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A Brief Overview of Transgender Identity (2001)

A Brief Overview of Transgender Identity (2001)

©2001, 2013 by Carol D. Denniston and Dallas Denny.

Source: Denniston, Carol, & Denny, Dallas. (2001, Summer). A brief overview of transgender identity: Historical and mental health perspectives. Psychology & AIDS Exchange (American Psychological Association), No. 30, pp. 1, 5, 8, 16.

I was honored to be asked by Carol Denniston to co-author this article.



Psychology & AIDS Exchange (PDF)


A Brief Overview of Transgender Identity: Historical and Mental Health Perspectives 

Carol D. Denniston, Ph.D.

Dallas Denny, M.A.


Transgender is a term used to describe individuals who have persistent and significant discomfort with their assigned gender (White &Townsend, 1998). Transgender individuals were born biologically male or female, but live their lives to varying degrees as the opposite gender. Gender identity refers to an individual’s self-identification as male, female, or other. Male and female are extremes on the gender continuum and many transgender people identify as somewhere in the middle, or gender variant. A transsexual is a transgender individual who seeks genital reassignment surgery. Not all transgender individuals are seeking to “transition” through hormone therapy, aesthetic surgery, or genital surgery; in fact, many do not. Transgender people are referred to as male-to-female (MTF) or female-to-male (FTM).

It is also important to distinguish between gender identity and sexual orientation. It is a myth that all MTF transgender individuals are attracted to men, or that they are really homosexuals. Many MTF’s are happily married and have no desire to leave their wives. MTF’s and FTM’s may be attracted to men, women, or both and may identify as homosexual, bisexual, or heterosexual. It is important not to confuse these issues.

Variant expressions of gender — what we today call transgender and transsexualism — have been present throughout human history (Taylor, 1996). Gender roles outside the binary male/female were recognized members of a variety of tribal cultures (Herdt, 1994), but until recently have been repressed in Western societies (Bullough & Bullough, 1993). Historical documents suggest that many women lived socially as men (Dekker & van de Pol, 1989; Hall, 1996) from the Middle Ages on. Legal documents showing that men lived as women are less common, but this may be artifactual, due at least partly to the fact that until recently women were largely excluded from activities which would have generated legal documents. Nonetheless, there are many reports of men who lived as women (Bullough & Bullough, 1993).

Gender-variant expression came to the attention of the early sexologists Hirschfeld (1910, 1991) and Ellis (1906), who differentiated it from homosexuality. As the twentieth century progressed, gender variance became increasingly medicalized, especially after Christine Jorgensen’s sex reassignment in Denmark (Hamburger et al., 1953). Following Jorgensen’s sex reassignment, increasing numbers of men and women began demanding similar treatment (Hamburger, 1953). This eventually resulted in the formation of the first U.S. gender clinic at Johns Hopkins University (Money & Schwartz, 1969). A textbook by Benjamin (1966) defined the syndrome of transsexualism and another by Green & Money (1969) described Johns Hopkins’ interdisciplinary approach to sex reassignment.

The psychomedical literature of the second half of the 1950’s treated transsexualism and crossdressing as forms of mental illness. In 1980, transsexualism found its way into the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association, and remains in the current DSM-IVTR as “Gender Identity Disorder.” Crossdressing is present in DSM-IVTR as “Transvestic Fetishism.”

In the early 1990s, the term “transgender” arose as an umbrella to describe all sorts of gender-variant people, including crossdressers and transsexuals, and a category which had previously been ignored, transgenderists — those who choose to live as members of the other sex with no desire for genital surgery and sometimes with no hormonal therapy or other body modifications (see Bolin, 1994, for an anthropological perspective on the social change within the transgender community). The newly formed transgender community looked at gender variance not as mental illness, but as an inevitable and important social role toward which some human beings were predisposed. Cross-cultural support to support this interpretation was becoming available (Dragoin, 1997; Herdt, 1994; Roscoe, 1990; Williams, 1986).

This transgender paradigm shift has had a significant impact on the mental health community. However, many would say it has not had enough of an impact. Some mental health professionals continue to pathologize transgender people and lack the understanding and training to effectively provide mental health services to transgender individuals (Cole, Denny, Eyler, & Samons, 2000). Clinical work with transgender individuals requires an understanding and sensitivity to a broad range of transgender experiences as well as various transgender resources. The transgender community has pointed out that few people are entirely comfortable within rigid bipolar gender norms (Boswell, 1991, 1998), and that most people violate these norms to a greater or lesser degree in terms of their sexual orientation, manner of dress, choice of occupation, hobbies, gestures, and speech patterns (Wilchins, 1997).

Today a large community exists, consisting of crossdressers, transsexuals, and transgenderists, most of whom are from the middle and upper classes, and most of whom are Caucasian. There is a second and largely underground group of transgendered people with incomes below the poverty level. This group does not enjoy the same access to health care as the first, and faces a variety of health risks, including HIV.

In all but a few U.S. municipalities, transgender and transsexual people face employment discrimination (see Currah & Minter, 2000, for a list of cities and states with nondiscrimination laws). They are often rejected by their families, and are at high risk for attack on the street simply because of the way they look (Wilchins, et al. 1997). A study of transgender individuals in the U.S. indicated that approximately 60% had experienced some form of harassment or violence and that 37% had experienced some form of economic discrimination (Lombardi, Wilchins, Priesing & Malouf, in press). Inability to find a job can force them to turn to sex work; inability to procure legal hormones can lead to sharing needles; and, among MTF’s, a desire to achieve instant curves via silicone can lead to injection by backroom “practitioners” (Tobin, 2001).

All these activities subject them to risk of HIV infection. This risk has translated into high rates of actual infections. Studies of MTF sex workers in the U.S. report prevalence rates ranging from 20% up to 68% (Clements-Nolle, Marx, Guzman, & Katz, 2001).  Fortunately, data are accumulating that document the aforementioned risks and rates of infections; unfortunately, little has been done to reduce risks.

It is difficult to assess accurately the impact HIV has had on the transgender community. Transgenders are rendered invisible by the CDC’s policy of classifying them under the MSM (Men who have Sex with Men) category. Additionally, there are very few studies on rates of HIV infection among transgender individuals who do not work in the sex industry. Finally, there is very little in the way of research addressing HIV and FTM individuals.

Transgender Resources

 International Foundation for Gender Education, P.O. Box 229, Waltham, MA 02254-0229, 781-899-2212.

FTM International, 1360 Mission Street, Suite 200, San Francisco, CA 94103, 415-553-5987.

Gender Education & Advocacy.

Intersex Society of North America, P.O. Box 31791, San Francisco, CA 94131, 415-575-3885.

Renaissance Education Association, P.O. Box 552, King of Prussia, 19406, 610-975-9119.

World Professional Association for Transgender Health


References and Recommended Reading

 Benjamin, H. (1966). The transsexual phenomenon: A scientific report on transsexualism and sex conversion in the human male and female. New York: Julian Press.

Bolin, A.E. (1994). Transcending and transgendering: Male-to-female transsexuals, dichotomy, and diversity. In G. Herdt (Ed.), Third sex, third gender: Essays from anthropology and social history, pp. 447-485. New York: Zone Publishing.

Boswell, H. (1991). The transgender alternative. Chrysalis Quarterly, 1(2), 29-31.

Boswell, H. (1998). The transgender paradigm shift toward free expression. In D. Denny (Ed.), Current concepts in transgender identity, pp. 55-61. New York: Garland Publishing.

Bullough, V.L., & Bullough, B. (1993). Cross-dressing, sex, and gender. Philadelphia: University of Pennsylvania Press.

Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. American Journal of Public Health, 91(6), 915-921.

Cole, S.S., Denny, D., Eyler, A.E., & Samons, S. (2000). Diversity in gender identity: Issues of transgender.  In L.Szuchman & F. Muscarella (Eds.), The psychological science of sexuality, pp. 149-195. New York: John Wiley & Sons, Inc.

Currah, P., & Minter, S. (2000). Transgender equality: A handbook for activists and policymakers. Washington, DC: National Gay and Lesbian Task Force.

Dekker, R.J., & van de Pol, L.C. (1989). The tradition of female transvestism in early modern Europe. New York: St. Martin’s Press.

Denny, D. (1995). The paradigm shift is here! AEGIS News, 1(4), 1, 4-5.

Dr. Walker arrested because of male garb. Atlanta Constitution, 2 February, 1913, 10B.

Dragoin, W. (1997). The gynemimetic shaman: Evolutionary origins of male sexual inversion and associated talent? In B. Bullough, V. Bullough, & J. Elias (Eds.), Gender blending, pp. 227-247. Amherst, NY: Prometheus Press.

Ellis, H.H. (1906). Studies in the psychology of sex: Erotic symbolism, mechanism of detumescence, the psychic state in pregnancy. Philadelphia: F.A. Davis Co.

Green, R., & Money, J. (Eds.). (1969). Transsexualism and sex reassignment. Baltimore: The Johns Hopkins University Press.

Hall, R. (1996). Patriots in disguise: Women warriors of the Civil War. New York: Marlowe & Company.

Hamburger, C. (1953). The desire for change of sex as shown by personal letters from 465 men and women. Acta Endocrinologica, 14, 361-375.

Hamburger, C., Sturup, G.K., & Dahl-Iversen, E. (1953). Transvestism: Hormonal, psychiatric, and surgical treatment. Journal of the American Medical Association, 12(6), 391-396.

Herdt, G. (Ed.). (1994). Third sex, third gender: Essays from anthropology and social history. New York: Zone Books.

Hirschfeld, M. (1910). Die transvestiten: Eine untersuchung uber den erotischen verkleidungstrieh. Berlin: Medicinisher Verlag Alfred Pulvermacher & Co.

Hirschfeld, M. (1991). Transvestites: The erotic drive to cross dress. (Michael A. Lombardi-Nash, translator). Buffalo, NY: Prometheus Books.

Lombardi, E.L., Wilchins, R.A., Priesing, D, & Malouf, D. (In Press). Gender violence: transgender experiences with violence and discrimination. The Journal of Homosexuality.

Money, J., & Schwartz, F. (1969). Public opinion and social issues in transsexualism. In R. Green & J. Money (Eds.), Transsexualism and sex reassignment, pp. 253-269. Baltimore: The Johns Hopkins University Press.

Roscoe, W. (1990). The Zuni man-woman. University of New Mexico Press.

Taylor, T. (1996). The prehistory of sex: Four million years of human sexual culture. New York: Bantam Books.

Tobin, T. (2001, 18 April). “Tis’ food, drink, and injections.” St. Petersburg Times (FL).

White, J.C. & Townsend, M.H. (1998). Transgender medicine: Issues and definitions. Journal of the Gay and Lesbian Medical Association, 2, 1-3.

Wilchins, R.A. (1997). Read my lips: Sexual subversion and the end of gender. Ithaca, NY: Firebrand Books.

Wilchins, R.A., Lombardi, L., Priesing, D., & Malouf, D. (1997, 13 April). Genderpac First National Survey of Transgender Violence. New York: Gender Public Advocacy Coalition.

Williams, W.L. (1986). The spirit and the flesh: Sexual diversity in American Indian culture. Boston: Beacon Press.