Ireland
— In Ireland today, a very small number of people
live with a condition that, to a large extent, exists at
the margins of medical practice. The condition is known
as Gender Identity Disorder (GID) and is more commonly
referred to as Transsexualism.
In essence, it is
characterised by the strong conviction that one belongs
to the opposite sex to that which one was born into. The
ultimate conclusion of any quest for medical care may,
for some, involve sex re-assignment surgery (SRS).
Diagnosing Gender
Identity Disorder
The generally accepted
key features of GID are:
- Strong and persistent
cross-gender identification.
- Persistent discomfort
with their assigned natal sex and its associated
gender role.
- Absence of any
physical intersex condition (for example, true or
pseudo hermaphroditism, etc).
- Clinically
significant distress or impairment of social or
occupational functioning.
Although diagnosis is not
arrived at by means of any objective criteria, but rather
on the basis of subjective information provided by the
patient, it is possible, through careful evaluation over
an extended period, to arrive at a conclusive diagnosis.
This will normally involve a consultant psychiatrist,
with special experience of gender problems.
Individuals having
Gender Identity Disorder
For the transsexual (TS),
a sense of inappropriateness with regard to the assigned
gender role is first experienced in early childhood and
persists into adult life.
The dichotomy between the
inner sense of self and living in the gender role
appropriate to one’s biological sex can cause
intense frustration and frequently precipitate a
significant level of emotional stress, anxiety or
depression.
Very often these will
pass a clinical threshold and may require treatment with
anxiolytic or anti-depressant drugs. Transsexualism may
sometimes be confused with fetishistic paraphilias, such
as transvestitism and autogynephilia, in which the
individual concerned achieves sexual arousal through
wearing the clothes of the opposite sex or indulging in
fantasies of being a member of the opposite sex
respectively.
However, transsexualism
is distinguished from these situations by the fact that
the cross sex behaviour, and the sense of being a member
of the opposite sex, is not accompanied by any sexual
arousal whatsoever.
Invariably, some sense of
awareness of the condition usually manifests itself well
before the onset of conscious sexual awakening, sometimes
from as early as four or five years old.
Some transsexuals may
refer to true or genuine transsexualism in order to
differentiate their experience from others whose
behaviour is based on the paraphilias mentioned
above.
From all the available
evidence, transsexualism is significantly more common in
biological males than biological females. Furthermore,
the condition is not related in any way to sexual
preferences.
Resolving the Gender
Identity Conflict
Resolving the transsexual
dilemma is ultimately about achieving a sense of
completeness or continuity between one’s own
experience of one’s gender identity and one’s
external appearance in order to live, and be accepted, in
the target gender.
For some individuals, the
condition will be so intense that they will seek to alter
their appearance through hormone treatment, gender
confirming facial surgery and sex reassignment surgery,
in order to become a member of the opposite sex.
For others, where surgery
is not an option, due to personal, family and other
issues, their gender conflict may have to be resolved in
some other manner that goes some way towards a greater
experience of what they believe to be their true gender
identity.
Medical and legal
perspectives
While instances of GID
have featured throughout history and in all
civilisations, it is a condition whose medical parameters
are still being explored. The condition was first
described in detail by Dr Harry Benjamin
<http://www.symposion.com/ijt/benjamin/>.
Various theories have
been put forward over the last 40 years, attempting to
explain the origin of transsexualism in terms of nature,
nurture or a combination of both.
However, more recently, a
group working in the Netherlands has been presenting the
most compelling evidence yet to support a neurobiological
explanation of GID.
The increased medical
interest and emerging evidence that suggests a
physiological aetiology to the condition, has been
accompanied by material improvement in the law throughout
the European Union. European law prohibits discrimination
and guarantees the equal status for transsexual
people.
However successive
governments have shown a reluctance to extend the
provisions of European law to the statute books in this
jurisdiction, thus exposing a minority of citizens to
wide variety of rights abuses.
Public perceptions of
Gender Identity
Owing to the stigmatism
that persists in matters appertaining to both sexual and
mental health, many people prefer not to disclose that a
gender identity conflict is an ongoing reality in their
lives for fear of rejection or ridicule.
Some individuals may well
be receiving treatment for depression and yet are too
embarrassed to discuss the root cause of their problems
with their GP, or any other health care professionals
with whom they may be involved.
The stigmatism that
overshadows transsexualism is perpetuated by the fact
that responsible discussion of the issue is almost
non-existent in this country, and exacerbated by the
voyeurism of the tabloid press.
Regrettably, the greatest
exposure tends to involve an appetite for stories
suggesting a dysfunctional past of alcoholism, failed
relationships and attempted suicide, or indeed more lurid
sexual tales suggesting GID is the stuff of either the
psychiatrically disturbed or the sexually perverted.
Thus, it can easily be
appreciated that coming to terms with the condition is
made much more difficult for the genuine TS, as such
exposure only increases the difficulty of confronting
their identity issues with families, friends and work
colleagues.
In such a context, a GP
with a knowledge of the subject could offer a most
important starting point for a professional resolution of
the complex issues involved.
Undesirable
alternatives
The existence of any void
tends to be filled by undesirable substitutes and GID is
no exception, with two especially unacceptable options
coming to the fore.
Firstly, in recent years,
internet websites have sprung up offering a range of
prescription drugs without any safeguards. Any persons
believing themselves to be suffering from GID, and using
the internet for hormones etc, is unequivocally on a road
to self-harm.
Secondly, there are also
individuals and groups happy to offer their own self-help
and self-interested versions of the best way to proceed.
One such group that has emerged in recent times purports
to be a national support network representing the
interests of transsexuals.
However, evidence
suggests that the approach adopted is very much about
recruitment in order to advance a political agenda, which
has little or no regard for the complexities that GID
poses, both for the medical profession or indeed the
individuals affected by the condition.
Legitimate support groups
can only have a role to play if they operate within
clearly defined parameters, which would ideally be agreed
on in association with clinicians working in the area.
This approach is grounded in the reality that the nature
of the TS issue makes it imperative that persons seeking
help should contemplate only healthcare professionals who
are properly accredited by recognised professional
regulatory bodies.
For the genuine TS,
rather than being problematic, the natural and
understandable caution of healthcare professionals is
beneficial in that it ensures that only those that have
been tested to the fullest, progress their treatment to
sex re-assignment surgery.
This minimises the
possibility of subsequent unhappiness that the post-SRS
situation might entail, such as has occurred in other
jurisdictions where access to SRS is much more freely
available.
Concluding
comment
In Ireland, we are
fortunate to have healthcare professionals in primary and
secondary care that have the highest clinical standards
and that place the wellbeing of the patient at the top of
their agenda.
The purpose of writing
this article is to draw some attention to Gender Identity
Disorder, as it is essential that people with gender
identity questions avail of such professional help rather
than the unacceptable alternatives that make living with
a fundamental life issue even more problematic than it
need be.
*About the
Author:
The author is a
transsexual and is a graduate in Physics, Mathematics,
Biochemistry, and Pharmacology. Over the past 15 years
she has held posts in nuclear medicine, oncology,
clinical biochemistry and cytogenetics.
Further
Reading
Benjamin, H. The
Transsexual Phenomenon. Julian Press,
1966.
Brown M. & Roundsley
C. True Selves, Understanding Transsexualism.
Jossey Bass, 1996.
Zhou JN, Hofman MA,
Gooren LJ. Swaab DF. A Sex Difference in the Human Brain
and its Relation to Transsexuality. Nature.
378:68-70, 1995.
Kruijver FP, Zhou JN,
Pool CW, Hofman MA, Gooren LJ. Swaab DF. Male-to-Female
Transsexuals Have Female Neuron Numbers in a Limbic
Nucleus J Clin Endocrinol Metab 85: 2034-2041,
2000.
The Harry Benjamin
International Gender Dysphoria Association’s
Standards
of Care for Gender Identity
Disorders.
