Gender identity is the personal sense of one's own gender . Gender identity can correlate with a person's assigned sex or can differ from it. In most individuals, the various biological determinants of sex are congruent, and consistent with the individual's gender identity. Gender expression typically reflects a person's gender identity, but this is not always the case. While a person may express behaviors, attitudes, and appearances consistent with a particular gender role , such expression may not necessarily reflect their gender identity. The term gender identity was coined by psychiatry professor Robert J. Stoller in 1964 and popularized by psychologist John Money .
172-764: A transgender (often shortened to trans ) person is someone whose gender identity differs from that typically associated with the sex they were assigned at birth . Often, transgender people desire medical assistance to medically transition from one sex to another; those who do may identify as transsexual . Transgender does not have a universally accepted definition, including among researchers; it can function as an umbrella term . The definition given above includes binary trans men and trans women and may also include people who are non-binary or genderqueer . Other related groups include third-gender people, cross-dressers , and drag queens and drag kings ; some definitions include these groups as well. Being transgender
344-486: A college textbook , although many of Money's ideas have since been challenged. In the late 1980s, gender studies scholar Judith Butler began lecturing regularly on the topic of gender identity, and in 1990, they published Gender Trouble: Feminism and the Subversion of Identity , introducing the concept of gender performativity . Butler argues that the traditional view of gender is limiting in that it adheres to
516-653: A gender binary to which most people adhere and which includes expectations of masculinity and femininity in all aspects of sex and gender : biological sex , gender identity, gender expression and sexual orientation. Some people do not identify with some, or all, of the aspects of gender associated with their biological sex; some of those people are transgender , non-binary, or genderqueer . Some societies have third gender categories. The 2012 book Introduction to Behavioral Science in Medicine says that with exceptions, "Gender identity develops surprisingly rapidly in
688-453: A guru . These communities have consisted over generations of those who are in abject poverty or who have been rejected by or fled their family of origin. Many work as sex workers for survival. The word "hijra" is a Hindustani word. It has traditionally been translated into English as "eunuch" or " hermaphrodite ", where "the irregularity of the male genitalia is central to the definition". However, in general hijras are born male, only
860-545: A "dislike and sometimes incapacity for needlework". During the mid-1900s, doctors pushed for corrective therapy on such women and children, which meant that gender behaviors that were not part of the norm would be punished and changed. The aim of this therapy was to push children back to their "correct" gender roles and thereby limit the number of children who became transgender. In 1905, Sigmund Freud presented his theory of psychosexual development in Three Essays on
1032-492: A "growing chorus of voices contesting the pathologization of transgender lives and the dominance of medical-scientific narratives about trans experience." As such, in 2019, the World Health Organization removed gender dysphoria from the mental illness chapter and moved it instead to the sexual health chapter, changing the term "Gender Dysphoria" to "Gender Incongruence," thereby removing gender dysphoria as
1204-645: A 'cure'." The "Yogyakarta Principles in Action" says "it is important to note that while 'sexual orientation' has been declassified as a mental illness in many countries, 'gender identity' or 'gender identity disorder' often remains in consideration." These Principles influenced the UN declaration on sexual orientation and gender identity . In 2015, gender identity was part of the United States Supreme Court case Obergefell v. Hodges in which marriage
1376-505: A 2005 academic paper questioned the classification of gender identity problems as a mental disorder , speculating that certain DSM revisions may have been made on a tit-for-tat basis when certain groups were pushing for the removal of homosexuality as a disorder. This remains controversial, although the vast majority of today's mental health professionals follow and agree with the current DSM classifications. In recent years, however, there has been
1548-437: A broader shift in the understanding of transgender people's sense of self and the increasing recognition of those who decline medical reassignment as part of the transgender community. Transgender can also refer specifically to a person whose gender identity is opposite (rather than different from ) the sex the person had or was identified as having at birth. In contrast, people whose sense of personal identity corresponds to
1720-473: A child's attitude on gender. A mother's behavior was especially influential on a child's assumptions of the child's own gender. For example, mothers who practiced more traditional behaviors around their children resulted in the son displaying fewer stereotypes of male roles while the daughter displayed more stereotypes of female roles. No correlation was found between a father's behavior and his children's knowledge of stereotypes of their own gender. Fathers who held
1892-430: A child's life. The social learning theory posits that children furthermore develop their gender identity through observing and imitating gender-linked behaviors, and then being rewarded or punished for behaving that way, thus being shaped by the people surrounding them through trying to imitate and follow them. Large-scale twin studies suggest that the development of both transgender and cisgender gender identities
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#17327724437262064-425: A condition related to gender identity rather than sexuality . Some transsexual people object to being included in the transgender umbrella. In his 2007 book Imagining Transgender: An Ethnography of a Category , anthropologist David Valentine asserts that transgender was coined and used by activists to include many people who do not necessarily identify with the term and states that people who do not identify with
2236-501: A diagnosis of gender identity disorder can be made, and the disorder is further subdivided into specific diagnoses based on age, for example gender identity disorder in children (for children who experience gender dysphoria). The concept of gender identity appeared in the third edition of the DSM, DSM-III (1980), in the form of two psychiatric diagnoses of gender dysphoria: gender identity disorder of childhood (GIDC), and transsexualism (for adolescents and adults). The 1987 revision of
2408-583: A different gender role. In 1994, the DSM IV entry was changed from "Transsexual" to "Gender Identity Disorder". In 2013, the DSM V removed "Gender Identity Disorder" and published "Gender Dysphoria" in its place. In many places, transgender people are not legally protected from discrimination in the workplace or in public accommodations. A report released in February 2011 found that 90% of transgender Americans faced discrimination at work and were unemployed at double
2580-475: A durable biological element underlying gender identity. Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity. Some studies have investigated whether there is a link between biological variables and transgender or transsexual identity. Several studies have shown that sexually dimorphic brain structures in transsexuals are shifted away from what
2752-465: A few having been born with intersex variations. Some hijras undergo an initiation rite into the hijra community called nirvaan, which involves the removal of the penis, scrotum, and testicles . Gender-affirming surgery Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a person's physical appearance and sexual characteristics to resemble those associated with their identified gender . The phrase
2924-491: A gender different than the gender they were thought to be at birth." Detransition was associated with assigned male sex at birth, nonbinary gender identity, and bisexual orientation, among other cohorts. Only 5% of detransitioners (or 0.4% of total respondents) reported doing so because gender transition was "not for them"; 82% cited external reason(s), including pressure from others, the difficulties of transition, and discrimination. "The most common reason cited for de-transitioning
3096-444: A gender transition. Clinical training lacks relevant information needed in order to adequately help transgender clients, which results in a large number of practitioners who are not prepared to sufficiently work with this population of individuals. Many mental healthcare providers know little about transgender issues. Those who seek help from these professionals often educate the professional without receiving help. This solution usually
3268-407: A girl than Reimer's, and who remained a woman into adulthood. She reported that she had been somewhat tomboyish during childhood, enjoying stereotypically masculine childhood toys and interests, although her childhood friends were girls. While she was bisexual , having had relationships with both men and women, she found women more sexually attractive and they featured more in her fantasies. Her job at
3440-508: A girl. Reimer underwent sex reassignment surgery at seventeen months and grew up as a girl, dressing in girl clothes and surrounded by girl toys. In the early 1970s, Money reported that Reimer's sex reassignment to female was a success, influencing the academic consensus toward the nurture hypothesis, and for the following 30 years, it became standard medical practice to reassign intersex infants and male infants with micropenises to female. After Reimer tried to commit suicide at age 13, he
3612-455: A healthcare team consisting of a variety of providers including endocrinologists , whom the surgeon may consult when determining if the patient is physically fit for surgery. Health providers including pharmacists can play a role in maintaining safe and cost-effective regimens, providing patient education, and addressing other health issues including smoking cessation and weight loss. People with HIV or hepatitis C may have difficulty finding
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#17327724437263784-599: A larger number of surgical procedures performed as part of a medical treatment for gender dysphoria . WPATH says medically necessary gender-affirming surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation ... including breast prostheses if necessary, genital reconstruction (by various techniques which must be appropriate to each patient ...)... and certain facial plastic reconstruction." Other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial hair electrolysis . Voice feminizing surgery
3956-609: A larger, more " cis -appearing" penis in multiple stages. On 12 June 2003, the European Court of Human Rights ruled in favor of Carola van Kück, a German trans woman whose insurance company denied her reimbursement for sex reassignment surgery as well as hormone replacement therapy . The legal arguments related to the Article 6 of the European Convention on Human Rights as well as the Article 8 . This affair
4128-609: A lifelong course of masculinizing or feminizing hormone replacement therapy to support the endocrine system. Sweden became the first country in the world to allow transgender people to change their legal gender after "reassignment surgery" and provide free hormone treatment, in 1972. Singapore followed soon after in 1973, being the first in Asia. Gender-affirming surgery is known by many other names, including gender-affirmation surgery , sex reassignment surgery , gender reassignment surgery , and gender confirmation surgery . It
4300-474: A long tradition in LGBTQ culture . Generally the term drag queen covers men doing female drag, drag king covers women doing male drag, and faux queen covers women doing female drag. Nevertheless, there are drag artists of all genders and sexualities who perform for various reasons. Drag performers are not inherently transgender. Some drag performers, transvestites, and people in the gay community have embraced
4472-441: A major role in the behavior of different sexes. The researchers in the lab would inject the pregnant rat with testosterone, which would then find its way to the baby's bloodstream. The females that were born had genitalia that looked like male genitalia. The females in the litter also behaved like male rats and would even try to mount other female rats, proving that biology played a major role in animal behavior. One criticism of
4644-408: A manner that distances the sons from femininity, with Kane stating that "the parental boundary maintenance work evident for sons represents a crucial obstacle limiting boys' options, separating boys from girls, devaluing activities marked as feminine for both boys and girls, and thus bolstering gender inequality and heteronormativity." Many parents form gendered expectations for their child before it
4816-436: A masquerade, and so on. These individuals are cross dressing but are not cross dressers." Cross-dressers may not identify with, want to be, or adopt the behaviors or practices of the opposite gender and generally do not want to change their bodies medically or surgically. The majority of cross-dressers identify as heterosexual. The term transvestite and the associated outdated term transvestism are conceptually different from
4988-558: A minimum duration of psychological evaluation and living as a member of the target gender full-time, sometimes called the real life experience (RLE) (sometimes mistakenly called the real life test [RLT]) before sex reassignment surgeries are covered by insurance. Standards of Care usually give certain very specific "minimum" requirements as guidelines for progressing with treatment, causing them to be highly controversial and often maligned documents among transgender patients seeking surgery. Alternative local standards of care exist, such as in
5160-626: A pathological mental illness. The Yogyakarta Principles , a document on the application of international human rights law , provide in the preamble a definition of gender identity as each person's deeply felt internal and individual experience of gender, which may not correspond with the sex assigned at birth, including the person's sense of the body (which may involve, if freely chosen, modification of bodily appearance or function by medical, surgical or other means) and other experience of gender, including dress, speech and mannerism. Principle 3 states that "Each person's self-defined [...] gender identity
5332-400: A period of real-life experience living in the desired gender. Feminization surgeries are surgeries that result in female-looking anatomy, such as vaginoplasty , vulvoplasty and breast augmentation . Masculinization surgeries are those that result in male-looking anatomy, such as phalloplasty and breast reduction . In addition to gender-affirming surgery, patients may need to follow
Transgender - Misplaced Pages Continue
5504-937: A person's gender identity is inconsistent with their biological sex characteristics (genitals and secondary sex characteristics ), resulting in individuals dressing and/or behaving in a way which is perceived by others as outside cultural gender norms. These gender expressions may be described as gender variant , transgender, or genderqueer (or non-binary ) (there is an emerging vocabulary for those who defy traditional gender identity), and people who have such expressions may experience gender dysphoria (traditionally called gender identity disorder or GID). Transgender individuals are often greatly affected by language and gender pronouns before, during, and after their transition . In recent decades it has become possible to provide sex reassignment surgery . Some people who experience gender dysphoria seek such medical intervention to have their physiological sex match their gender identity; others retain
5676-1730: A person's sexual orientation without reference to their gender identity. Therapists are coming to understand the necessity of using terms with respect to their clients' gender identities and preferences. The 2015 U.S. Transgender Survey reported that of the 27,715 transgender and non-binary respondents, 21% said queer best described their sexual orientation, 18% said pansexual , 16% said gay , lesbian , or same-gender-loving , 15% said straight , 14% said bisexual , and 10% said asexual . A 2019 Canadian survey of 2,873 trans and non-binary people found that 51% described their sexual orientation as queer, 13% as asexual, 28% as bisexual, 13% as gay, 15% as lesbian, 31% as pansexual, 8% as straight or heterosexual, 4% as two-spirit , and 9% as unsure or questioning . A 2009 study in Spain found that 90% of trans women patients reported being androphilic and 94% of trans men patients reported being gynephilic. Some non-binary (or genderqueer) people identify as transgender. These identities are not specifically male or female. They can be agender, androgynous, bigender, pangender, or genderfluid , and exist outside of cisnormativity . Bigender and androgynous are overlapping categories; bigender individuals may identify as moving between male and female roles (genderfluid) or as being both masculine and feminine simultaneously (androgynous), and androgynes may similarly identify as beyond gender or genderless (agender), between genders (intergender), moving across genders ( genderfluid ), or simultaneously exhibiting multiple genders (pangender). Non-binary gender identities are independent of sexual orientation. A transvestite
5848-476: A predominantly masculine gender identity or presentation. Transgendered is a common term in older literature. Many within the transgender community deprecate it on the basis that transgender is an adjective, not a verb. Organizations such as GLAAD and The Guardian also state that transgender should never be used as a noun in English (e.g., "Max is transgender " or "Max is a transgender man ", not "Max
6020-518: A primitive form of gender-affirming surgery . Worldwide, a number of societies have had traditional third gender roles, some of which continue in some form into the present day. The Hippocratic Corpus (interpreting the writing of Herodotus ) describes the "disease of the Scythians " (regarding the Enaree ), which it attributes to impotency due to riding on a horse without stirrups. This reference
6192-438: A request for it. Genital surgery may also involve other medically necessary procedures, such as orchiectomy , penectomy , or vaginectomy . Complications of penile inversion vaginoplasty are mostly minor; however, rectoneovaginal fistula (abnormal connection between the neovagina and the rectum) can occur in about 1–3% of patients. These require further surgery to correct. As underscored by WPATH, gender transition may entail
6364-432: A result of the new understanding of gender, academic usage of the term sex began to be more restricted to biological aspects, and associated with the choices male and female , while the term gender was associated initially with man or boy , girl or woman . While academic usage of terms man and woman began to diverge at the same time, and become more restricted to concepts related to gender, this distinction
6536-625: A study on the impact of parental support on trans youth found that among trans children with supportive parents, only 4% attempted suicide, a 93% decrease. Autism is more common in people who are gender dysphoric. It is not known whether there is a biological basis. This may be due to the fact that people on the autism spectrum are less concerned with societal disapproval, and feel less fear or inhibition about coming out as trans than others. Medical and surgical procedures exist for transsexual and some transgender people, though most categories of transgender people as described above are not known for seeking
6708-417: A surgeon able to perform successful surgery. Many surgeons operate in small private clinics that cannot treat potential complications in these populations. Some surgeons charge higher fees for HIV and hepatitis C-positive patients; other medical professionals assert that it is unethical to deny surgical or hormonal treatments to transgender people solely on the basis of their HIV or hepatitis status. Fertility
6880-417: A therapist and most of their issues have nothing to do, specifically, with being transgendered. It has to do because they've had to hide, they've had to lie, and they've felt all of this guilt and shame, unfortunately usually for years!" Many transgender people also seek mental health treatment for depression and anxiety caused by the stigma attached to being transgender, and some transgender people have stressed
7052-710: A third gender. They are anatomically male but dress and behave in a manner considered typically feminine. According to Tamasailau Sua'ali'i ( see references ), fa'afafine in Samoa at least are often physiologically unable to reproduce. Fa'afafine are accepted as a natural gender, and neither looked down upon nor discriminated against. Fa'afafine also reinforce their femininity with the fact that they are only attracted to and receive sexual attention from straight masculine men. They have been and generally still are initially identified in terms of labour preferences, as they perform typically feminine household tasks. The Samoan Prime Minister
Transgender - Misplaced Pages Continue
7224-552: A trend towards less well-defined gender roles and identities, as studies of the parental association ("coding") of toys as masculine, feminine, or neutral indicate that parents increasingly code kitchens and in some cases dolls as neutral rather than exclusively feminine. However, Emily Kane found that many parents still showed negative responses to items, activities, or attributes that were considered feminine, such as domestic skills, nurturance, and empathy. Research has indicated that many parents attempt to define gender for their sons in
7396-425: A vagina . The most common techniques are penile inversion , rectosigmoid vaginoplasty and peritoneal pullthrough vaginoplasty (PPT). Another technique, the non-penile inversion technique, uses perforated scrotal tissue to construct the vaginal canal. For trans men , genital reconstruction may involve the construction of a penis through either phalloplasty or metoidioplasty . For non-binary people, both
7568-660: A variety of non-genital surgeries that change primary or secondary sex characteristics, any of which are considered "gender-affirming surgery" when done to affirm a person's gender identity . For trans men, these may include mastectomy (removal of the breasts) and chest reconstruction (the shaping of a male-contoured chest), or hysterectomy and bilateral salpingo-oophorectomy (removal of ovaries and fallopian tubes ). For some trans women, facial feminization surgery , hair transplants , and breast augmentation are also aesthetic components of their surgical treatment. The best-known gender-affirming procedures are those that reshape
7740-539: Is a transgender "). "Transgender" is also a noun for the broader topic of transgender identity and experience. Assigned Female At Birth ( AFAB ), Assigned Male At Birth ( AMAB ), Designated Female at Birth ( DFAB ), and Designed Male at Birth (DMAB) are terms used to represent a person's sex assigned at birth; they are considered to be more gender-inclusive than the related terms biological male or biological female . Health-practitioner manuals, professional journalistic style guides, and LGBT advocacy groups advise
7912-546: Is a person who cross-dresses, or dresses in clothes typically associated with the gender opposite the one they were assigned at birth. The term transvestite is used as a synonym for the term cross-dresser , although cross-dresser is generally considered the preferred term. The term cross-dresser is not exactly defined in the relevant literature. Michael A. Gilbert, professor at the Department of Philosophy, York University, Toronto, offers this definition: "[A cross-dresser]
8084-485: Is a person who has an apparent gender identification with one sex, and who has and certainly has been birth-designated as belonging to [that] sex, but who wears the clothing of the opposite sex because it is that of the opposite sex." This definition excludes people "who wear opposite sex clothing for other reasons", such as "those female impersonators who look upon dressing as solely connected to their livelihood, actors undertaking roles, individual males and females enjoying
8256-515: Is a procedure in which the overall pitch range of the patient's voice is reduced. Adam's apple reduction surgery ( chondrolaryngoplasty ) or tracheal shaving is a procedure in which the most prominent part of the thyroid cartilage is reduced. There is also Adam's apple enhancement therapy, in which cartilage is used to bring out the Adam's apple in female-to-male patients. Reports of people seeking gender-confirming surgery (vaginoplasty) go back to
8428-580: Is also a factor considered in gender-affirming surgery, as patients are typically informed that if an orchiectomy or oöphoro-hysterectomy is performed, it will make them irreversibly infertile. Gender-affirming surgery is generally not performed on children under 18, though in rare cases may be performed on adolescents if health care providers agree there is an unusual benefit to doing so or risk to not performing it. Preferred treatments for children include puberty blockers , which are thought to have some reversible physical changes, and sex hormones, which reduce
8600-462: Is also sometimes called a sex change , though this term is usually considered offensive. Top surgery and bottom surgery refer to surgeries on the chest and genitals respectively. Some transgender people who want medical assistance to transition from one sex to another identify as " transsexual ". Trans women and others assigned male at birth may undergo one or more feminizing procedures: genital surgeries such as penectomy (removal of
8772-690: Is an individual's enduring pattern of attraction, or lack thereof, to others (being straight , lesbian , gay , bisexual , asexual , etc.), whereas gender identity is a person's innate knowledge of their own gender (being a man, woman, non-binary, etc.). Transgender people can have any orientation, and generally use labels corresponding to their gender, rather than assigned sex at birth. For example, trans women who are exclusively attracted to other women commonly identify as lesbians, and trans men exclusively attracted to women would identify as straight. Many trans people describe their sexual orientation as queer, in addition to or instead of, other terms. For much of
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#17327724437268944-829: Is assigned to the provinces and territories. This includes legal change of gender classification. On June 19, 2017, Bill C-16 , having passed the legislative process in the House of Commons of Canada and the Senate of Canada , became law upon receiving Royal Assent , which put it into immediate force. The law updated the Canadian Human Rights Act and the Criminal Code to include "gender identity and gender expression" as protected grounds from discrimination, hate publications and advocating transgender genocide . The bill also added "gender identity and expression" to
9116-422: Is associated with their birth sex and towards what is associated with their preferred sex. The volume of the central subdivision of the bed nucleus of a stria terminalis or BSTc (a constituent of the basal ganglia of the brain which is affected by prenatal androgens ) of transsexual women has been suggested to be similar to women's and unlike men's, but the relationship between BSTc volume and gender identity
9288-504: Is called van Kück vs Germany . In 2011, Christiane Völling won the first successful case brought by an intersex person against a surgeon for non-consensual surgical intervention described by the International Commission of Jurists as "an example of an individual who was subjected to sex reassignment surgery without full knowledge or consent". As of 2017, some European countries require forced sterilization for
9460-529: Is distinct from sexual orientation , and transgender people may identify as heterosexual (straight), homosexual (gay or lesbian), bisexual , asexual , or otherwise, or may decline to label their sexual orientation. The opposite of transgender is cisgender , which describes persons whose gender identity matches their assigned sex. Accurate statistics on the number of transgender people vary widely, in part due to different definitions of what constitutes being transgender. Some countries, such as Canada , and
9632-431: Is due to genetic factors, with a small potential influence of unique environmental factors. John Money was instrumental in the early research of gender identity, though he used the term gender role . He disagreed with the previous school of thought that gender was determined solely by biology. He argued that infants are born a blank slate and a parent could be able to decide their babies' gender. In Money's opinion, if
9804-435: Is even born, after determining the child's sex through technology such as ultrasound . The child thus is born to a gender-specific name, games, and even ambitions. Once the child's sex is determined, most children are raised to in accordance with it, fitting a male or female gender role defined partly by the parents. When considering the parents' social class, lower-class families typically hold traditional gender roles, where
9976-522: Is exclusive to humans. In a position statement, the Endocrine Society stated: The medical consensus in the late 20th century was that transgender and gender incongruent individuals suffered a mental health disorder termed "gender identity disorder." Gender identity was considered malleable and subject to external influences. Today, however, this attitude is no longer considered valid. Considerable scientific evidence has emerged demonstrating
10148-506: Is extremely difficult to change gender identity. Martin and Ruble conceptualize this process of development as three stages: (1) as toddlers and pre-schoolers, children learn about defined characteristics, which are socialized aspects of gender; (2) around the ages of five to seven years, identity is consolidated and becomes rigid; (3) after this "peak of rigidity", fluidity returns and socially defined gender roles relax somewhat. Barbara Newmann breaks it down into four parts: (1) understanding
10320-421: Is good for transsexual people but is not the solution for other transgender people, particularly non-binary people who lack an exclusively male or female identity. Instead, therapists can support their clients in whatever steps they choose to take to transition or can support their decision not to transition while also addressing their clients' sense of congruence between gender identity and appearance. Research on
10492-562: Is integral to their personality and is one of the most basic aspects of self-determination, dignity and freedom. No one shall be forced to undergo medical procedures, including sex reassignment surgery, sterilisation or hormonal therapy, as a requirement for legal recognition of their gender identity." Principle 18 states that "Notwithstanding any classifications to the contrary, a person's sexual orientation and gender identity are not, in and of themselves, medical conditions and are not to be treated, cured or suppressed." Relating to this principle,
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#173277244372610664-893: Is made from testosterone in the body, can be converted into estrogen , and external estrogen is a risk factor for endometrial cancer. Detransition refers to the cessation or reversal of a sex reassignment surgery or gender transition. Formal studies of detransition have been few in number, of disputed quality, and politically controversial. Estimates of the rate at which detransitioning occurs vary from less than 1% to as high as 13%. Those who undergo sex reassignment surgery have very low rates of detransition or regret. The 2015 U.S. Transgender Survey, with responses from 27,715 individuals who identified as "transgender, trans, genderqueer, [or] non-binary", found that 8% of respondents reported some kind of detransition. "Most of those who de-transitioned did so only temporarily: 62% of those who had de-transitioned reported that they were currently living full time in
10836-488: Is most often associated with transgender health care and intersex medical interventions , though many such treatments are also pursued by cisgender and non-intersex persons. It is also known as sex reassignment surgery (SRS), gender confirmation surgery (GCS), and several other names . Professional medical organizations have established Standards of Care , which apply before someone can apply for and receive reassignment surgery, including psychological evaluation, and
11008-417: Is neither determined entirely by childhood rearing nor entirely by biological factors. Several prenatal biological factors, including genes and hormones, may affect gender identity. It has been suggested that gender identity is controlled by prenatal sex steroids , but this is hard to test because there is no way to study gender identity in animals. According to biologist Michael J. Ryan , gender identity
11180-461: Is often misinterpreted as implying that all transgender people suffer from GD, which has confused transgender people and those who seek to either criticize or affirm them. Transgender people who are comfortable with their gender and whose gender is not directly causing inner frustration or impairing their functioning do not suffer from GD. Moreover, GD is not necessarily permanent and is often resolved through therapy or transitioning. Feeling oppressed by
11352-609: Is patron of the Samoa Fa'afafine Association . Translated literally, fa'afafine means "in the manner of a woman." Hijras are officially recognized as third gender in the Indian subcontinent, being considered neither completely male nor female. Hijras have a recorded history in the Indian subcontinent since antiquity, as suggested by the Kama Sutra . Many hijras live in well-defined and organised all-hijra communities, led by
11524-569: Is relatively new. The term gender incongruence is listed in the ICD by the WHO . In the American ( DSM ), the term gender dysphoria is listed under code F64.0 for adolescents and adults , and F64.2 for children . (Further information: Causes of gender incongruence .) France removed gender identity disorder as a diagnosis by decree in 2010, but according to French trans rights organizations, beyond
11696-481: Is still unclear. Similar brain structure differences have been noted between gay and heterosexual men, and between lesbian and heterosexual women. Transsexuality has a genetic component. Research suggests that the same hormones that promote the differentiation of sex organs in utero also elicit puberty and influence the development of gender identity. Different amounts of these male or female sex hormones can result in behavior and external genitalia that do not match
11868-542: Is the removal of all external genitalia except the urethral opening, typically pursued by people assigned male at birth. Gender-affirming surgery can also refer to operations pursued by cisgender people, such as mammaplasty , penile implant , or testicular implants following orchiectomy . Gender-affirming surgery is often sensationalized and misrepresented by anti-trans activists through terms such as genital-mutilation surgery . For trans women , genital reconstruction usually involves surgical construction of
12040-450: Is thus distinct from gender identity in that it is the external expression of gender but may not necessarily portray a person's gender identity and may vary "according to racial/ethnic background, socio-economic status and place of residence." In late-19th-century medical literature, women who chose not to conform to their expected gender roles were called "inverts", and they were portrayed as having an interest in knowledge and learning, and
12212-402: Is widely agreed that core gender identity is firmly formed by age 3. At this point, children can make firm statements about their gender and tend to choose activities and toys which are considered appropriate for their gender (such as dolls and painting for girls, and tools and rough-housing for boys), although they do not yet fully understand the implications of gender. After age three, it
12384-529: The Diagnostic and Statistical Manual of Mental Disorders or DSM) is the formal diagnosis of people who experience significant dysphoria (discontent) with the sex they were assigned at birth and/or the gender roles associated with that sex: "In gender identity disorder, there is discordance between the natal sex of one's external genitalia and the brain coding of one's gender as masculine or feminine." The DSM (302.85) has five criteria that must be met before
12556-708: The UCLA Medical Center for the study of intersex and transsexual individuals. Psychoanalyst Robert Stoller generalized many of the findings of the project in his book Sex and Gender: On the Development of Masculinity and Femininity (1968). He is also credited with introducing the term gender identity to the International Psychoanalytic Congress in Stockholm, Sweden , in 1963. Behavioral psychologist John Money
12728-716: The United Kingdom collect census data on transgender people. Generally, less than 1% of the worldwide population is transgender, with figures ranging from <0.1% to 0.6%. Many transgender people experience gender dysphoria , and some seek medical treatments such as hormone replacement therapy , gender-affirming surgery , or psychotherapy . Not all transgender people desire these treatments, and some cannot undergo them for legal, financial, or medical reasons. The legal status of transgender people varies by jurisdiction. Many transgender people experience transphobia ( violence or discrimination against transgender people) in
12900-985: The University of Ulster . By 1992, the International Conference on Transgender Law and Employment Policy defined transgender as an expansive umbrella term including "transsexuals, transgenderists, cross dressers", and anyone transitioning. Leslie Feinberg 's pamphlet, "Transgender Liberation: A Movement Whose Time has Come", circulated in 1992, identified transgender as a term to unify all forms of gender nonconformity ; in this way transgender has become synonymous with queer . In 1994, gender theorist Susan Stryker defined transgender as encompassing "all identities or practices that cross over, cut across, move between, or otherwise queer socially constructed sex/gender boundaries", including, but not limited to, "transsexuality, heterosexual transvestism, gay drag, butch lesbianism, and such non-European identities as
13072-457: The voice , skin , face , Adam's apple , breasts , waist , buttocks , and genitals . Surgical procedures for trans men masculinize the chest and genitals and remove the womb , ovaries, and fallopian tubes . The acronyms " Gender-affirming surgery (GAS) " and "sex reassignment surgery" (SRS) refer to genital surgery. The term "sex reassignment therapy" (SRT) is used as an umbrella term for physical procedures required for transition. Use of
13244-425: The § 1950s and 1960s , the term gender was used exclusively as a grammatical category . The terms male and man , or female and woman , were used more or less interchangeably when referring to people of one sex or the other. As the term gender took on new meaning following the work of John Money , Robert Stoller , and others, a distinction began to be drawn between the terms sex and gender . As
13416-508: The "Jurisprudential Annotations to the Yogyakarta Principles" observed that "Gender identity differing from that assigned at birth, or socially rejected gender expression , have been treated as a form of mental illness . The pathologization of difference has led to gender-transgressive children and adolescents being confined in psychiatric institutions, and subjected to aversion techniques – including electroshock therapy – as
13588-442: The 1960s. To this day they are usually used in that sense, though a few scholars additionally use the term to refer to the sexual orientation and sexual identity categories gay , lesbian and bisexual . Gender expression is distinct from gender identity in that gender expression is how one chooses to outwardly express their gender through one's "name, pronouns, clothing, hair style, behavior, voice or body features." It
13760-556: The 1980s. In 2020, the International Journal of Transgenderism changed its name to the International Journal of Transgender Health "to reflect a change toward more appropriate and acceptable use of language in our field." By 1984, the concept of a "transgender community" had developed, in which transgender was used as an umbrella term. In 1985, Richard Ekins established the "Trans-Gender Archive" at
13932-571: The 1990s, transsexual has generally been used to refer to the subset of transgender people who desire to transition permanently to the gender with which they identify and who seek medical assistance (for example, sex reassignment surgery) with this. Distinctions between the terms transgender and transsexual are commonly based on distinctions between gender and sex . Transsexuality may be said to deal more with physical aspects of one's sex, while transgender considerations deal more with one's psychological gender disposition or predisposition, as well as
14104-549: The 20th century, transgender identity was conflated with homosexuality and transvestism . In earlier academic literature, sexologists used the labels homosexual and heterosexual transsexual to categorize transgender individuals' sexual orientation based on their birth sex. Critics consider these terms " heterosexist ", "archaic", and demeaning. Newer literature often uses terms such as attracted to men (androphilic), attracted to women (gynephilic) , attracted to both (bisexual), or attracted to neither (asexual) to describe
14276-453: The 2nd century, such as Roman Emperor Elagabalus . In the US in 1917, Alan L. Hart , an American tuberculosis specialist, became one of the first trans men to undergo hysterectomy and gonadectomy as treatment of what is now called gender dysphoria. Dora Richter is the first known trans woman to undergo complete male-to-female genital surgery. She was one of several transgender people in
14448-603: The Affordable Care Act and extends to "regulations pertaining to access to health insurance." This rule "is one of the many rules and regulations put forward by the Trump administration that defines "sex discrimination" as only applying when someone faces discrimination for being male or female, and does not protect people from discrimination on the basis of sexual orientation or gender identity." Gender dysphoria (previously called "gender identity disorder" or GID in
14620-527: The December 1969 issue of Transvestia , a national magazine for cross-dressers she founded. By the mid-1970s both trans-gender and trans people were in use as umbrella terms, while transgenderist and transgenderal were used to refer to people who wanted to live their lives as cross-gendered individuals without gender-affirming surgery . Transgenderist was sometimes abbreviated as TG in educational and community resources; this abbreviation developed by
14792-549: The German and ultimately modeled after German Transsexualismus (coined in 1923), the English term transsexual has enjoyed international acceptability, though transgender has been increasingly preferred over transsexual . The word transgender acquired its modern umbrella term meaning in the 1990s. Although the term transgenderism was once considered acceptable, it has come to be viewed as pejorative , according to GLAAD. Psychiatrist John F. Oliven of Columbia University used
14964-784: The Health of Transgender and Gender Diverse People (SOC). The most widespread SOC in this field is published and often revised by the World Professional Association for Transgender Health (WPATH, formerly the Harry Benjamin International Gender Dysphoria Association or HBIGDA). Many jurisdictions and medical boards in the US and other countries recognize the WPATH Standards of Care for the treatment of transgender individuals. Some treatment may require
15136-687: The Native American berdache or the Indian Hijra ". Between the mid-1990s and the early 2000s, the primary terms used under the transgender umbrella were "female to male" (FtM) for men who transitioned from female to male, and "male to female" (MtF) for women who transitioned from male to female. These terms have been superseded by "trans man" and "trans woman", respectively. This shift in preference from terms highlighting biological sex ("transsexual", "FtM") to terms highlighting gender identity and expression ("transgender", "trans man") reflects
15308-862: The Netherlands, Germany, and Italy. Much of the criticism surrounding the WPATH/HBIGDA-SOC applies to these as well, and some of these SOCs (mostly European SOC) are actually based on much older versions of the WPATH SOC. Other SOCs are entirely independent of the WPATH. The criteria of many of those SOCs are stricter than the latest revision of the WPATH-SOC. Many qualified surgeons in North America and many in Europe adhere almost unswervingly to
15480-695: The Orono school district in January 2014 before the Maine Supreme Judicial Court. On May 14, 2016, the United States Department of Education and Department of Justice issued guidance directing public schools to allow transgender students to use bathrooms that match their gender identities. Gender identity In most societies, there is a basic division between gender attributes associated with males and females,
15652-572: The Reimer case is that Reimer lost his penis at the age of eight months and underwent sex reassignment surgery at seventeen months, which possibly meant that Reimer had already been influenced by his socialization as a boy. Bradley et al. (1998) report the contrasting case of a 26-year-old woman with XY chromosomes whose penis was lost and who underwent sex reassignment surgery between two and seven months of age (substantially earlier than Reimer), whose parents were also more committed to raising their child as
15824-584: The Scythian disease. Other writers of the late 1700s and 1800s (including Hammond's associates in the American Neurological Association ) had noted the widespread nature of transgender cultural practices among native peoples. Explanations varied, but authors generally did not ascribe native transgender practices to psychiatric causes, instead condemning the practices in a religious and moral sense. Native groups provided much study on
15996-568: The Theory of Sexuality , giving evidence that in the pregenital phase children do not distinguish between sexes, but assume both parents have the same genitalia and reproductive powers. On this basis, he argued that bisexuality was the original sexual orientation and that heterosexuality was resultant of repression during the phallic stage , at which point gender identity became ascertainable. According to Freud, during this stage, children developed an Oedipus complex where they had sexual fantasies for
16168-529: The U.S. Supreme Court affirmed that Title VII prohibits discrimination against transgender people in the case R.G. & G.R. Harris Funeral Homes Inc. v. Equal Employment Opportunity Commission . Nicole Maines , a trans girl, took a case to Maine's supreme court in June 2013. She argued that being denied access to her high school's women's restroom was a violation of Maine's Human Rights Act; one state judge has disagreed with her, but Maines won her lawsuit against
16340-544: The United Nations Office of the High Commissioner for Human Rights , "do not fit typical binary notions of male or female bodies". An intersex variation may complicate initial sex assignment and that assignment may not be consistent with the child's future gender identity. Reinforcing sex assignments through surgical and hormonal means may violate the individual's rights . A 2005 study on
16512-486: The United States reported that 25% of respondents reported had undergone such a surgery. Some medical conditions, including diabetes , asthma , and HIV, can lead to complications with future therapy and pharmacological management. Typical gender-affirming surgery procedures involve complex medication regimens, including sex-hormone therapy , throughout and after surgery. Typically, a patient's treatment involves
16684-590: The United States, the Affordable Care Act provided that health insurance exchanges would have the ability to collect demographic information on gender identity and sexual identity through optional questions, to help policymakers better recognize the needs of the LGBTQ community. In 2020, however, the Trump administration finalized a rule that "would remove nondiscrimination protections for LGBTQ people when it comes to health care and health insurance" in
16856-522: The WPATH SOC or other SOCs. However, in the United States many experienced surgeons are able to apply the WPATH SOC in ways which respond to an individual's medical circumstances, as is consistent with the SOC. Many surgeons require two letters of recommendation for gender-affirming surgery. At least one of these letters must be from a mental health professional experienced in diagnosing gender identity disorder (now recognized as gender dysphoria ), who has known
17028-436: The adoption by others of the name and pronouns identified by the person in question, including present references to the transgender person's past. Inspired by Magnus Hirschfeld 's 1923 term seelischer Transsexualismus , the term transsexual was introduced to English in 1949 by David Oliver Cauldwell and popularized by Harry Benjamin in 1966, around the same time transgender was coined and began to be popularized. Since
17200-443: The belief of equality between the sexes had children, especially sons, who displayed fewer preconceptions of their opposite gender. Estimates of the number of people who are intersex range from 0.018% to 1.7%, depending on which conditions are counted as intersex. An intersex person is one possessing any of several variations in sex characteristics including chromosomes , gonads , sex hormones , or genitals that, according to
17372-513: The care of sexologist Magnus Hirschfeld at Berlin's Institute for Sexual Research . In 1922, Richter underwent orchiectomy. In early 1931, a penectomy, followed in June by vaginoplasty. In 1930-1931, Lili Elbe underwent four sex reassignment surgeries, including orchiectomy, an ovarian transplant , and penectomy. In June 1931, she underwent her fourth surgery, including an experimental uterine transplant and vaginoplasty, which she hoped would allow her to give birth. However, her body rejected
17544-574: The concept of gender, (2) learning gender role standards and stereotypes, (3) identifying with parents, and (4) forming gender preference. According to the United Nations Educational, Scientific and Cultural Organization (UNESCO) comprehensive sexuality education should raise awareness of topics such as gender and gender identity. Although the formation of gender identity is not completely understood, many factors have been suggested as influencing its development. In particular,
17716-478: The dominant societal constraints that label gender as binary. In scrutinizing gender, Butler introduces a nuanced perception in which they unite the concepts of performativity and gender. Transgender people sometimes wish to undergo physical surgery to refashion their primary sexual characteristics , secondary characteristics, or both, because they feel they will be more comfortable with different genitalia. This may involve removal of penis, testicles or breasts, or
17888-517: The early 1800s. One of the earliest recorded gender nonconforming people in America was Thomas(ine) Hall , a seventeenth century colonial servant. The most complete account of the time came from the life of the Chevalier d'Éon (1728–1810), a French diplomat. As cross-dressing became more widespread in the late 1800s, discussion of transgender people increased greatly and writers attempted to explain
18060-514: The early childhood years, and in the majority of instances appears to become at least partially irreversible by the age of 3 or 4". The Endocrine Society has stated "Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity. Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity." Social constructivists argue that gender identity, or
18232-434: The effect of social factors on gender identity formation. In the 1960s and 1970s, factors such as the absence of a father, a mother's wish for a daughter, or parental reinforcement patterns were suggested as influences; more recent theories suggesting that parental psychopathology might partly influence gender identity formation have received only minimal empirical evidence, with a 2004 article noting that "solid evidence for
18404-400: The expectations of others or whose gender identity conflicts with their body may benefit by talking through their feelings in depth. While individuals may find counseling or psychotherapy helpful, it is no longer recommended as a prerequisite for further transition steps. Research on gender identity with regard to psychology, and scientific understanding of the phenomenon and its related issues,
18576-572: The extent to which it is determined by nurture (social environmental factors) versus biological factors (which may include non-social environmental factors) is an ongoing debate in psychology, known as " nature versus nurture ". There is increasing evidence that the brain is effected by the organizational role of hormones in utero, circulating sex hormones and the expression of certain genes. Social factors which may influence gender identity include ideas regarding gender roles conveyed by family, authority figures, mass media, and other influential people in
18748-471: The fashioning of a penis, vagina or breasts. In the past, sex assignment surgery has been performed on infants who are born with ambiguous genitalia. However, current medical opinion is strongly against this procedure on infants, and recommends that the procedure be only conducted when medically necessary. Today, gender-affirming surgery is performed on people who choose to transition so that their external sexual organs will match their gender identity. In
18920-490: The father works and the mother, who may only work out of financial necessity, still takes care of the household. However, middle-class "professional" couples typically negotiate the division of labor and hold an egalitarian ideology. These different views on gender can shape the child's understanding of gender as well as the child's development of gender. A study conducted by Hillary Halpern demonstrated that parental gender behaviors, rather than beliefs, are better predictors of
19092-554: The field of study. The Institut was destroyed when the Nazis seized power in 1933, and its research was infamously burned in the May 1933 Nazi book burnings. Transgender issues went largely out of the public eye until after World War II. Even when they re-emerged, they reflected a forensic psychology approach, unlike the more sexological that had been employed in the lost German research. People who experience discord between their gender and
19264-550: The first technique for female-to-male gender-affirming surgery , producing a technique that has become a modern standard, called phalloplasty . Phalloplasty is a cosmetic procedure that produces a visual penis out of grafted tissue from the patient. In 1971, Roberto Farina performed Brazil's first male-to-female gender-affirming surgery. In 1984 , Jalma Jurado developed a new surgical technique, which he used in surgeries for more than 500 trans women in Brazil and from around
19436-610: The focus on diagnosis and instead emphasized the importance of flexibility in order to meet the diverse health care needs of transsexual, transgender, and all gender-nonconforming people. The reasons for seeking mental health services vary according to the individual. A transgender person seeking treatment does not necessarily mean their gender identity is problematic. The emotional strain of dealing with stigma and experiencing transphobia pushes many transgender people to seek treatment to improve their quality of life. As one trans woman reflected, "Transgendered individuals are going to come to
19608-403: The following treatments. Hormone replacement therapy for trans men induces beard growth and masculinizes skin, hair, voice, and fat distribution. Hormone replacement therapy for trans women feminizes fat distribution and breasts, as well as diminishes muscle mass and strength. Laser hair removal or electrolysis removes excess hair for trans women. Surgical procedures for trans women feminize
19780-556: The following: In June 2008, the American Medical Association (AMA) House of Delegates stated that the denial to patients with gender dysphoria or otherwise covered benefits represents discrimination, and that the AMA supports "public and private health insurance coverage for treatment for gender dysphoria as recommended by the patient's physician." Other organizations have issued similar statements, including WPATH,
19952-519: The gender identity outcomes of female-raised 46,XY persons with penile agenesis , cloacal exstrophy of the bladder, or penile ablation , found that 78% of the study subjects were living as female, as opposed to 22% who decided to initiate a sex change to male in line with their genetic sex. The study concludes: "The findings clearly indicate an increased risk of later patient-initiated gender re-assignment to male after female assignment in infancy or early childhood, but are nevertheless incompatible with
20124-399: The genitalia they were born with (see transsexual for some of the possible reasons) but adopt a gender role that is consistent with their gender identity. Within recent years modern society has made strides towards the acknowledgement and destigmatization of those who identify as non-binary or a gender variant, with sex reassignment surgery expected to grow by an annual rate of about 11% from
20296-423: The genitals, which are also known as genital reassignment surgery , genital reconstruction surgery , sex reassignment surgery, and bottom surgery (the latter is named in contrast to top surgery , which is surgery to the breasts). However, the meaning of "sex reassignment surgery" has been clarified by the medical organization, the World Professional Association for Transgender Health (WPATH), to include any of
20468-493: The idea of gender identity as being biologically rooted, as they do not identify with their anatomical sex despite being raised and their behaviour reinforced according to their anatomical sex. One study by Reiner et al. looked at fourteen genetic males who had suffered cloacal exstrophy and were thus raised as girls. Six of them changed their gender identity to male, five remained female and three had ambiguous gender identities (though two of them had declared they were male). All
20640-651: The impact of the announcement itself, nothing changed. In 2017, the Danish parliament abolished the F64 Gender identity disorders. The DSM-5 refers to the topic as gender dysphoria (GD) while reinforcing the idea that being transgender is not considered a mental illness. Transgender people may meet the criteria for a diagnosis of gender dysphoria "only if [being transgender] causes distress or disability." This distress may manifest as depression or inability to work and form healthy relationships with others. This diagnosis
20812-471: The importance of acknowledging their gender identity with a therapist in order to discuss other quality-of-life issues. Rarely, some choose to detransition . Problems still remain surrounding misinformation about transgender issues that hurt transgender people's mental health experiences. One trans man who was enrolled as a student in a psychology graduate program highlighted the main concerns with modern clinical training: "Most people probably are familiar with
20984-531: The importance of postnatal social factors is lacking." A 2008 study found that the parents of gender-dysphoric children showed no signs of psychopathological issues aside from mild depression in the mothers. It has also been suggested that the attitudes of the child's parents may affect the child's gender identity, although evidence is minimal. Parents who do not support gender nonconformity are more likely to have children with firmer and stricter views on gender identity and gender roles. Recent literature suggests
21156-451: The insufficient training most therapists receive prior to working with transgender clients, potentially increasing financial strain on clients without providing the treatment they need. Many clinicians who work with transgender clients only receive mediocre training on gender identity, but introductory training on interacting with transgender people has recently been made available to health care professionals to help remove barriers and increase
21328-419: The intersex condition as a difference of sex development, not as a disorder . Gender-affirming surgery can be hard to obtain due to financial barriers, insurance coverage, and lack of providers. A growing number of surgeons are now training to perform such surgeries. In many regions, a person's pursuit of gender-affirming surgery is often governed, or at least guided, by documents called Standards of Care for
21500-401: The legal recognition of sex reassignment. As of 2020 , Japan also requires an individual to undergo sterilization to change their legal sex. The early history of gender-affirming surgery in trans people has been reviewed by various authors. The prevalence of transgender-related surgeries is difficult to measure and likely underestimated. In 2015, the largest survey of transgender people in
21672-737: The level of service for the transgender population. In February 2010, France became the first country in the world to remove transgender identity from the list of mental diseases. A 2014 study carried out by the Williams Institute (a UCLA think tank) found that 41% of transgender people had attempted suicide, with the rate being higher among people who experienced discrimination in access to housing or healthcare, harassment, physical or sexual assault, or rejection by family. A 2019 follow-up study found that transgender people who wanted and received gender-affirming medical care had significantly lower rates of suicidal thoughts and attempts. However,
21844-570: The list of aggravating factors in sentencing, where the accused commits a criminal offence against an individual because of those personal characteristics. Similar transgender laws also exist in all the provinces and territories. In the United States, transgender people are protected from employment discrimination by Title VII of the Civil Rights Act of 1964 . Exceptions apply to certain types of employers, for example, employers with fewer than 15 employees and religious organizations. In 2020,
22016-667: The listing of their sex in public records unless they can furnish a physician's letter attesting that sex reassignment surgery has been performed. In some jurisdictions legal gender change is prohibited in any circumstances, even after genital or other surgery or treatment. A growing number of public and commercial health insurance plans in the US now contain defined benefits covering sex reassignment-related procedures, usually including genital reconstruction surgery (MTF and FTM), chest reconstruction (FTM), breast augmentation (MTF), and hysterectomy (FTM). For patients to qualify for insurance coverage, certain insurance plans may require proof of
22188-446: The males raised as male switched their gender identity. Those still living as females still showed marked masculinisation of gender role behaviour and those old enough reported sexual attraction to women. The study's authors caution drawing any strong conclusions from it due to numerous methodological caveats which were a severe problem in studies of this nature. Rebelo et al. argue that the evidence in totality suggests that gender identity
22360-457: The manual, DSM-III-R , added a third diagnosis: gender identity disorder of adolescence and adulthood, nontranssexual type. This latter diagnosis was removed in the subsequent revision, DSM-IV (1994), which also collapsed GIDC and transsexualism into a new diagnosis of gender identity disorder. In 2013, the DSM-5 renamed the diagnosis gender dysphoria and revised its definition. The authors of
22532-492: The mid-1900s. Historical depictions, records and understandings are inherently filtered through modern principles, and were largely viewed through a medical and (often outsider) anthropological lens until the late 1900s. Some historians consider the Roman emperor Elagabalus to have been transgender. Elagabalus was reported to have dressed in a feminine manner, preferred to be called "Lady" instead of "Lord" and may have even sought
22704-499: The need for future surgery. Medical protocols typically require long-term mental health counseling to verify persistent and genuine gender dysphoria before any intervention, and consent of a parent or guardian or court order is legally required in most jurisdictions. Infants born with intersex conditions might undergo interventions at or close to birth. This is controversial because of the human rights implications. There can be negative outcomes (including PTSD and suicide) when
22876-402: The negative attitudes and behaviours of such others as legal entities does not indicate GD. GD does not imply an opinion of immorality; the psychological establishment holds that people with any kind of mental or emotional problem should not receive stigma. The solution for GD is whatever will alleviate suffering and restore functionality; this solution often, but not always, consists of undergoing
23048-418: The norm of their sex assigned at birth, and in acting and looking like their identified gender. Social scientists tend to assume that gender identities arise from social factors. In 1955, John Money proposed that gender identity was malleable and determined by whether a child was raised as male or female in early childhood. Money's hypothesis has since been discredited, but scholars have continued to study
23220-525: The notion of a full determination of core gender identity by prenatal androgens." A 2012 clinical review paper found that between 8.5% and 20% of people with intersex variations experienced gender dysphoria . Sociological research in Australia, a country with a third 'X' sex classification, shows that 19% of people born with atypical sex characteristics selected an "X" or "other" option, while 52% are women, 23% men, and 6% unsure. At birth, 52% of persons in
23392-503: The origin of psychic life, and that Freud did not give adequate description to the female child (Freud rejected this suggestion). During the 1950s and '60s, psychologists began studying gender development in young children, partially in an effort to understand the origins of homosexuality (which was viewed as a mental disorder at the time). In 1958, the Gender Identity Research Project was established at
23564-493: The origins of being transgender. Much study came out of Germany, and was exported to other Western audiences. Cross-dressing was seen in a pragmatic light until the late 1800s; it had previously served a satirical or disguising purpose. But in the latter half of the 1800s, cross-dressing and being transgender became viewed as an increasing societal danger. William A. Hammond wrote an 1882 account of transgender Pueblo "shamans" [ sic ] ( mujerados ), comparing them to
23736-492: The parent ascribed the opposite gender and hatred for the parent ascribed the same gender, and this hatred transformed into (unconscious) transference and (conscious) identification with the hated parent who both exemplified a model to appease sexual impulses and threatened to castrate the child's power to appease sexual impulses. In 1913, Carl Jung proposed the Electra complex as he both believed that bisexuality did not lie at
23908-484: The parent confidently raised their child as the opposite sex from earlier than age two, the child would believe that they were born that sex and act accordingly. Money believed that nurture could override nature. A well-known example in the nature-versus-nurture debate is the case of David Reimer , born in 1965, otherwise known as "John/Joan". As a baby, Reimer went through a faulty circumcision, losing his male genitalia. John Money advised Reimer's parents to raise him as
24080-469: The patient for over a year. Letters must state that sex reassignment surgery is the correct course of treatment for the patient. Many medical professionals and many professional associations have stated that surgical interventions should not be required for transsexual individuals to change sex designation on identity documents. However, depending on the legal requirements of many jurisdictions, transsexual and transgender people are often unable to change
24252-529: The penis), orchiectomy (removal of the testes), vaginoplasty (construction of a vagina), vulvoplasty (construction of a vulva); as well as breast augmentation , tracheal shave (reduction of the Adam's apple ), facial feminization surgery , and voice feminization surgery among others. Trans men and others assigned female at birth may undergo one or more masculinizing procedures; such as chest reconstruction , breast reduction , hysterectomy (removal of
24424-424: The pornographically derived term tranny for drag queens or people who engage in transvestism or cross-dressing; this term is widely considered an offensive slur if applied to transgender people. A precise history of the global occurrence of transgender people is difficult to assess because the modern concept of being transgender, and of gender in general in relation to transgender identity, did not develop until
24596-675: The rate of the general population, and over half had been harassed or turned away when attempting to access public services. Members of the transgender community also encounter high levels of discrimination in health care. As of 2017, 36 countries in Europe require a mental health diagnosis for legal gender recognition and 20 countries require sterilisation. In April 2017, the European Court of Human Rights ruled that requiring sterilisation for legal gender recognition violates human rights. Jurisdiction over legal classification of sex in Canada
24768-410: The related social expectations that may accompany a given gender role. Many transgender people reject the term transsexual . Christine Jorgensen publicly rejected transsexual in 1979 and instead identified herself in newsprint as trans-gender , saying, "gender doesn't have to do with bed partners, it has to do with identity." Some have objected to the term transsexual on the basis that it describes
24940-618: The relative urgency of their need (if any) for sex reassignment surgery. Contemporary views on gender identity and classification differ markedly from Harry Benjamin's original opinions. Sexual orientation is no longer regarded as a criterion for diagnosis, or for distinction between transsexuality, transvestism and other forms of gender-variant behavior and expression. Benjamin's scale was designed for use with heterosexual trans women, and trans men's identities do not align with its categories. Gender, gender identity, and being transgender are distinct concepts from sexual orientation. Sexual orientation
25112-404: The same operations as binary trans people of the same sex assignment and bigenital or gender nullification surgeries are available. Bigenital operations include androgynoplasty, a procedure that retains the penis, or vagina-preserving phalloplasty. However, these procedures are extremely rare. In 2017, one of the leading UK trans surgeons, James Bellringer , commented that he had never received
25284-417: The sex and gender assigned to them at birth – that is, those who are neither transgender nor non-binary or genderqueer – are called cisgender . Transfeminine is a term for any person, binary or non-binary, who was assigned male at birth and has a predominantly feminine gender identity or presentation. Transmasculine refers to a person, binary or non-binary, who was assigned female at birth who has
25456-536: The specific problems faced by the transgender community in mental health has focused on diagnosis and clinicians' experiences instead of transgender clients' experiences. Therapy was not always sought by transgender people due to mental health needs. Prior to the seventh version of the Standards of Care (SOC), an individual had to be diagnosed with gender identity disorder in order to proceed with hormone treatments or sexual reassignment surgery. The new version decreased
25628-432: The study were assigned female, and 41% were assigned male. A study by Reiner & Gearhart provides some insight into what can happen when genetically male children with cloacal exstrophy are sexually assigned female and raised as girls, according to an 'optimal gender policy' developed by John Money : in a sample of 14 children, follow-up between the ages of 5 and 12 showed that 8 of them identified as boys, and all of
25800-579: The subject, and perhaps the majority of all study until after WWII. Critical studies first began to emerge in the late 1800s in Germany, with the works of Magnus Hirschfeld. Hirschfeld coined the term "transvestite" in 1910 as the scope of transgender study grew. His work would lead to the 1919 founding of the Institut für Sexualwissenschaft in Berlin. Though Hirscheld's legacy is disputed, he revolutionized
25972-810: The subjects had at least moderately male-typical attitudes and interests, providing support for the argument that genetic variables affect gender identity and behavior independent of socialization. Gender identity can lead to societal security issues among individuals that do not fit on a binary scale. As of 2022, only 23 states plus Washington D.C. currently have state laws that explicitly prohibit discrimination based on sexual orientation and gender identity. Moreover, only "53% of [the] LGBTQ population live in states prohibiting housing discrimination based on sexual orientation and gender identity", while "17% of [the] LGBTQ population lives in states explicitly interpreting existing prohibition on sex discrimination to include sexual orientation and/or gender identity". In some cases,
26144-505: The subjects had moderate to marked interests and attitudes consistent with that of biological males. Another study, using data from a variety of cases from the 1970s to the early 2000s (including Reiner et al.), looked at males raised as females due to a variety of developmental disorders ( penile agenesis , cloacal exstrophy or penile ablation). It found that 78% of those males raised as females were living as females. A minority of those raised as female later switched to male. However, none of
26316-601: The surgically assigned gender does not match the person's gender identity, which will be realized by the person only later in life. Milton Diamond at the John A. Burns School of Medicine , University of Hawaii recommended that physicians not perform surgery on children until they are old enough to give informed consent and to assign such infants in the gender to which they will probably best adjust. Diamond believed introducing children to others with differences of sex development could help remove shame and stigma. Diamond considered
26488-879: The term transvestic fetishism , as transvestic fetishist refers to those who intermittently use clothing of the opposite gender for fetishistic purposes. In medical terms, transvestic fetishism is differentiated from cross-dressing by use of the separate codes 302.3 in the Diagnostic and Statistical Manual of Mental Disorders ( DSM ) and F65.1 in the ICD . Drag is clothing and makeup worn on special occasions for performing or entertaining, unlike those who are transgender or who cross-dress for other reasons. Drag performance includes overall presentation and behavior in addition to clothing and makeup. Drag can be theatrical, comedic, or grotesque. Drag queens have been considered caricatures of women by second-wave feminism . Drag artists have
26660-552: The term transgender should not be included in the transgender spectrum. Leslie Feinberg likewise asserts that transgender is not a self-identifier (for some people) but a category imposed by observers to understand other people. According to the Transgender Health Program (THP) at Fenway Health in Boston, there are no universally-accepted definitions, and confusion is common because terms that were popular at
26832-481: The term transgenderism in his 1965 reference work Sexual Hygiene and Pathology , writing that the term which had previously been used, transsexualism , "is misleading; actually, transgenderism is meant, because sexuality is not a major factor in primary transvestism". The term transgender was then popularized with varying definitions by transgender, transsexual, and transvestite people, including Christine Jorgensen and Virginia Prince , who used transgenderal in
27004-433: The term "sex change" has been criticized for its emphasis on surgery, and the term "transition" is preferred. Availability of these procedures depends on degree of gender dysphoria, presence or absence of gender identity disorder, and standards of care in the relevant jurisdiction. Trans men who have not had a hysterectomy and who take testosterone are at increased risk for endometrial cancer because androstenedione , which
27176-573: The term transgender, but maybe that's it. I don't think I've had any formal training just going through [clinical] programs ... I don't think most [therapists] know. Most therapists – Master's degree, PhD level – they've had ... one diversity class on GLBT issues. One class out of the huge diversity training. One class. And it was probably mostly about gay lifestyle." Many health insurance policies do not cover treatment associated with gender transition, and numerous people are under- or uninsured, which raises concerns about
27348-437: The time of the study was a blue-collar occupation that was practiced almost exclusively by men. Griet Vandermassen argues that since these are the only two cases being documented in scientific literature, this makes it difficult to draw any firm conclusions from them about the origins of gender identity, particularly given the two cases reached different conclusions. However, Vandermassen also argued that transgender people support
27520-538: The transplanted uterus, and she died of post-operative complications in September, at age 48. A previous sex reassignment surgery patient was Magnus Hirschfeld's housekeeper , but their name has not been discovered. Elmer Belt may have been the first U.S. surgeon to perform gender affirmation surgery, in about 1950. In 1951, Harold Gillies , a plastic surgeon active in World War II, worked to develop
27692-558: The turn of the 21st century may have since been deemed offensive. The THP recommends that clinicians ask clients what terminology they prefer, and avoid the term transsexual unless they are sure that a client is comfortable with it. Harry Benjamin invented a classification system for transsexuals and transvestites, called the Sex Orientation Scale (SOS), in which he assigned transsexuals and transvestites to one of six categories based on their reasons for cross-dressing and
27864-431: The uterus), oophorectomy (removal of the ovaries). A penis can be constructed through metoidioplasty or phalloplasty , and a scrotum through scrotoplasty . As knowledge of non-binary genders expands in the medical community, more surgeons are willing to tailor operations to individual needs. Bigenital operations allow individuals to construct a penis or vagina and retain their original organs. Gender nullification
28036-709: The way it is expressed , are socially constructed , determined by cultural and social influences. Constructivism of this type is not necessarily incompatible with the existence of an innate gender identity, since it may be the expression of that gender that varies by culture. There are several theories about how and when gender identity forms, and studying the subject is difficult because children's immature language acquisition requires researchers to make assumptions from indirect evidence. John Money suggested children might have awareness of and attach some significance to gender as early as 18 months to 2 years; Lawrence Kohlberg argued that gender identity does not form until age 3. It
28208-616: The workplace, in accessing public accommodations, and in healthcare. In many places, they are not legally protected from discrimination. Several cultural events are held to celebrate the awareness of transgender people, including Transgender Day of Remembrance and International Transgender Day of Visibility , and the transgender flag is a common transgender pride symbol. Before the mid-20th century, various terms were used within and beyond Western medical and psychological sciences to identify persons and identities labeled transsexual , and later transgender from mid-century onward. Imported from
28380-423: The world. Following phalloplasty, in 1999, the procedure for metoidioplasty was developed for female-to-male surgical transition by the doctors Lebovic and Laub. Considered a variant of phalloplasty, metoidioplasty works to create a penis out of the patient's present clitoris. This allows the patient to have a sensation-perceiving penis head. Metoidioplasty may be used in conjunction with phalloplasty to produce
28552-532: The years 2022 to 2030. Although sex reassignment surgery is expected to become more popular, the surgery is still not destigmatized in a lot of countries, including the United States. Such stigmatization has been shown to have adverse health effects on LGBTQ+ individuals, especially during the COVID-19 pandemic. The terms gender identity and core gender identity were first used with their current meaning—one's personal experience of one's own gender —sometime in
28724-406: Was also instrumental in the development of early theories of gender identity. His work at Johns Hopkins Medical School 's Gender Identity Clinic (established in 1965) popularized an interactionist theory of gender identity, suggesting that, up to a certain age, gender identity is relatively fluid and subject to constant negotiation. His book Man and Woman, Boy and Girl (1972) became widely used as
28896-562: Was no longer legally restricted to be only between man and woman. No objective measurement or imaging of the human body exists for gender identity, as it is part of one's subjective experience. Numerous clinical measurements for assessing gender identity exist, including questionnaire-based, interview-based and task-based assessments. These have varying effect sizes among a number of specific sub-populations. Gender identity measures have been applied in clinical assessment studies of people with gender dysphoria or intersex conditions. Before
29068-592: Was not universal (and still is not) even in academic usage, and even less so in more informal writing or in speech, which often conflate the two. Some people, and some societies, do not construct gender as a binary in which everyone is either a boy or a girl, or a man or a woman. Those who exist outside the binary fall under the umbrella terms non-binary or genderqueer . Some cultures have specific gender roles that are distinct from "man" and "woman." These are often referred to as third genders . In Samoan culture , or Faʻa Samoa , fa'afafine are considered to be
29240-413: Was pressure from a parent (36%)." Legal procedures exist in some jurisdictions which allow individuals to change their legal gender or name to reflect their gender identity. Requirements for these procedures vary from an explicit formal diagnosis of transsexualism , to a diagnosis of gender identity disorder, to a letter from a physician that attests the individual's gender transition or having established
29412-506: Was told that he had been born with male genitalia. Reimer stopped seeing Money, and underwent surgery to remove his breasts and reconstruct his genitals. In 1997, sexologist Milton Diamond published a follow-up, revealing that Reimer had rejected his female reassignment, and arguing against the blank slate hypothesis and infant sex reassignment in general. Diamond was a longtime opponent of Money's theories. Diamond had contributed to research involving pregnant rats that showed hormones played
29584-500: Was well discussed by medical writings of the 1500s–1700s. Pierre Petit writing in 1596 viewed the "Scythian disease" as natural variation, but by the 1700s writers viewed it as a "melancholy", or "hysterical" psychiatric disease. By the early 1800s, being transgender separate from Hippocrates' idea of it was claimed to be widely known, but remained poorly documented. Both trans women and trans men were cited in European insane asylums of
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