This leaflet is about gender dysphoria, commonly known as transsexualism. It tries to explain what transsexualism is, and to answer some questions you might have about the condition.
Most people never have to ask themselves the question "Am I male or female?". They only have to look at their body and the answer is obvious. For transsexuals, the sex of their body feels totally wrong, because the way that they see the world is that of the opposite physical sex.
This is often very confusing for the transsexual, since most people expect a male body to contain a man, and a female body to contain a woman. This is not true for transsexuals, and the fact that they have the wrong physical characteristics for their true sex makes them very unhappy.
There are two types of transsexuals. Male to female transsexuals have a male body and a female mind, whereas female to male transsexuals have a female body and a male mind. Transsexualism is a rare condition (although no one knows exactly how rare), but there are thousands of transsexuals living in Britain. In fact, although you may not have realised it, you have probably already met a transsexual.
Nobody knows for sure. Some people think that transsexualism is a psychological condition, with no physical cause, but recent research into the human brain has shown that male and female brains are different in structure. Scientists who have studied the brains of transsexuals have found that their brains are structured like those of their psychological rather than their physical sex.
This strongly suggests that there is a physical event that causes the condition which occurs during the development of the brain while in the womb, and that it is a type of intersex condition (that is, the body is physically neither male nor female but has some characteristics of both). There are a number of possible causes for this.
Not always. The world is full of people who are the same sex as their bodies, and it is often difficult for transsexuals to understand exactly what the problem is. Instead they just have a deep feeling of wrongness that takes many years to understand for what it is.
Some transsexuals know that they are members of the 'opposite' sex from the time that they are aware that there is a difference between men and women, others are aware that they want to be the other sex without understanding why, and others believe that they are not transsexual into middle or old age before they understand the truth about themselves.
Absolutely not. The process of changing gender role is an extremely painful one, and is always a last resort, usually done only after years of soul searching. Transsexuals are sometimes accused of being selfish, but the difficult change that they undergo is never the result of a whim, idle curiosity or boredom. They choose that path because no other way of life is bearable for them. Transsexuals are born, not made.
No. It is easy to confuse sexual orientation (whether someone is attracted to men or women) with gender identity (whether someone is male or female). Transsexuals have a gender identity that is different from their physical sex, and this is not related to whether they are sexually attracted to men or women. There are heterosexual, homosexual, bisexual and asexual transsexuals.
No again. Transvestites are people who get sexual or emotional pleasure from wearing the clothing of the opposite sex. The vast majority of transvestites are men. Transvestites are perfectly content to remain with the body that they have, but enjoy the fantasy of pretending to be a member of the opposite sex.
Because transsexuals have the wrong body it can be difficult for them to develop sexually. Sometimes they are not very attracted to members of either sex, since the role that they would have to perform in any sexual relationship would feel wrong. The idea of being a member of the opposite physical sex may become the only way in which they can express their own sexuality, and their sexual fantasies can become geared towards being that sex. This is not the same as transvestism, but it is easy to confuse the two, and sometimes these transsexuals mistakenly assume that they are transvestites.
Earlier this century, when the condition was less well understood. transsexualism was classed as a mental illness. Psychiatrists tried to 'cure' transsexuals by using techniques like aversion therapy or drugs. This never worked. There is no way that a genuine transsexual can ever be content living in the wrong gender role, and attempts to make a transsexual 'normal' always fail.
Transsexuals themselves often try to deal with the question of their gender identity by ignoring it, or by denying that there is a problem. Unfortunately neither of these methods works in the long term. They are simply ways of putting off something that has to be dealt with, and only cause the transsexual's sense of unhappiness to deepen until it reaches a crisis point. In general the sooner transsexualism is treated the better the results of treatment are, so delay can be very damaging.
The only successful treatment that has ever been found for transsexuals is for them to live as members of the sex that they psychologically are. How this is done varies from transsexual to transsexual, and can involve counselling, speech therapy, electrolysis (removal of facial hair), hormones, and surgery.
However, sex reassignment is not an overnight fix for transsexualism. It is a long, expensive and sometimes painful process, and the final result is something of a compromise (for example, surgery makes transsexuals sterile). However, nearly all transsexuals find that, despite sometimes being subject to prejudice or discrimination, sex reassignment does offer them a suitable, enjoyable and extremely fulfilling life.
It is usually a good idea for you to arrange counselling. This can sometimes be done through your GP, although you may need to find a counsellor through a helpline or support group. You should be very careful when looking for a counsellor, since the wrong advice can be extremely harmful. Try to find a qualified and experienced counsellor, preferably one with experience in dealing with clients with gender identity issues.
Counselling will hopefully help you to decide whether or not you are transsexual and the best way to proceed. Surgery is not the only alternative. For various reasons, for example family commitments, some transsexuals choose to put up with the acute unhappiness of living in the wrong gender role, or to change role but stop short of taking hormones or of surgery. It is you who will have to live with the consequences of any decision that you make, so it is best to look carefully at all the alternatives and decide which one is best for you. Counselling or psychotherapy will hopefully help you to do this.
You may also find it helpful to join a support group. No matter how understanding your GP or your counsellor might be, it is impossible for them to understand what it actually feels like to be going through the process of coming to terms with your gender and what to do about it. The experience of others going through the same process can be very helpful, although you should be aware that you will not necessarily get on with someone just because they have the same medical condition as you. Some organisations support both transsexuals and transvestites, others are exclusively for transsexuals. At the end of this leaflet there is a list containing some possible contacts
If you think that hormones and/or surgery are the right course of action for you, then you will need to see a consultant psychiatrist. You can do this either privately or through the NHS. Either way you must have lived in the new gender role for at least a year (this is called the Real Life Test) and have the approval of two psychiatrists before surgery can take place.
The current situation within the NHS requires that you be referred to a specialist Gender Identity Clinic. Some health authorities are refusing to pay for any treatment, but even if you are lucky enough to be able to get funding, there is a very long waiting list and it is highly unlikely you will be seen before two years is up. The NHS insist on a minimum of two years Real Life Test (sometimes more), and will sometimes not prescribe hormones until a year or longer after the start of this.
With the current lack of money within the NHS, getting NHS treatment for transsexualism is becoming more and more difficult, and involves a much longer wait than private treatment. A private psychiatrist can also prescribe hormones before the start of the Real Life Test, which can make being accepted in the new gender role easier, since it causes some of the physical characteristics of the new sex to develop.
It is important to realise that there is far more to a successful transition than hormones and surgery. If your GP can arrange speech therapy then this will help you to develop the characteristics and social skills appropriate to your new gender role. Sometimes a physical characteristic such as size will mean that no matter how hard you work to adapt to your new role, people will still be able to tell that you are a transsexual. Counselling may help in coming to terms with this.
Finally it is important to understand that whatever you choose to do is entirely up to you. Others can offer advice and help, but your decision and the responsibility for it must be yours alone. Above all, remember that you are not alone, that many others have struggled with similar problems and overcome them. With time and support you can overcome them too.
This leaflet is only a brief introduction to gender dysphoria. More information can be obtained from the following places.
The Beaumont Trust, BM Charity, London, WC1N 3XX
Helpline -- (0171) 730 7453 -- Tuesday 7-11pm for transvestites, Thursday 7-11pm for transsexuals
A support group for transvestites and transsexuals.
The FTM Network, BM Network, London. WC1N 3XX
A support group for female to male transsexuals.
The Gender Trust, BM Gentrust, London, WC1N 3XX
Helpline -- 07000 790347 until 10pm each evening.
Internet -- http://www3.mistral.co.uk/gentrust/
A group providing information and help to transsexuals.
The Looking Glass Society:
Internet -- http://www.looking-glass.greenend.org.uk/
Email -- email@example.com
An organisation providing detailed information on transsexualism including a general primer and a medical guide, available free over the Internet. They can also provide contact with a counsellor or a psychiatrist.
Northern Concord, PO Box 258, Manchester, M60 1LN
Internet -- http://www.personal.u-net.com/~nconcord/
A support group in Manchester for transvestites and transsexuals.
Transsexual Women's Resource
Internet -- http://www.mindspring.com/~alawrence/
An excellent US based World Wide Web site containing information for male to female transsexuals.
©The Looking Glass Society 1997. This leaflet may be freely reproduced in its entirety on a not-for-profit basis for any purpose which helps transsexuals, provided the text is not altered.