Transgender in the United States: A Brief Discussion (1999)
©1999, 2013 by Dallas Denny
Source: Denny, Dallas. (1999, October-November). Transgender in the United States: A brief discussion. SIECUS Report, 28(1), pp. 8-13.
SIECUS is the Sexuality Information and Education Council of the United States. The organization is dedicated to sex and sexuality education, sexual health, and sexual rights.
This is a longer version than the published edit.
Editor’s note. Dallas Denny was licensed for 20 years as a psychological examiner; she recently retired her license. She founded and was executive director for ten years of the American Educational Gender Information Service, Inc., a national clearinghouse for transgender issues. She was editor and publisher of Chrysalis: The Journal of Transgressive Gender Identities. She has published extensively on transsexual issues and participated in and written about the developing transgender paradigm. Her books Gender Dysphoria: A Guide to Research, and Identity Management in Transsexualism were published in 1994, and her edited text Current Concepts in Transgender Identity was published in 1998. Dallas is a former senior advisor to Mayor Bill Campbell of Atlanta on gay, lesbian, bisexual, and transgender affairs, and the former secretary of the Board of Directors of Atlanta Pride.
Transgender in the United States: A Brief Discussion
By Dallas Denny
Transgender is a term which arose in the 1990s to describe individuals whose appearance, behavior, or self-identification varies from binary gender norms. In one sense, transgender is a global term which encompasses crossdressers, transsexuals, and transgenderists. However, when taken to mean transgressively gendered (Bornstein 1994), transgender can be seen as encompassing not only the more visibly gender-different, but anyone who feels uncomfortable with, dislikes, or resists John Wayne/Marilyn Monroe gender stereotypes. In this interpretation, gay men, lesbians, and bisexuals are transgendered because they transgress gender norms in regard to their sexual orientation, and, regardless of whether they identify as such, all women who are less than perfectly feminine and all men who are less than perfectly masculine (i.e., almost all of us) can thus be said to be transgendered (Rotello, 1996).
Our entire society can be viewed as somewhat transgendered because for the past several hundred years it has been steadily relaxing strict gender norms. This is perhaps most apparent in the changing sartorial styles and increasing civil equality of women. The casual dress of most contemporary American women would have been considered scandalous 50 years ago and was illegal less than 100 years ago, when women were routinely arrested for appearing in public in trousers. Changing gender norms are also reflected in the American workplace, in which women enter occupations and achieve levels of authority and responsibility once closed to them.
Transgender then, is not only a new term, but an alternate way of looking at gender. Transgender sensibility blends elements of feminist and queer and deconstructionist theory to posit that male and female genders are not natural categories, but are socially constructed and vary from culture to culture and over time within cultures.
Under the medical model which prevailed until the arise of this transgender sensibility, individuals whose gender presentation varied from binary norms were considered not merely different, but deviant. The transgender model has changed the locus of pathology from the individual to the society; it is not transsexuals, crossdressers, transgenderists, homosexuals, feminine men, or masculine women who are mentally ill or morally lacking, but rather a society which will not tolerate difference. This shift of perspective has forced a re-evaluation of the traditional clinical categories to which gender-different people have been assigned and cast light upon the often-erroneous and sexist assumptions of clinicians and researchers who have historically studied these populations. Transgender sensibility has also enabled transgendered and transsexual [2] people to cast aside their shame and forge new and proud identities, and to come together as a community.
Transgender History
Transgender history has been largely lost, sometimes deliberately repressed because of societal sensibilities, sometimes misinterpreted as gay or lesbian or mainstream history, and more usually simply ignored. Historians and anthropologists have begun to explore the fragmented historical record and are finding compelling evidence that people we would today call transgendered have existed from prehistoric times and until the modern era in hundreds of cultures on six continents (Cole, et al., 2000; R. Green, 1998; Taylor, 1996). Many societies have had formal and often honored social roles for transgendered men and women. [3]
In the West, existing transgender traditions began to be systematically eradicated about the time of the rise of Christianity (Bullough & Bullough, 1993, pp. 39-40, 45; Roscoe, 1994). Transgendered people thereafter lived largely in secret, but left legal and other records which later provided hundreds of case histories (cf Dekker & Van de Pol, 1989; Lowry, 1994). Many of our most revered historical personages, including more than a few saints, emperors, kings, queens, pharaohs, artists, writers, musicians, politicians, and great warriors lived as members of the other sex or otherwise exhibited characteristics which we can today consider transgendered (Feinberg, 1996).
The Medical Model
During the nineteenth and early twentieth centuries, clinicians like Ellis (1913), Hirschfeld (1910), Krafft-Ebing (1894), and Ulrichs (1994) began to study the people we today call intersexed, gay, and transgendered. They devised categories based on supposed psychopathology which have evolved and differentiated over the years into terms currently in use, for instance transvestite, transsexual, gender dysphoria, transvestic fetishism, and gender identity disorder. Initially, homosexuality and gender variance were conflated; it was not sexual orientation but masculinity in females and femininity in males which was considered the primary defining characteristic of homosexuality. Even after Hirschfeld (1910) differentiated transvestism and homosexuality, homosexuality was viewed as a psychopathology. It was included in the first edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association and remained until 1974, when it was moved to the back of the 2nd edition (DSM-II) (Bayer, 1987). With the publication of the DSM-III in 1980, homosexuality was removed entirely and has subsequently lost much of its stigma, but transsexualism was included for the first time in DSM-III and both transsexualism and crossdressing remain in DSM-IV under the respective diagnostic categories Transvestic Fetishism (302.3) and Gender Identity Disorder (302.6 for children, 302.85 for adults). Many mental health professionals continue to view crossdressing and transsexualism as mental disorders and are unaware of or choose to ignore the growing body of evidence which suggests otherwise.
Slave Names
Terms like transvestite and transsexual suggest pathology and were imposed upon transgendered and transsexual people. As such, they are similar to the “slave names” of Africans taken into slavery and forced to give up their names in favor of new names their masters found easy to pronounce. Clinical terms tend to constrain and direct the ways in which transgendered and transsexual people are discussed and viewed; for instance, transvestite, transsexual, and their analogs Transvestic Fetishism and Gender Identity Disorder are considered to be “diagnostic categories.” Diagnosis supposes psychopathology. It is difficult to view people as whole and sane when the language used to describe them argues otherwise.
Transgendered and transsexual people have begun to experiment with new identities and new names which do not pathologize them. The term transgender has gained consensus, and many people who would once have called themselves transvestites or transsexuals now simply say “I am transgendered.” The term transgender came into widespread use around 1994 and is now the most frequent term used by the gay and mainstream press and most researchers and clinicians and many transgender and transsexual people. However, transgendered people use a wide variety of terms to refer to themselves, and some still prefer the clinical terms. Words like transvestite and transsexual can still be useful, if only to distinguish between those who crossdress on occasion and those who crosslive full time and are in pursuit of or have had sex reassignment surgery.
Crossdressing
Crossdressing is a time-honored tradition in many societies, including our own. In American society, crossdressing is common in motion pictures, television, on the stage, and in the pages of our novels. Female impersonation has long been widespread in gay night clubs, but has always had a wide audience in the mainstream. “Womanless weddings” are still held from time to time in the South, and drag is common at Halloween and other times of celebration. Even the ecclesiastical robes worn by clergy in many Christian sects and the robes of judges are but ritualized crossdressing.
Crossdressing was long considered an activity practiced exclusively by gay males, but the second half of the twentieth century has seen the popularization of another type of crossdressing, that of the heterosexual male. While heterosexual males have always crossdressed (cf Farrer, 1987), they are now free to do so in public with little fear of arrest or harassment. Social and support groups for crossdressers can be found in many cities, and there is a small but thriving industry of publishers, makeover services, and manufacturers of silicone breast forms and womens’ shoes and clothing in larger sizes.
Heterosexual crossdressers began to meet in private in the 1950s and 1960s (Beigel, 1969), often with great fear of exposure. By the 1970s there was a national organization for them. Tri-Ess, the Society for the Second Self, was formed from two earlier organizations and styled itself as a “sorority” for crossdressers. From its inception, Tri-Ess vigilantly policed its ranks, excluding members who were openly gay or bisexual or transsexual, or were suspected of being so (Prince, n.d.). This made some sense in the 1950s and 1960s, when homosexuality was highly stigmatized, but is an embarrassment today in light of the political gains made by homosexuals. Tri-Ess continues to exclude gay men and transsexuals, but most transgender community organizations and events are open to anyone, regardless of sexual orientation or gender identity.
Motivations for Heterosexual Crossdressing
For many heterosexual males, there is a strong erotic component in crossdressing; indeed, episodic partial crossdressing is common among males in general. Many men expand their crossdressing and begin to totally emulate females, depilating their bodies and wearing wigs and makeup. For many such men, the erotic and fetishistic aspects of crossdressing diminish or disappear over time and the crossdressing becomes driven by a sense of internal femininity. Crossdressing becomes an expression of the “woman within” (Prince, 1967). This replacement of the erotic by the personal is poorly understood by researchers and clinicians, who tend to think of the crossdressing of heterosexual males as exclusively sexual in nature. Most clinicians also believe there is a vast difference between crossdressers and transsexuals, but in my experience this is often not the case. In fact, many male crossdressers become gender dysphoric and eventually come to identify as transsexuals and pursue sex reassignment.
Transsexualism
Technologies perfected in the twentieth century, specifically the ability to surgically alter genitalia and breasts, the synthesis of human sex hormones, and electrolysis made sex reassignment practical. Before the emergence of these technologies, passing as a member of the other gender was difficult or impossible for most men, who were betrayed by their secondary sex characteristics. In general, women could pass more easily, which may explain why there are more accounts in the literature of passing women (i.e., women who pass as men) than passing men.
History of Transsexualism
In the early 1950s a young American named George Jorgensen journeyed to Denmark and underwent hormonal and surgical treatments which allowed him to return to the United States as a woman (Hamburger et al., 1953). The publicity upon Christine Jorgensen’s return to the United States was enormous. While Jorgensen was not the first modern-day transsexual, she was the one who caught the attention of the press. Because of her, the world became aware that gender was not necessarily synonymous with biological sex, and that it was possible to alter one’s appearance and social role from one gender to another. Immediately, Jorgensen and her physicians were deluged from men and women desperate for a sex change (Hamburger, 1953). A demand for sex changing technologies had been created. This demand eventually led to the creation of a sex-changing industry.
Harry Benjamin, a New York endocrinologist, was involved with the early treatment of the people who would come to be known as transsexuals. In 1966, he published The Transsexual Phenomenon, in which he defined the syndrome of transsexualism and postulated that sex reassignment was an effective treatment for persons who were dysfunctional and unhappy in their gender of birth. Benjamin’s book popularized the term transsexual, which had not until then been widely used.
The term sex reassignment originated in the laboratories of John Money, who, in 1969, published, with Richard Green, Transsexualism and Sex Reassignment, an edited text which provided a treatment protocol for Benjamin’s transsexual syndrome. Money was instrumental in opening, at Johns Hopkins University in 1966, the first gender identity clinic in the United States.
By the late 1970s there were more than 50 gender clinics in the U.S. Some were better than others, but in general the clinics were characterized by a cautious approach to transsexualism which resulted in rejection for treatment of most applicants, many for reasons which today seem sexist or otherwise discriminatory (Denny, 1992). For example, applicants were rejected because they did not have the “proper” (i.e., pre-transition homosexual and thus post-transition heterosexual) sexual orientations, because the clinic’s clinicians deemed they would not “pass” successfully as a member of the new sex, because they did not apply for treatment at an early enough age, because they did not seem sufficiently feminine or masculine to the clinicians, because they did not sexually arouse the clinicians (Kessler & McKenna, 1978, p. 118), because they were married, or because they had achieved some measure of success in their birth gender. It was common for clinics to impose unwanted lifestyle choices on their patients, requiring them to divorce, change jobs, and even select particular sexual partners.
Most clinics were affiliated with universities and were thus centers for research as much as treatment. Most of the scientific articles published about transsexualism in the 1970s originated from the clinics, and concerned, not surprisingly, the diagnosis, treatment, and management of transsexual patients. In general, the literature of this period depicts transsexuals as immature, hysterical, or otherwise dysfunctional, due more, I am certain, to the biased selection criteria used by the clinics than to the nature of the transsexuals themselves. Reports also presented clinical distinctions such as primary and secondary transsexualism (Person & Ovesey, 1974a, 1974b), which may ultimately prove to be an artifact of the assumptions and treatment regimens of the time. [4]
Unfortunately, even as the new millennium begins, some gender programs are still applying unfair and biased selection criteria (Petersen & Dickey, 1995).
1979
1979 was a watershed year for transsexualism, for three reasons: First, feminist author Janice Raymond published her book The Transsexual Empire, attacking transsexualism as a plot by male physicians to render women obsolete. Unfortunately, Raymond did not limit herself to invective, but campaigned to deny transsexuals the right to surgical and hormonal treatment (cf. Raymond, 1980).
The second significant event of 1979 was the publication, in Archives of Gender Psychiatry, of an outcome study by Jon Meyer and Donna Reter which purported to show “no objective advantage” to sex reassignment surgery for male-to-female transsexuals. Meyer, who was the director of the Hopkins gender clinic, timed the release of the article so John Money, the clinic’s primary proponent, would be out of the country, and popularized his findings via press releases, with the result that every major newspaper and magazine of the day carried the story that sex reassignment did not benefit transsexuals.
Meyer’s methodology was sloppy, to say the least, and his article came under immediate attack (for a review, see Blanchard & Sheridan, 1990). Eventually, it was demonstrated that the study was part of a plot to discredit sex reassignment, and was thus probably fraudulent (McHugh, 1992; Ogas, 1994). However, the study had the intended effect, with the result that the Hopkins program was closed. Domino-like, the other gender programs in the United States shut down for the next few years.
What the conspirators didn’t realize was that the closure of the clinics would ultimately prove beneficial to transsexuals, for it led to the development of a market economy, with the ultimate result that the technologies of sex reassignment became available to virtually everyone rather than the select few who had been accepted by the clinics.
The third significant event of 1979 was the development of the Standards of Care of the Harry Benjamin International Gender Dysphoria Association (Walker, et al., 1984). These standards drew upon protocols developed at Johns Hopkins, most notably the real-life test, which required an individual to live full-time as a member of the new gender in order to become eligible for sex reassignment test). The Standards of Care also required letters of authorization from counseling professionals before the transsexual individual was allowed access to hormones and surgery.
The Standards of Care have been updated periodically, most notably in 1998 (Levine et al., 1998), which marked the first time they saw significant—and controversial—changes. The Standards were revised again in 2000, and are once again undergoing revision.
Men
This review would not be complete without some discussion of transgendered and transsexual men [5], that is female crossdressers and transgenderists and female-to-male transsexuals. Initially, transsexual men were considered to be somewhat more rare than transsexual women. The DSM-IV, for example, gives the prevalence of male-to-female transsexuals at 1:40,000 and female-to-male transsexuals at 1:100,000. Many authorities now consider there to be many more female-to-male transsexuals than was once believed. It would seem it merely took a while for the men’s community to become established and for transgendered and transsexual men to begin to come forward in large numbers (J. Green, 1998). There are any number of reasons postulated for this: first, in our culture, females are able to be quite masculine without attracting undue attention, and so did not necessarily need to apply to gender programs in order to dress and behave in the manner of nontranssexual men; second, genital surgery for transsexual men, although expensive and painful and with often questionable outcomes, has improved considerably over the years, and good quality chest reconstruction surgery has become more available; and third, transgendered and transsexual men were simply overshadowed by the attention paid by researchers and the media to male-to-female transsexuals (Cromwell, 1999).
The professional literature is replete with declarations that there is but one category of female-to-male transsexuals, women who have been extremely masculine throughout their lives and are sexually attracted exclusively to nontranssexual females. The literature flatly states that female crossdressers do not exist, and some clinicians continue to deny that they do, regardless of the fact that female crossdressers have been writing about their experiences for many years (Cole & Meyer, 1998). This denial on the part of clinicians would seem to stem from the belief, erroneous on both counts, that all male crossdressing is fetishistic in nature, and that females do not show such fetishism. When the men’s community began to come together in significant numbers, transgendered and transsexual men discovered they were a diverse community with many different ways of identifying and expressing themselves (J. Green, 1998). We now know there are indeed female crossdressers, and that some obtain erotic satisfaction from crossdressing. We also know many transsexual men are attracted to other men, and that some were quite feminine when living in the female role (see Devor, 1997 for a typology of female gender variance).
Sexual Orientation
It’s also important to address the issue of the sexual orientation of transgendered and transsexual people, for the general populace and unfortunately many clinicians do not seem to understand that gender expression does not dictate sexual orientation (Denny & J. Green, 1996). Transgendered and transsexual people show the same range of sexual attractions and orientations found in the general populace. Transsexuals may be either heterosexual, bisexual, or homosexual before transition, and this orientation may or may not change after transition. Many transgendered and transsexual people are attracted to other transgendered and transsexual people. Unfortunately, the DSM-IV continues to classify transsexual people by their sexual orientation, and clinicians sometimes zero in on sexual orientation when the presenting problem is gender identity (see Lawrence, 1998, for an example of this).
Counseling the Transgendered Client
Transgendered and transsexual persons often experience confusion and anxiety about their gender identity. In the past, guilt and denial were pervasive, but today the availability of support groups, the many resources which can be found on the internet, and exposure to individuals who feel positively about being transgendered or transsexual help many to work through their issues without therapy. Most, however, do seek counseling, either to help them deal with feelings of guilt and denial or the disruption of their lives caused by the reactions of others to their transgendered or transsexual natures, or to seek the requisite authorization letters required for sex reassignment. The role of the therapist is to help the individual explore his or her feelings and explore the many options available for self-expression. If the individual seeks sex reassignment, the therapist can serve as a resource by locating needed services and making referrals, and can be a sounding board for issues which arise during transition. The therapist can help family members and life partners deal with their often tumultuous feelings about the transgender issue, and serve as an educator for employers who wish to learn more about gender identity issues so they can accommodate the individual during transition. When appropriate, the therapist can refer the individual to a formal gender program; however, despite the existence of several excellent programs, most transsexuals prefer the “a la carte” approach to sex reassignment, in which they serve as the case managers for their own transitions, choosing which procedures to have, when they will be performed, and who will perform them. Currently, there are dozens of sex reassignment surgeons, hundreds of endocrinologists and plastic surgeons, and thousands of electrologists who are willing to assist transsexual men and women before, during, and after their gender transitions.
Resources: Some Transgender and Transsexual Referral Sources
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.
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
Notes
[1] Transgenderists are individuals who identify somewhere between the two traditional genders. Some transgenderists live publicly as members of the other sex, but without the sex reassignment surgery desired by transsexuals. Transgenderists tend to be highly individualistic in the ways they view their gender. Some see themselves as neither man nor woman, others as both man and woman, and some as members of a third or alternate sex.
[2] Some transsexuals object to being classified as transgendered; therefore I have whenever possible used the term transgendered and transsexual to refer to the constellation of crossdressers, transgenderists, and transsexuals.
[3] It is of course impossible to determine how someone from another culture or another time would identify when presented with a list of contemporary gender definitions. Perhaps some would call themselves transsexual, some gay, some crossdressers, and some transgenderists, but we cannot be sure of this. We do know, however, that many individuals showed extreme variance in their gender presentations, including the wearing of clothing and the taking on of social roles characteristic of the other sex, and that some males voluntarily had themselves castrated and emasculated.
[4] The classification of transsexuals into primary and secondary categories was limited to male-to-females; female-to-males were considered to be all of a kind (cf Lothstein, 1983). Primary transsexuals were considered to be more “naturally” feminine, to have experienced gender dysphoria from an earlier age, and to be better prospects for sex reassignment than secondary transsexuals, who tended to present at a later age with a more masculine facade, have trouble passing, and were believed to be poor prospects for sex reassignment. I have argued that the real distinction may be the age at which the individual comes to grips with and begins to do something about his transsexualism rather than the differing etiologies postulated by early researchers (Denny, unpublished).
[5] Early researchers described transsexuals in relation to their biological gender rather than the gender of identification. Thus, transsexuals transitioning from male to female were called male transsexuals and their female-born counterparts were called female transsexuals. Today, the terms male-to-female transsexual and female-to-male transsexual are more commonly used in the clinical literature. Recent data show many transsexuals prefer the term transsexual women and transsexual men to refer to, respectively, male-to-female and female-to-male transsexuals (Cromwell, Green, & Denny, 2001). Note that in this usage transsexual is an adjective rather than a noun and thus does not tend to objectify the individual.
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