.

Another one is: Non-identification with, or non-presentation as, the gender one was assigned at birth.

Transgender people may or may not have had medical gender reassignment therapy, also called sexual reassignment surgery, and may or may not have any interest in such a procedure. In other words, not all transgender people are necessarily transsexual.

When referring to the two basic "directions" of transgender, the terms transman for female-to-male (which may be further abbreviated to FtM) transgender people and transwoman for male-to-female (which may be further abbreviated to MtF) transgender people may be used. In the past it had always been assumed that there were considerably more transwomen than transmen. However, the ratio is approaching 1:1.

Transgender can include a number of sub-categories, which, among others, including transsexual, cross-dressing, transvestite, consciously androgynous people, people who are genderqueer, people who live cross-gender, drag kings and drag queens, among many others. Usually not included, because in most cases it is not a gender issue (although in practice the line can be hard to draw) are transvestic fetishists.

Many people also identify as plainly transgender, although they may fit the definition of any of the previously mentioned categories as well.

The extent to which intersex people (those with genitalia or other physical sexual characteristics that not strictly either male or female) are included in the transgender category is often debated. Not all intersex people have a problem with the gender role they were assigned at birth, nor do all intersex people have any problems with gender identity. Those who have, though, are sometimes included in transgender.

The opposite of transgender is cisgender.

The terms "gender dysphoria" and "gender identity disorder" are used in the medical community to explain these tendencies as a psychological condition and the reaction to its social consequences. Strictly speaking, gender dysphoria and gender identity disorder are considered to be mental illnesses, as recorded in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard for mental healthcare professionals. Unfortunately, many mental healthcare providers know little about transgender life, and persons seeking help from these professionals often end up educating the professional rather than receiving help. Among those therapists, psychologists, etc. who do know about transgender issues, many believe that transitioning from one sex to another "the standard transsexual model" is the best or only solution. This usually works well for those who are transsexual, but often far less well for those cross-gender people who do not identify as plainly male or female.

Other definitions

Originally, the term transgender was coined in the 1970s by Virginia Prince in the USA, as a contrast with the term "transsexual," to refer to someone who does not desire surgical intervention to "change sex," and/or who considers that they fall "between" genders, not identifying strictly to one gender or the other, identifying themselves as neither fully male, nor female.

Transgenderists and non-operative transsexuals

Often in older writings (pre ~ 1990s), but rarely today, the term transgender is used to refer to these "non-op transsexuals" or "non-op transpeople" who live as the gender opposite to their birth gender and, though sexual reassignment surgery is possible, have chosen not to undergo it; sometimes they also choose not have other medical gender reassignment therapy. However, sometimes, for example in the Netherlands (but not in the rest of Europe), the term transgender is still in use for this particular group instead of being used as such an umbrella term.

This group is also sometimes known as "transgenderists" or "non-op transsexuals". Many point out that the term "non-op transsexual", however, is very far from ideal, in that it seems to be an oxymoron (people who want to become the other sex yet don't) or a case of defining people by what they are not rather than what they are. Unfortunately, there seems to be no perfect term in English for this sort of person as of yet.

Transgender as "in between"

Transgender is sometimes also used specifically in an "in-between" sense, rather than as an umbrella term.

A newer related term is "genderqueer", which refers to the mixing of qualities traditionally associated with "male" and "female," and can also refer to the "in-between" sense sometimes associated with transgender or transgenderism.


Main article: Transsexual

Transsexual people are people who desire to have, or have achieved, a different physical sex from that which they were assigned at birth. One typical (though oversimplified) explanation is of a "woman trapped in a man's body" or vice versa; many transsexual women state that they were in fact always of the female gender, but were assigned the male gender as a child on the basis of their genitals, and having realized that they are female, wish to change their bodies to match; transmen, naturally, feel exactly the opposite.

The process of physical transition for transsexuals usually includes hormone replacement therapy and may include sexual reassignment surgery (a.k.a. gender reassignment surgery). For transwomen, electrolysis for hair removal is often required, while many transmen have breast-reduction surgery as early as possible, whether accompanied by genital surgery or not.

Some spell the term transexual with one s in order to reduce the association of their identity with psychiatry and medicine.

Terminology and concepts, compared to transgender

Transgender is often used as a euphemistic synonym for transsexual people by some. One set of reasoning for this is that it removes the conceptual image "sex" in "transsexual" that implies transsexuality is sexually motivated, which it is not. This usage is problematic because it can cause transgender people who do not identify as transsexual to be confused with them. It also seems to remove the issue of social presentation (gender, in its social sense) from the question, even though gender role and presentation is an important part of the equation.

Furthermore, many transsexuals reject the term "transgender" as an identification for themselves, either as a synonym or as an umbrella term. They advance a number of arguments for this. One argument is that the use of the umbrella term inaccurately subsumes them and causes their identity, history, and existence to be marginalized. Another is that they perceive the term to be the breaking down of gender barriers, whereas transsexual people themselves usually identify as men or as women -- just not as they were assigned at birth. A third occasionally mentioned is that they did not change gender at any point -- they have always had their gender (identity), and the difficulty is their sex (anatomy), which they desire to change. However, others point out that transsexual people do change their gender role at some point, and that most non-transsexual transgender people always had their gender identity, too.

A more problematic dispute with the use of the term "transsexual" is that it refers to processes of chemical and/or anatomical modification that do not actually render an individual reproductively viable after transition processes, nor change sex chromosomes. Particularly, criticism of transsexual women by some feminists includes the contention that their transition is cosmetic rather than fundamental, and they are thus not "really" changing their sex at all (thus the use of transgender). These critics claim that the presumption of reproductive viability is what distinguishes "women" from "men". This argument is used to discount the rights of identification and association with other women that transsexual women might claim. However, many arguments that link whether someone is a "woman" or a "man" based on reproductive capability, or chromosomes, fall apart when considering non-transsexual people who are infertile or non-transsexual men or women who have a chromosomal configuration different from other men and women in the general population.

Probably many of these problems are associated with the history of the term "transgender" and its other definitions; see above.

To respect the identity of those transsexual people who do not identify as transgender, the constructions trans, trans*, or transgender and transsexual sometimes are used to describe all transpeople.

Further, many people who this article would define as transgender reject the term altogether, along with other related terms (transsexual, crossgender, etc.). This is most commonly seen with people who have changed sex but who do not define themselves as transsexual. A common statement is that a transsexual is someone who is undergoing a change from one sex to another; someone who has already done so is simply a "man" or a "woman". This brings up issues of the extent to which someone who is not a part of a group may define it, also seen in the case of, for example, "men who have sex with men" (MSMs), who do not see themselves as homosexual but could still be defined as such.


Main articles: cross-dressing, transvestism, drag king, drag queen, transvestic fetishism

A person who is cross-dressing is any person who, for any reason, wears the clothing of a gender other than that to which they were assigned at birth. Cross-dressers may have no desire or intention of adopting other behaviours or practices common to that gender, and particularly does (currently) not wish to undergo medical procedures to facilitate physical changes. Contrary to common belief, most male-bodied cross-dressers prefer female partners.

Drag involves wearing highly exaggerated and outrageous costumes or imitating movie and music stars of the opposite sex. It is a form of performing art practiced by drag queens and drag kings. Drag is often found in a gay or lesbian context. The term "drag king" can also apply to people from the female-to-male side of the transgender spectrum who do not see themselves as exclusively male identified, therefore covering a much wider ground than a "drag queen".

Transvestic fetishism is a term used in the medical community to refer to one who has a fetish for wearing the clothing of the opposite gender. This is considered a derogatory term by some, as it implies a hierarchy of value in which the sexual element of transgender behaviour is of low social value. Many reject the term "transvestite" for this reason, preferring cross-dresser instead. It is often difficult to distinguish between fetishism that happens to have female clothing as an object and transgender behaviour that includes sexual play. Some people feel that transvestic fetishism does not count as cross-dressing.


"Transgender" is also used to describe behaviour or feelings that cannot be categorized into these older sub-categories, for example, people living in a gender role that is different from the one they were assigned at birth, but who do not wish to undergo any or all of the available medical options, or people who do not wish to identify themselves as "transsexuals", "men" or "women", and consider that they fall between genders, or transcend gender.

Some people who present as female, but with male genitalia may have been born intersexual but may also be transsexual or transgender, who do transition (taking oestrogens and/or other methods) to achieve some desired secondary sex characteristics, but not sexual reassignment surgery. Sometimes these individuals are referred to as ladyboy or shemale (compare there), but these terms are considered derogatory by many, including most transgender or transsexual people not working in the sex industry.

Other Issues

(Trans-)gender identity is different from, though related to, sexual orientation. Sexual orientations among transgender people vary just as much as they do among cisgender people. Although few studies have been done, transgender groups almost always report that their members are more likely to be attracted to those with the same gender identity, compared to the population as a whole; that is, transwomen are more likely to be attracted to other women, and transmen are more likely to be attracted to other men. Many transgender people who are attracted to others of the same gender will identify as gay, lesbian, or bisexual.

Note that in the professional literature, "homosexual" and "heterosexual" are very often used respective to clients' birth sex, instead of their desired sex. Transgender people may feel misunderstood by caregivers because of this practice; it is also quite confusing when a relationship that is considered gay or lesbian by both partners is labeled heterosexual, or a relationship that consists, as far as the partners are concerned, of a man and a women is labeled homosexual. The existence of transgender people and their sexual relationships points to certain inadequacies of language.

Many Western societies today have some sort of procedure whereby an individual can change their name, sometimes also their legal gender, to reflect their gender identity; see Legal aspects of transsexualism. Medical procedures for transgender people are also available in most Western and many non-Western countries. However, because gender roles are an important part of many cultures, those engaged in strong challenges to the prevalence of these roles, such as many transgender people, often have to face considerable prejudice.

Transgender in non-Western cultures

This article describes primarily Western modes of transgenderism. Many other cultures have or have had similar phenomena:

  • The so-called berdache in many Native American groups is recognized as a separate gender, a woman-living-man, not as a man who wants to be a woman. The term "berdache" is a misnomer, however, as no Native American group actually used the term; different ethnic groups had different names for the role, such as the winkte. The husband of such a person is not viewed as being gender-different themself, but as a normal male. In some societies there is a corresponding gender for man-living-women ( amazons).
  • In Thai culture, there is the kathoey, who is very similar to the English definition of transgender, but is sometimes broader, including effiminate gay males moreso than "transgender" does.
  • South Asian cultures have hijra, usually genetic males who have been castrated and live as women.
  • Chinese cultures have a wide variety of transgender modes of existence. See transgender in China.

Gender identity disorder

Transgender and transsexualism are only regarded as a disorder if they make a person unhappy and unsatisfied, or causes problems in relations to other people. If they are happy with it, and it causes no problem, it is a personality trait, but not a disorder.

Persons with a gender identity disorder have had strong feelings since childhood that they were born in the wrong body. They want to belong to the opposite sex, e.g. they want to be a woman instead of a man and vice versa. This can be seen in children when they keep on indicating that they want to belong to the opposite sex, want to wear clothes of the opposite sex and have a strong and continuous preference for playing the role of the other sex or pretending to belong to this sex. They also want to play games and have pastimes of the other sex and preferably play with pals of the other sex.

Note that transgender need not include a wish to have sex playing another sex role than born with. Note also that some people normally use their normal gender role, but sometimes wish to try out the reverse gender role.

In adolescents this disorder is very noticeable by signs like wishing to belong to the opposite sex, living like someone of the other sex, being treated as someone of the other sex or be convinced that he or she has the typical feelings and reactions of the other sex. Transsexuals are not transvestites; transvestites are people who every now and then feel good in the clothes of the other sex, but don't want to live like this forever.

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