Poster presented at the World Association for Sexual Health conference, Sydney, 15-21 April, 2007, by Dr Tracie O’Keefe DCH
This is a discursive paper about the way in which the term ‘transgender’ has been solicited to take on the meaning of all those humans beings who are not seen as strictly male or female, but are unable to claim or choose not to claim an intersex identity. Since the 1990s the American term transgender has been increasingly used by academics, lawmakers, medical professionals and transgender campaigners to replace the medical diagnosis of gender dysphoria.
In 2006 the Harry Benjamin International Gender Dysphoria Association (HBIGDA), the world’s largest organisation for professionals helping persons with sex and gender identity issues, changed its name to the World Professional Association for Transgender Health (WPATH). This took place after years of campaigning to rid that organisation of a title that reflected medical pathologisation.
The increasing use of the term transgender, however, as a cumbersome, careless catch-all description now marginalises groups of people who do not consider themselves transgendered but consider themselves as transsexual, transsexed, androgynous or without sex or gender identity (neuter). These groups of people may not consider that they have crossed or stretch across the bipolar gender divide. They also may not want to and find it damaging to be primarily identified as people who are having gender issues when the self-formatting of their identities is seen as more complex than being ‘other than’ normally gendered.
The author proposes that it is the primary responsibility of psycho-sexual therapists to support sex and gender dysphoric and/or diverse patients in differentiating their own identities. Just as the ‘queer’ label is being rejected by many individuals who prefer to consider themselves gay, lesbian, bisexual, transgendered or polyamorous, so too is the transgender label not applicable for all sex and gender diverse people.
The term ‘transgender’ was first made popular by Virginia Prince (1978), who used it to describe people whom she said were like her. These were people who live as their opposite biological sex or assume many cross-sex and gender characteristics but do not want to undergo genital surgery to become the opposite biological sex because they still largely identify as their original biological sex.
“Sex and gender are not the same thing.” (Prince,1973)
“Prince’s term ‘transgenderist’ – for those males like herself who “elected” to live full time and permanently as women, though male – first appeared in print 1978 (Prince, 198a) although in 1969 she used the term transgenderal’ in the same sense as the later ‘transgenderist’ (Prince, 169a:65). Since the mid 1990s the term ‘transgender’ has increasingly come to be used as an umbrella term to include transsexuals, transvestites, transgenderists, drag kings and queens, and so on. Prince considered her term to have been ‘hijacked’ and regards the current usage as being too all-encompassing to be useful (Interview with RE, Nashville 2002).” (Ekins & King, 2005).
In 2004 the Harry Benjamin International Gender Dysphoria Association (HIBIGDA) changed its name to the World Professional Association For Transgender Health (WPATH). This took place after many years of lobbying to the association by members and the public that its name did not reflect the experiences of many of the client group it aimed its efforts towards. Unfortunately the new name appears to have been chosen for many of the wrong reasons:
1. Many academics involved in that process of changing the association’s name made their living and bolstered their kudos around the term transgender. For them it was the branding of their work and a commercial investment.
2. In America the word transgender has been homogenised like the phrase ‘fast food’ which is a linguistic nominalisation and generalisation that loses much of its meaning through lack of specificity. The majority of the members of the HBIGDA are American and wanted the Americanisation of the association’s title.
3. HIBGDA’s philosophy of practice has heavily leaned towards pathologising the client, giving those who are sex and gender variant specific psychiatric catagorisations. This means doctors can charge fees and then claim it back from private health insurance companies. That way the client often gets what they want in the short term (hormones and surgey) and the members of the HBIGDA now WPATH get paid for their fees. America is a country that has no national health system and the majority of healthcare practitioners make their living from patients’ private health insurance. Without a label that suggested something other than normality the members of WPATH would not get their fees. One of the golden goals of HBIGDA was always to get private insurance companies to pay for gender dysphoria treatment and now for transgender treatment. Hence pathological labelling is seen as king.
4. Americans are often sex phobic. In New York you can say sex until you are blue in the face and no one takes any notice. However, much of the rest of America can be quite religious and an association with sex in the title may have been considered too controversial.
5. Over the past fifteen years the intersex community has been very critical of the members of the HBIGDA, criticising them as being over controlling with their patients using the psychiatric sword of Damocles to grant or withhold treatment. If HBIGDA had used the phrase sex and gender diverse it may primarily have come into conflict with the intersex community as they may have seen it as attempting to expand its authoritative stance to include people who were intersex.
The problem with HBIGDA/WPATH using the label transgender in its title is that once you have clinically labelled something as a medical dysfunction the label sticks like an everlasting bad smell. For instance years after a motorbike accident doctors often refer to that person as the person who had that motorbike accident. Or a woman who had pregnancy terminations becomes known as the woman who had the abortion instead of simply a person. What constantly happens in the doctor’s office is that years after people have transitioned their identities, the doctor and members of society are still referring to them as a pathologised labels, which in this case will be transgendered, This is linguistic objectification that turns those persons into ‘other’ and often causes them to be ostracised minorities.
People who are unhappy with the phase transgendered when applied to them
Transsexed people who consider themselves intersexed and believe that any transition they have made had nothing to do with their gender presentation but was because their physical body did not match their mind.
Jules: “It was hard enough for me to become a man in the first place. My family were so against my transition all the way, right from when I was 13 years old and told them what I was going to do. My wife has been wonderful and we have two children by artificial insemination. No one knows about my history where I live in a rural community and I’m just an ordinary guy. I don’t ever want to be labelled as transgender and different from other people. I know what happened to me was a physical thing because since I could walk I knew I was really a boy. I always behaved like a boy and I have not changed my gender.”
Transsexual people who consider their that transition from one sex to another was an accommodation of many different factors and not solely a gender-based accommodation of self.
Monica: “Before I had transitioned at thirty I had been on the gay scene with loads of screaming queens so I know all about prejudice. Something inside me though said I was not one of them. Ever since I took my first hormone pill, life just fitted into place. After my surgery in Thailand I went to work in Saudi Arabia as a nurse and everyone just treated me like the rest of the nurses and I was accepted. I don’t want to be a thing because I’m a woman now with my documents changed. This transgender thing has nothing to do with me. I had a sex change right, and now I just want to get on with my life undisturbed.”
Androgynous people who may consider themselves as more than one sex and do not want to be caught up in the pragmatics of limiting laws that pertain to transgender.
Nunu: “I’m not into politics. I was registered as a boy at birth but I was hypogonadal and failed to thrive; consequently I stayed very small. I’ve always worn my hair long and I started taking my mother’s birth pills when I was twelve and eventually grew small breasts. I have two passports, one for Australia and one for my mother’s country. I was born here so that one is for male but the one for my mother’s country I got in female. At twenty two I get away with passing as either sex and I like to do that. I am not like those transgender people because I’m not that, I’m just me and I don’t want anyone telling me I’m transgender.
Sex and gender confused people who are exploring their identities and do not want to be pegged with labels that carry the danger of turning into self-fulfilling prophesies.
Morris: “Please tell me I’m not transgender. I read on the internet about so many terrible things that happen to them. My wife is completely freaked out that I have come to see you; she thinks I’m going to try to become a woman. I’m just confused about why I keep wanting to put on her cloths every time she goes out. If you tell me I’m transgender I’m not going to come back again because I really don’t want to hurt my family.”
Reasons not to use the term transgender as a generalisation in clinical practice
Many people who consider themselves transsexual or transexed just wish to gently slip into society and live a quiet, peaceful uneventful life as their destination identity. Well if you are always going to be known as the ‘transgendered’ person, there seems very little chance of that happening.
The HBIGDA committee that changed the name to WPATH could have used more open language such as sex and gender diverse people. This would have allowed patients/clients to have greater scope in the way they explored and developed their own identities. Open language is always the better choice when helping people find their own real identities.
If you call someone a Negro, Moslem or Jew they immediately begin to take on that identify even if you had not meant that label to be derogatory. In the case of people trying to adjust their sense of sex and gender identity, labelling them as transgender is harmful because they might be transexed, transsexual, androgynous or have a sense of being neuter so the clinician has immediately stolen their ability to self-identify. It is putting the diagnosis before the client and taking away their ability to identify freely.
Therapists particularly have to communicate from an expansive perspective not a reductionism one. It is much better to allow people to come to their own identities because they are more sustainable. If we block people in then we restrict their choices.
A parallel for this argument can be drawn from the use of the word ‘queer’ from 1980s to date. The word queer when used by heterosexual people about gay people was originally used as a non-normative insult. In the 1980s gay people began to own the word by calling themselves queer, thereby depotentiating the insult. Many people however who were gay, lesbian, bisexual, or transgendered never felt comfortable with the label and distanced themselves from gay or queer culture, causing division.
So the question this paper asks is: Will transgender be another ghettoised label? And the answer must be categorically yes because it is the automatic identification of ‘other’ than the rest of society. It is ghettoisation and to many sex and gender diverse people, this is extremely offensive. Only if the client chooses to use that label should the clinician aquiese to its use.
Finally, in considering this paper the author adds her own voice. I am a woman who was registered as male at birth. Since I was fifteen years old I have lived as female. I always felt I was female. Behaving as a female always came naturally to me and doing the gender performance of male seemed foreign. My own transition was about bringing the physical body in line with my identity it was not about gender performance. I am transexed; that is I was born transsexual intersexed, not transgendered, and for someone to refer to me as transgender is to wholly misunderstand and detract from who or what I am.
Ekins, Richard & King, Dave, Introduction: International Journal of Transgenderism. Volume 8, number 4, Haworth Press, 2005. USA.
Prince, Virginia Sex vs Gender (1973). (Republished) International Journal of Transgenderism, volume 8, number 4, Haworth Press, 2005. USA.
Prince, Virginia, Transsexuals and Pseudotranssexuals (1978). (Republished) International Journal of Transgenderism, volume 8, number 4, Haworth Press, 2005. USA.