By Dr Tracie O’Keefe DCH first published in July 1997. Reprinted in Sex, Gender & Sexuality: 21st Century Transformations by the same author, 1999.
In this paper I am considering the administration of hormone treatment therapy to the transgendered individual and who specifically does not identify as being transsexual. In my 1997 book Trans-X-U-All: The Naked Difference my co-author Katrina Fox and I distinguish between the transsexual who identifies as belonging to their opposite biological sex and the transgendered person, who identifies as their original biological sex, but wishes to partially alter their body to physically represent their opposite biological sex.
To help the reader more clearly understand the transgender identification I shall also say that in America transgender covers the whole of the Trans-community. However, I have had difficulty with this definition because it implies that the transsexual has in some way crossed over from one identity to another. The true transsexual believes they have simply adjusted their identity to realigning it with their true sex.
The transgendered person is happy to be identified with having crossed some kind of gender barrier, but not the sex barrier. These individuals will exhibit facets of multiple sexes and genders, or in fact they may very well seek self-labelling according to what suits them.
A biological male who seeks to be transgendered may undergo hormone treatment, plastic surgery and electrolysis, living socially and working as a female or transgendered person full or part time. However, this person will still identify during sex and privately through self-image, to a large part, as male. These individuals are not to be confused with the prefemisexual who is a transsexual awaiting vaginoplasty.
A biological female who seeks transgender self-identification may undergo hormonal and surgical procedures, including bilateral mastectomy. This person will not undergo any form of genital surgery, identifying strongly with their female genitals as being the very core of their true identity as a woman living as a male. This category of person is not to be confused with the premascusexual (a transsexual originally biologically female, awaiting phalloplasty or who has decided not to have phalloplasty because of surgical risks). These individuals do not think of themselves as a men but as women with social male characteristics.
Furthermore the transgendered person is not a physical hermaphrodite, transvestite, or a person who wishes to represent themselves as being androgenous, because of the clear identification with their original biological sex. It may help the reader here to refer to the paper I presented to the 1997 Harry Benjamin International Conference on Gender Dysphoria in Vancouver, namely The Treatment of Sex, Gender and Sexuality States by Respectful Pansexual Usage of Sociolinguistics. I designed this paper to extend the verbal representation of parts of the human experience.
A very important point to put across at this stage is that the transgendered person seeks their identification and is not a victim of misidentification. Of course they could have had other identifications before they aligned their self-image to that of a transgendered person or they could move on from transgendered to another self-identification.
Western culture has had great difficulty acclimatising to those members of society who identify as not belonging to the extremes of the sex and gender polarity scale of heterosexual male and female. For thousands of years, in many other cultures in the world, the existence of the less statically gendered has been celebrated, tolerated, or seen as benign.
Unfortunately the modern Western culture has developed a distinct phobia against those who are not stereotypical and who are representations of the diversity of sex, gender and sexuality. This hostility has, at times, been taken to a sociopathological extreme. All forms of prejudice are the results of sociopolitical and religious motives that often cite morality, fanaticism or law and order as their reason for persecution of minorities, including members of the Trans-community.
The transgendered person is the true sex and gender adventurer and they choose to make their journey out of a sense of exploration of their own experience. They are beyond those of us who are more strongly tethered to the narrow margins of our own sex, gender and sexualities. When they request hormones, providing there are no serious medical contraindications, they should be allowed to legally imbibe those hormones without moral judgement from the rest of us, including the medical establishment.
It is appropriate that a transgendered person should sign a form absolving the hormone administrator of blame should complications occur due to that administration. It is essential, however, that the administrator of the hormones and any therapists involved need to take sufficient care in advising the transgendered individuals of the advantages and pitfalls of their intended course.
Insufficient research exists to guarantee the transgendered person that there will be no side effects, so it would be unfair of them to hold the doctors and therapists solely responsible should complications happen. It is also the responsibility of any transgendered person who is taking hormones to monitor publicly available information on the research connected with the administration of those hormones.
Every day in our society people are allowed to tattoo, pierce and mutilate themselves, drink and smoke themselves to death and consume copious amounts of narcotics. Drug companies bombard us with products that are addictive and have disturbing side effects, none of which the consumer was warned about. Yet the transgendeedr person is often refused the hormones they require to continue their lives in the way they choose. There has been has been a trend in psychiatry and psychology to judge transgendered people as having a psychopathology, which bears no official diagnosis. Yet it allows the clinician to be abusive by using their own personal moral standpoints to contaminate other people’s desired experiences.
There is a great need for those professionals who work with sex, gender and sexuality to re-educate themselves to be empathic to the needs of all the Trans-community, and to reserve their judgmentalism. To date many of the sexologists and doctors I come into contact with daily have trouble understanding the dynamics of transsexualism, but when it comes to the trangendered issues they look at me as if I am speaking Martian.
It has been suggested to me that transgenderism is simply a social construct that is the result of our culture’s need to accept the diversity of nature. This may very well be true but even so, that still does not give those of us who are not transgendered the right to deny others their desired experiences.
In a free society if the individual has the legal right to commit suicide, then surely they must ultimately be allowed to live their lives as they see fit, without the interference of the moral majority. Transgendered people do not threaten other people’s existence or happiness, therefore they should not be denied the hormones they need to explore their own personal identities. A clinician, on the other hand, does need to point out that the course they take may have irreversible physiological, psychological and sociological repercussions.
I suppose the ultimate question that many would like answered about the transgendered is are they sex dysphoric and/or gender dysphoric? Some may be moving towards their developing identity through free will therefore not being either sex dysphoric or gender dysphoric. The alternative is that some may be moving away from their old identity, unhappy with it, therefore being sex dysphoric or gender dyphoric. The third option may include both scenarios. However, we should remember that each person has the right to make their own journey through life and that there are no correct formats when it comes to the human condition.
Psychotherapy rarely dissuades transgendered people from pursuing the course that they indicate they wish to take. What tends to happen is that they get the hormones on the black market anyway, but are robbed of any kind of reasonable medical supervision. This further takes them out of the caring system, isolates them, stops them from accessing social care should they need it and turns them into what Kate Bornstein calls Gender Outlaws.
I have had several cases of people who have lived as transgendered for a large part of their lives and these individuals have reported that this was the right decision for them. They did not want to be medicalised as transsexuals and neither did they want to live completely as their original biological sex. The ones who have been denied such treatment talk about having miserable lives held back by their unhappiness with their bodies. These people should have access to hormone treatment to change their bodies in order to facilitate their personalities and live a rewarding life.