By Dr Tracie O’Keefe DCH first published in December 1997. Reprinted in Sex, Gender & Sexuality: 21st Century Transformations by the same author, 1999.
As the 20th century draws to a close the availability of cross-biological sex hormone administration has been available for nearly 80 years. To begin with hormones were were used for people who were diagnosed as being hormonally deficient. They were also administered to the intersex categories of people who wished to define or re-define their sex. Later they were used with people who identified as being transsexual and who believed they belonged to their original opposite biological sexes. In the 1980s and 90s transgendered individuals were taking hormones to appear one sex whilst remaining and functioning sexually as their original biological sex.
This paper is specifically dealing with the cross-dressing community (also described as transvestites), who may live part or full time in the opposite role to their biological sex. When I talk of cross-dressers I include those who could be categorised as social or fetishistic transvestites. Social transvestites live cross dressed, dressing in clothes sociologically associated with the opposite biological sex, because that is how they feel comfortable presenting themselves. Fetishistic transvestites wear the clothes, generally associated with the stereotypes of the opposite biological sex, because they experience erotic stimuli associated with that particular kind of clothing.
I also deal here with other groups that are presently being described as androgyne, that is those who identify as either both or neither sex and gender; still further those calling themselves the third sex or gender. These are namely androgynons, androgynens, sinandrogynons, and sinandrogynans (O’Keefe 1997)
I realise at a later date dealing with these two groups together may, on reflection, seem primitive, but I do presently deal with them together because they are, in today’s clinical paradigms, both considered to be on the cutting edge of hormone administration. Some gender clinics will not administer hormones to these people and many clinicians speak out, suggesting that these people should not be entitled to hormone therapy.
A number of clinicians, when having been asked to assist these individuals with hormone therapy, have attempted to “normalise” their clients’ identities, forcing them to comply to the male and female polarity social stereotypes or even to transsexual profiles. This normalisation treatment has been implemented through psychological therapy, psychiatric drugs, aversion therapy, psychoanalysis and various forms of psychotherapy. At times administration of hormone treatment to strengthen characteristics of the original biological sex has been used, against the clients’ wishes or knowledge. These kind of treatments administered to individuals, who wanted to retain their sex, gender and sexuality diversities is now considered more widely as being unethical.
For those people who are absolutely convinced that they no longer wish to continue with the more unusual diverse identities, extensive psychotherapy is still acceptable to help them define a comfortable sense of who and what they are. That is not to say this should depend solely upon the moral or philosophical ideation of the clinician, but should always first consider the wishes, needs and general well-being of that client.
What are transvestites trying to achieve by taking cross-biological sex hormones?
They are attempting to either feminise or maculinise their identities to a small extent to assist them to be more convincing during the times they take the roles of their opposite biological sex. What they are not trying to do is change their bodies extensively, wishing to hang onto most of the major characteristics of their original biological sex. In ancient cultures this was done by biological males consuming the urine of pregnant mares. Today in most major cities many such people now buy hormones on the black market, imbibing them without any safe form of medical supervision.
The second question is: what are those of self identified androgyne individuals trying to achieve by hormone administration?
The andryogenon and androgenan identities are trying to become more like their opposite biological sex and gender and less like their original, in order to attain an androgynous concept of self, appearing to belong to both sexes and bipolar genders.
In the case of the sinandrogynon and sinandrogynan identities they are attempting to strip themselves, as much as possible, of all traces of bipolar sex and gender identities. In real and logistic terms they are attempting to become neuter, without sex or gender references.
Within the context of this paper it is unimportant why these people try to define themselves in these ways. The nature versus nurture debate looks set to run for eternity since variables are multiple. My clinical and personal codes of ethics follow the ideals that all human beings have the right to define themselves as they so wish providing they do no harm to others or severe harm to themselves.
In such cases minimal doses of hormones must be administered, because should the physiological development move too far in the direction of the opposite biological sex, then the object of the exercise has been superseded. It should also be explained to that person that there may be unforeseen side effects, for which the clinician could not be responsible since such administration is not a science, at the moment.
In biological males there will be a lowering in sperm count, possible change in psychological outlook, and the development of minimal secondary female bodily characteristics. There may be a slowing down of facial hair growth, but on such small doses, it is unlikely this will be dramatic.
In biological females there may be facial hair growth, acne, increase in sex drive, lowering of the voice, cessation of periods, and increased danger of polycystic ovaries.
Each patient should be told by the endocrinologist involved, that they are responsible to research at their library, the effects and adverse effects of the hormonal preparation they are taking.
I am aware in suggesting that this is acceptable hormonal therapy to administer to individuals that in some cultures my opinions may go against philosophical, moral or religious beliefs. However, such beliefs, when transported out of those cultures, lose their validity. Human beings are not simply the bipolar stereotypes of man and woman that so many authoritarian philosophies dictate. The nature of sex, gender and sexuality is highly complex and diverse and each individual has the right to explore these concepts within the bounds of well-being. In saying this I would like to point out that prohibition of these developments can cause mental and physical disintegration and ill health. Furthermore each human being needs to have the right to be the eventual arbitrator of their own body.
We now have available to us the contraceptive pill both for men and women. These prescriptions are administered to a person on request and it is considered, within social and medical thought, that an individual has a right to define their own destiny through these drugs. Therefore I propose that such logic is applied to the subjects of this paper, in that a person must have the moral and legal right to define their own identities, without interference or prohibitions by authoritarian archetypes.
However, I would caution that if an individual wishes to take this course they should consult a medical practitioner who is a specialist in the field of endocrinology. They should also spend a number of sessions talking over the pros and cons of the situation with a doctor, psychiatrist, psychologist, psychotherapist or counsellor who specialises in this field of sex, gender and sexuality, since some of the effects of hormone therapy will be irreversible.
Androgynon: A person who comes from the male end of the biological spectrum, but who identifies as being both sexes, sometimes describing themselves as the “third sex”.
Androgynan: A person who comes from the female end of the biological spectrum, but who identifies as being both sexes, sometimes describing themselves as the “third sex”.
Sinandrogynon: A person who comes from the male end of the biological spectrum, but who does not wish to be identified with either of the polarity biological sexes, having negative self-identification of their original sex and gender image.
Sinandrogynan: A person who comes from the female end of the biological spectrum, but who does not wish to be identified with either of the polarity biological sexes, having negative self-identification of their original sex and gender image.