Transgender Definitions

(Recent dialog between Dana and a Transgender Teen)

Dana: The WPATH guidelines say that age 16 you can start taking sex hormones and begin transsexual transition.

Trans teenager: What is a transsexual?

Dana: A transsexual is a person who changes their body to make it more consistent with what people expect from a person in that gender category.

Trans teenager: We don’t use that word anymore.

Of late, I have received several inquiries regarding “transsexual,” “transgender” and related words and their past and current meanings. If you think you know all about this, you may be wrong because things are changing fast.

First, I need to point out that there is only one word used to describe transgender behavior did not start out as a pathological term. (As we will see below, the word “transgender” itself started out as a pathological term for transsexuals). The only word not to start out as a psychiatric pathological term is “crossdresser.” It is a good, home-grown English word. It avoids Latin and Greek roots that mental health people use to sound more scientific and mysterious and beyond the understanding of “ordinary” people. Most dictionary definitions say that crossdressing is the act of presenting as people of the opposite sex but these definitions are wrong. Crossdressing is the act of presenting as people (e.g. dress, comportment) of the opposite gender category to which a person is assigned at birth. This definition error is due to the current conflation of the terms sex and gender.

We can thank John Money for repurposing the word gender from language declensions to mean assignment to one of the two Western gender behavior categories. In Western culture, people are automatically assigned to one of two gender categories according to birth sex.

People crossdress for a wide variety of reasons. Some crossdress for work, political demonstrations or entertainment while others crossdress because behaving in a particular gender category is more natural and authentic (current transgender definition). History tells us of people who crossdressed to fulfill their work ambitions such as playing music or becoming a soldier or working as a spy. In many cases we do not know whether they crossdressed for just their vocation or whether they did it because they felt more natural and authentic. Drag Queens and Kings still entertain us. The word drag is believed to come from English theater in which males “dressed as a girl” in times when it was illegal for a female to perform. But most drag queens are gay men and do not crossdress or display transgender behavior when they are not performing. No doubt some are transgender but most are non-transgender gay males and some are even non-transgender females.

The term transsexual has retained its meaning for those who change their bodies to conform to cultural expectations of presentation in a congruent gender category. However, it has lost the connotation that transsexuals crossdress for sexual arousal. WPATH provides mental health and medical Standards of Care for transgender people. The current WPATH definition of transsexual is:

Transsexual: Adjective (often applied by the medical profession) to describe individuals who seek to change or who have changed their primary and/or secondary sex characteristics through feminizing or masculinizing medical interventions (hormones and/or surgery), typically accompanied by a permanent change in gender role.

Notice from this definition that it does not specify which sex organs have to be changed for a person to be considered transsexual. Sex organs include not just external and internal genitalia but also breasts, the nervous system and brain, hair and the skin. All are involved in sex and/or reproduction.

The definition also does it specify how the changes are made. Neither hormone therapy (HT) mastectomy, electrolysis, breast implants, facial surgery, or transsexual genital plastic surgery (GPS) are specified. The WPATH term is hormone therapy, not hormone replacement therapy because this latter term applies to people who have lost their ability to form certain hormones. Transsexual genital plastic surgery is my replacement term for GRS, GCS, or SRS. I consider all other terms I have heard to be misnomers. Some transsexuals have medical conditions that preclude having transition procedures for example an MTF with a history of blood clots may want to forgo HT with endocrinologist advice. Some transsexuals do not get hormone therapy and instead go directly to breast implants because they believe that their genetic heritage precludes adequate breast growth or because they do not want to take drugs that might affect their brain. Only about 15-25% of transsexuals get genital plastic surgery. Name change was once required but is no longer. Transsexual transition is not a competition in which one has to reach the GPS mountaintop to win, it is a series of choices about changing one’s body. When they decide that they are done with changes, they have completed transition. Transsexuals tend to live full time in their congruent gender category but some move back and forth to avoid rejection from family, business, or the public.

We have gravitated away from using the word “crossdressing” for those who do it to feel more authentic and natural in their congruent gender behavior category. Instead we now using the word “transgender.” Transgender was defined by the psychiatrist John Oliven in 1965 as a word for transsexuals with the belief that they were not motivated to change their bodies for sexual arousal. Up until that time, transsexuals and crossdressers were thought to crossdress to get sexual thrills and might be called transvestites. Today transgender is an umbrella term that includes transsexuals and, more recently, “genderqueer” and gender non-conforming people. Some also include drag kings and queens, although I do not unless they exhibit transgender behavior while not entertaining. A transgender person crossdresses to behave in a gender behavior category that is congruent with their biological gender predisposition, not with their assigned gender behavior category based on natal sex. Genderqueer pertains to those who do not feel comfortable in either gender behavior category. It is increasingly popular with current transgender children and teenagers as a temporary category and is included under the transgender umbrella. Another recent term, gender non-conforming is mainly used for children who crossdress but are too young to actually label themselves as either transgender or genderqueer. It is used primarily by mental health professionals as a pathological term.

There are some non-transsexual transgender people who also change their bodies. Although Virginia Prince (VP) was opposed to transsexualism, she did take hormones for breast growth.  And there are some transgender people who live full or part time without changing their bodies.  VP also was bicoastal. In the East VP was in the masculine gender (managing her business) and on the West Coast in the feminine gender.

Your second takeaway from this discussion is that transgender people are adept at repurposing pathological terms and turning them into neutral or even positive terms. In turn, the mental health community responds by making up new pathological terms. The word transgender is a prime example of this. But there are others currently in the process of being repurposed.

Some relatively new terms are now in use that are derived from pathological terms and are in the process of being repurposed. The term gender identity was developed in the tradition of psychiatrists Freud and Erikson. Richard Green (famous for his book The Sissyboy Syndrome,” added the word disorder to form gender identity disorder in time for the DSM-3 (Diagnostic and Statistical Manual of Mental Disorders, Version 3, 1980) list of mental disorders or diseases. The DSM is used by mental health and medical people to claim payments for treating transgender and other people. After it was realized that being transgender was not a disorder, and after the word had been repurposed, the DSM was changed in DSM-5 to delete gender identity disorder and instead start a new category using the term gender dysphoria. Dysphoria is derived from the Greek meaning dislike (euphoria means the opposite in Greek). The term gender dysphoria had been kicking around psychiatric circles for many years. As of November 2016, the International Classification of Diseases list is currently in use instead of the DSM for billing. Many practitioners do not know this because DSM categories are automatically converted to ICD categories by computer. The conversion from DSM gender dysphoria goes to gender identity disorder in the ICD. So, gender dysphoria is still a pathological term. There is a movement to delete any transgender-related pathological term in the DSM and ICD but to include a separate normal medical treatment category to allow for medical treatment of transsexuals, much as normal pregnancy is included in a separate category in the ICD.

Transgender people undoubtedly got the newer terms gender identity and gender dysphoria from the mental health community and have been busily converting them into non-pathological terms. Transgender people are now using “I identify as feminine/masculine” as a circumlocution for objective behavior as in “I crossdress and present as a woman/man.” Just say what gender you are—masculine/feminine/other. No need to use the term gender identity.

One problem with gender identity is that identity and identify has different meaning in sociology. It has no permanent, objective referent as in “I identify as a Georgian” or identify as an Atlanta Braves fan.” When I move to Colorado, “I will become a Coloradan” and “I will probably become a Colorado Rockies soccer fan.” The problem is that transgender attacks now take the form of “That person identifies as Santa Claus or Napoleon or a dog” with the implication that being transgender is a delusion. The delusion explanation comes from psychiatrists Paul McHugh and Keith Ablow and the like; politicians have picked it up.

I hope teens do not think that being a transsexual is something bad. As for the word transsexual going away, that is fine by me as long as my grandchildren refer to me with a non-pathological word. By then we will probably have a new repurposed word for transgender.

Tags: crossdressing, featured, fetish, Identity, Transgender, Transsexual

Category: Transgender Body & Soul