Raising the Awareness of Transsexualism and the differences to the Transgendered.
This is a talk that I recently gave to raise the awareness of Transsexualism:
Good Morning. I am pleased to be able to speak to you on a subject that there is much misinformation and lack of understanding. Some of you already know me but for those of you who do not, my name is Michelle Dibble. I am the chair of the Metropolitan Police IAG and a member of the Hillingdon Partnership.
I am going to explain the differences between Transsexual and Transgendered and help to raise the awareness of Transsexualism.
I am not medically trained, in fact, a good part of my career, more than 30 years, was in senior management in pest control, so if you want to know about Rats, Mice and Cockroaches, I am your woman. When I started my transitioning in 2004, I quickly realised that there was a real lack of help or information and what there was, was hard to access and very sketchy. I studied and learnt as much as I could, especially about the hormones, surgeries, what Transsexualism is and the cause, initially to make my journey easier and more focused, but extended that learning and have put it to good use so that I could help other Transsexuals. I do not claim to know everything, nobody does, but I have a fairly good knowledge. I know what worked for me and has worked for others that I counselled and spoke to. Between April 2006 and September 2009, I studied and qualified as a Counsellor to help others face up to the condition and the resultant stress and depression. Often just talking to someone who shares and understands their condition helps. Gender Counsellors may well disagree with my opinion and findings, especially where it comes to the use of hormones. Most err on the safe side and prescribe insufficient dosages and regime. It is up to you what you agree with, after listening to and understanding what you have heard. Opinions and guidance are constantly changing and much of that understanding is being driven by Transsexuals, themselves. Experience is the finest tutor.
The Differences between Transsexual and Transgendered. There is a lot of confusion over the terms, ‘Trans’ and ‘Transgendered’. The Government uses them when talking about the Gender recognition Act and other Gender related subjects. They are words used by the LGBT community, who have been driving the Government on reforming the Gender Recognition Act, and you commonly see the words used in the media and on TV. When did you last hear the word ‘transsexual’ used? ‘Transgendered’ is an umbrella term covering the whole spectrum including transvestites, cross dressers, gender queers, drag queens/ artists, non-binary, gender fluid and wrongly Transsexuals, etc. When I started my research in 2002, only Transsexual, transvestites and drag was really ever spoken about. Transgender was rarely used and that was several years later. Many of the LGB groups did not even recognise Transsexuals and they were not inclusive.
How things change. When I was growing up “queer” referred to odd, different, strange or weird but later was used to insult homosexuals (same sex) but then because of that, was a word to avoid; it was an unpleasant and an insulting word to use. At that time, homosexuality was illegal and could result in imprisonment. That word has now been adopted by the ‘gender queer’. I still find the word ‘queer’ difficult and unpleasant to use. Gay is another word we have lost. Dictionary definition: happily excited, keenly alive and exuberant: having or inducing high spirits, brilliant in colour. Now if you Google ‘gay’ it comes up with mostly Gay (homosexual sites). What next? We love new identities don’t we?
The word ‘Transgender’ was originally thought to be penned by Virginia Prince (1912- 2009) who was an American Transvestite activist, who published Transvestia magazine and started the “Society for Second Self” for male heterosexual cross-dressers. She lived full time dressed as a woman but had no desires for the full re-assignment and surgery. She did not consider herself to be a transsexual, so penned the name as she felt it described her position better.
Transsexual or Transgendered? What is the difference? As we have already seen, transgender is an umbrella term covering the full spectrum. Unfortunately this leads people to believe that we are all the same, which of course we are not. Transsexualism is a condition that is caused at foetal stage in the womb. It can be looked on as a disability or birth defect that cannot be seen. The others can be a choice of lifestyle and/or for sexual gratification; most would not want to change their sex. Transsexuals should never be confused with the Transgendered.
‘Transgendered’ is now used when they are actually talking about Transsexuals. This is wrong and shows a general lack of respect and knowledge. It belittles and denies our existence. Perhaps they think that they are being ‘modern’ or ‘with it’ using Transgendered when they are referring to Transsexuals. If you are referring, in the broader term then Transgendered may be appropriate but if you are talking about Transsexuals specifically then refer to us, using the proper term, ‘transsexual’. The Trans community is trying to do away with the title ‘Transsexual’ and lump us all together saying calling us Transsexual is an insult to us. Trying to do away with the term ‘Transsexual’ is the insult and we will not allow it. It is to deny, devalue and minimise what is a very stressful medical condition and a birth defect, which most of the Trans community will never have to suffer.
At an earlier professional training session, we had a speaker from an LGBT support group and as part of his talk he was speaking about and was using the term ‘Transgendered’. I asked what he meant by transgendered and he said ‘someone who wanted to change sex’. I said that, that is a Transsexual and his response was, no and he used the comedian, Eddie Izzard as an example of a Transsexual. According to Eddie Izzard, "Most transvestites fancy women." He calls himself "a straight transvestite, or male lesbian" He does not describe himself as a Transsexual. And the LGBT are advising the Government?
Let us analyse the terms transgender or Transgendered. This suggests that we can change our gender; we cannot. Psychiatrists tried this for years, using their cruel ECT, Electro Convulsive Therapy, their preferred term; actually this was Electro Aversion Shock Therapy. They did not cure one Transsexual. What they achieved was to cause insanity, breakdowns and suicides. Transsexual people are thought to have, generally the highest ‘Attempted Suicide’ incidences among sexual minority groups, about 25%. When Psychiatrists were trying to ‘cure’ Transsexuals, their cruel treatment, doubled this rate. With medical intervention, cross sex hormones and surgery, you can change your sex but not your gender; that cannot be changed, that is fixed in the womb.
To be clear, Transsexualism is not a mental illness that can be cured with treatment. It cannot. Rather, transsexual people experience a persistent and real disconnect between the sex assigned to them at birth and their internal sense of who they are. This disconnect is referred to by medical professionals as “gender dysphoria” and it can cause undue pain and distress in the lives of Transsexual people. Transsexualism can on be cured by full sexual realignment by medical intervention; in short ‘sex change’.
So what is ‘sex’ and ‘gender’? Sex and Gender are two important and different concepts that are frequently confused. Some think that they are the same but they are not.
Sex refers to someone's physical sex, in other words, the genitals they were born with, the visual sexual identity. These are what are used to rely on, to sex a child and register that birth. Boy, Girl, Male or Female. Except in very rare cases of hermaphrodites, intersexed or poorly developed genitalia, birth sex is usually well-defined and easy to interpret.
Gender is rather more subtle, and refers to the person's own self-identity as a male or female. The overwhelming majority of the population have a gender that matches their birth sex, which is why few people understand that the two are different. Gender is less clearly defined than anatomical sex. It comes from the brain and cannot be seen and as yet there is no test. There may be other differences. Others claim to be gender neutral, gender fluid, etc. however, for this talk we will not be looking at that.
'Trans-' is a Latin prefix that means 'across,' 'through,' or 'beyond.' By the use of hormones and surgery you can move across or change sex, hence transsexual, you cannot change your gender so transgender is inaccurate and only useful as an umbrella term. On this basis, Transsexual is the correct term whereas Transgendered is inarguably, wrong.
Gender dysphoria (Transsexualism). So what is Transsexualism and what is it like to be a transsexual? Transsexualism is a recognised medical condition: it is not an illness but can and will lead to severe depression. Transsexualism is a condition where a person experiences discomfort or distress because there is a mismatch between their biological sex and what your brain tells you and what you feel. Transsexualism is the most extreme form of Gender dysphoria.
Those who experience the condition do not feel, on the inside, to be of the gender that their bodies appear to be. Most experience such intense and prolonged discomfort, that they undergo a process of transitioning in which they express their innate gender identities and obtain medical treatment, hormones and surgeries, to change their sex accordingly. They normally experience these feelings from a very early age.
Causes of Transsexualism: There are developmental stages in both male and females, inside the womb of the mother that among other things determine gender. Sex and gender as you we have already seen are very different qualities. Sex is mostly related to things we can see, external signs of maleness, or femaleness. Gender while perhaps more compelling to the individual, is nevertheless something that cannot be outwardly seen.
During the early development of the foetus all children begin as female. At a predetermined time, hormones produced by the mother in this case testosterone become awash in the foetus, the so-called testosterone bath or foetal wash, which changes the female foetus to male.
Malfunctioning hormones: In rare cases, the hormones that trigger the development of sex and gender may not work properly on the brain, gonads and genitals, causing variations between them. For example, the sex (as determined physically by the gonads and genitals) could be male, while the gender (as determined by the brain) could be female. This could be caused by additional hormones in the mother’s system or by the insensitivity of the foetus to the hormones, known as androgen insensitivity syndrome (AIS). In this way, gender dysphoria (Transsexualism) is most likely to be caused by hormones not working properly within the womb.
Transsexualism is a fairly rare Condition, Statistics:
The Government say that there are between 200,000- 500,000 Trans or Transgendered in the UK but this figure is misleading as it includes Transsexuals as well.
It is estimated that there are about 6000** Transsexuals in the UK, less than one in ten thousand of the population (2011 census of 63.2 Millions). Based on those statistics there are about 30 Transsexuals in the London Borough Hillingdon.
Since the start of the Gender Recognition Act 2004, in April 2005, there have been just under 5000 full Gender Recognition Certificates issued. Between July 2009 and June 2011, 484 full GRC’s were issued. Of these 362 were male to female and 122 female to male. Just under 5000 GRC’s issued in twelve years? This reflects the low numbers of Transsexuals in the UK and the difficulty in accessing NHS treatment.
Many GP’s will never see a Transsexual in their surgeries. I have been with my GP practice since 1983 and was the first in 2004. Since then they have seen 3 more.
Only about 25% of Transsexuals are female to male.
** Government Policy concerning Transsexual People 2002: Where they said that: There are a small number of people in the United Kingdom, perhaps just a few thousand, who are not comfortable with their gender identity. Some may feel they have been born into the wrong body, whilst others come to feel that their gender identity has become incompatible with the gender registered at birth. Estimates vary, but perhaps one man in every 12,000 feels he is a woman. The proportion of women who feel they are men is smaller, but they too are convinced that their birth gender does not match their gender identity.
What health concerns do Transsexuals have? Transsexuals face a unique set of emotional health issues. Living in a body that feels foreign, and being perceived widely as a sex that feels wrong and unnatural is enormously challenging; that awful feeling of being trapped in the wrong body and that disgusted feeling when you see yourself in a mirror.
Initially, you may not be in the best of health. You hate yourself and what you are. You will be depressed, your life style, most likely, will not have been ideal. You have little ambition or drive but try to hide your inner turmoil from others. Transsexuals are at increased risk of stress, isolation, anxiety, depression, overeating/obesity (comfort eating), self harm, drink/drug abuse, poor self-esteem and suicide. The UK population is over 65 million with a suicide rate of about 0.01%. Both suicides and attempted suicides are common in transsexuals. Studies generally report a pre-transition rate of about 25%, with male to females relatively 4 times more likely to attempt suicide than female to male. Transsexual people are far less likely to attempt suicide once they have completed the transition to the other sex.
In addition, the process of transitioning to the other sex brings up a myriad of specific challenges, some anticipated and others harder to predict or deal with. Transsexualism is a very lonely condition; it is not visible so others do not recognise that there is anything wrong with you and are unlikely to be sympathetic; if you can’t see it doesn’t exist. Outwardly you may appear quite normal but on the inside you will be tearing yourself apart.
Persons who are contemplating the process of transitioning from male-to-female or female-to-male may encounter a range of emotional reactions, both in themselves and among those around them. Some of these reactions may be anticipated and prepared for; others may be unanticipated, occasionally aggressive, transphobic and sometimes dismissive and difficult to manage. You are very likely to lose family and friends. I have heard expressions ‘doing it on a whim’, ‘a passing phase’, been told to ‘man up’ or ‘be a man’ and been called selfish. But most were supportive and I was lucky and managed to keep my family on board and only lost a couple of friends. I have made many more new friends since and one very special man.
From a very early age, our culture makes large and specific sets of assumptions about individuals based on perceptions of sex and gender. Our culture defines what is "appropriate" and "inappropriate”, setting boundaries, behaviour and activities for each gender. Transsexual individuals often experience anxiety and stress as they attempt to fit into a gender role that may match the outward appearance of their physical body but not their emotions or their more internal sense of their gender. Society dictates the differences in male and female behaviour, much of this is learnt and not instinctive. You are encouraged, to live in the sex that you appear to be and not what you feel. Pink and dolls for girls and blue and football for boys! Now it is i-phones and tablets.
Your Transsexualism must eventually be faced. You can fight it for many years but the effects will get stronger, affecting you physically and mentally and if not faced, can eventually destroy you.
Transsexuals have to unlearn how they have had to live all their lives and learn to live in a totally new role, in a very short time and at the same time change their whole bodies, physically, mentally, morally and emotionally by intrusive and high risk surgeries, very high doses of cross sex hormones (oestrogen and progesterone for male to female and Testosterone for female to male), several hundred hours of painful facial electrolysis (if you are male to female). Can you imagine the enormity of this, just to be the person you have always needed to be? We need to do this, whereas very few of the Transgendered community will ever feel that need.
From the day you start transitioning you should start planning every stage of your development:
- Your working future, can you carry on with your present occupation or will you have to look for alternative employment? Will you have to retrain?
- Have you told all your family and friends, if not have you thought of when and how you are going to tell them? The earlier you tell them, the more time they have to get used to all the changes that are going to be happening and in particular, the big day of your surgery. Don’t expect too much and give them time. Some may never understand or accept.
- Have you told your GP? His support will be imperative and long term. If he will not support you, you should find one that will.
- What about your facial hair. A nice dress and a five a clock shadow is a definite no! no!
- Have you told work colleagues? This is another important stage of your transitioning. How will they accept you and your new self? Do you turn up as your new self or do you tell them first? Do you speak to your boss before your colleagues or the HR department?
- Have you changed your documentation: legal name change, drivers licence, passport, bank cards, bank account, National insurance, Tax etc?
- Many Transsexuals are out of work and finding work during transitioning can be very difficult. Have you thought about how you are going to deal with this? Voluntary work is a useful alternative.
- What about going out in public, such as going to your local shops?
- What about travelling, to and from work on public transport?
- What about Public Conveniences, do you look for unisex or disabled?
- Hormones: do you wait, possibly a couple of years for them to be prescribed or do you self prescribe and buy on the internet?
This is your Real life Experience: Living, working, educated, socialising in your local community, in your new role. These are all things that have to be taken into account and dealt with.
The good news is that when you eventually accept and face your Transsexualism and transition, your future outlook can be so wonderful, happy and fulfilling. Male to Female, sexual reassignment surgery is one of the most successful surgeries and externally is indistinguishable from the natal female vulva. Only an internal examination will show any difference. However, it is not an operation to be undertaken lightly. It is non-reversible, highly intrusive carrying risks, such as: deep venous thrombosis, infection, rectal injury and vaginal prolapse.
Lili Elbe was the first known recipient of male-to-female sex reassignment surgery in Germany in 1930. She was the subject of several surgeries: including orchiectomy, penectomy, vaginoplasty. However, she died a couple of months after her last operation.
People have said to me ‘you are inspirational’, I admire you’, you are so brave’! Really, I am none of those things; it was something that I needed to do, I had no choice.
I am proud of what I have achieved and what I am now. Natural women cannot appreciate just how special and what a privilege it is to be a woman. There is so much more out there for us, if we want it and go for it. I hope that I have also achieved something, no matter how small, in helping our community with my voluntary work with the Domestic Abuse Action Forum, the Hillingdon Independent Advisory Group and joining in the fight for women’s equality. We are not there yet and there is still a way to go.
