Utilisateur:ChloeD/Transsexualisme

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Le transsexualisme est une condition dans laquelle l'identité de genre d'une personne est opposée au sexe qui lui a été attribué à la naissance. Le transsexualisme est un sujet considéré tabou dans de nombreuses parties du monde. Les opinions négatives au sujet du transsexualisme viennent la plupart du temps de croyances religieuses ou de normes culturelles. Cette condition est mieux connue depuis la fin du XXème siècle , grâce à la révolution sexuelle, mais ce sujet reste largement controversé.

Sommaire 1 Dysphorie de genre 2 Définir le transsexualisme 2.1 Terminologie concernant le genre des personnes transsexuelles 2.2 Terminologie alternative 3 Prevalence 4 Causes du transsexualisme 5 Psychological treatment 5.1 Diagnosing transsexualism 6 Sex reassignment therapy 7 Legal and social aspects 8 Coming out 8.1 Employment issues 8.2 Stealth 9 Regrets and detransitions 10 Depictions of transsexualism in the media 11 Transsexualism in non-Western cultures 12 References 13 Bibliography 14 See also 15 External links

[modifier] Dysphorie de genre

La plupart des personnes transsexuelles supportent la théorie de Harry Benjamin qui affirme que le genre est défini de manière invariable dans le cerveau avant la naissance. Ainsi, la plupart des personnes transsexuelles pensent que le transsexualisme est une condition intersexuée : le corps ne correspond pas à l'esprit. Le symptome principal de cette condition est un type de dépression bien particulier : la dysphorie de genre. La plupart des personnes transsexuelles considèrent que le genre (mental) ne peut être changé par un traitement psychiatrique. La seule alternative restant alors est de changer le corps afin qu'il corresponde à l'esprit. Si cette condition n'est pas traitée, elle peut mener à des troubles mentaux et émotionnels, et parfois au suicide.

La plupart des hommes et femmes transsexuels désirent mener leur vie en tant que membres du genre auquel ils s'identifient. Ils désirent aussi en général différents types de changements médicaux pour leur corps. Ces altérations physiques sont regroupées sous la dénomination de thérapie de réassignation sexuelle. Elles incluent souvent des thérapies hormonales et une chirurgie de réassignation sexuelle. Le fait de passer d'un rôle social à l'autre est appellé transition, et prend en général plusieurs années. Le processus de transition peut être très traumatisant et peut impliquer que la personne transsexuelle l'effectuant suspende toute activité professionnelle pendant un certain temps ^{[réf. nécessaire]}.

Afin de pouvoir prétendre à une thérapie de réassignation sexuelle, on demande en général aux personnes transsexuelles de consulter un psychiatre afin qu'il diagnostique un trouble de l'identité de genre. Selon les Standards de traitement du docteur Harry Benjamin, ces personnes doivent aussi vivre au moins durant un an en tant que membre du genre auquel elles s'identifient (cette expérience étant désignée comme un Real-Life Test), bien que cette période puisse s'allonger si le thérapeute a des doutes concernant le fait que la personne soit prête. Le but de ce délai et des autres règles des Harry Benjamin Standards of Care est d'éviter que des personnes pour qui cettr transition serait inappropriée (exemple extrème : une personne voulant effectuer sa transition afin d'échapper à la justice) ou pas pertinente (par exemple : un cross-dresser, qui s'identifie lui-même au genre qu'on lui a assigné à la naissance). Ces standards sont considérés par certaines personnes inefficaces, ou trop stricts, décourageant les "vraies" personnes transsexuelles dans la recherche des soins. Des enquêtes avant 1991 affirment qu'il y aurait moins de 1 % pour les hommes transsexuels (identifiés comme des filles à la naissance) et moins de 2 % pour les femmes transsexuelles (identifiées comme des garçons à la naissance) pour qui il y aurait des regrets. Les enquêtes après 1991 tendraient à affirmer que ces taux baissent encore, probablement grâce à l'amélioration des traitements psychiatriques et chirurgicaux. De telles recherches apportent un soutien aux protocoles existants pour le traitement des personnes transsexuelles. Toutefois, le suivi post-opératoire est très limité sinon inexistant. Une note du journal britannique Guardian Newspaper affirme (traduction):

Il n'y a pas de preuve évidente pour affirmer que les opérations de réassignement sexuel améliorent la vie des personnes transsexuelles, beaucoup de personnes restant en détresse voire même suicidaires après l'opération, selon un suivi médical conduit exclusivement pour le Guardian Weekend de demain. Le recoupement de plus de 100 études médicales internationales sur les personnes transsexuelles post-opératoires par un département de recherche de l'Université de Birmingham (Arif) tend à montrer qu'il n'est aucunement montré scientifiquement que les opérations de réassignement de genre (sic) sont cliniquement efficaces. ^[1]

(le terme réassignation de genre étant absurde selon les partisans de Benjamin, le genre étant pour eux considéré comme défini invariablement dans le cerveau)

Au sujet des taux de 1 et 2 %, le rapport affirme :

Paradoxalement, un nombre croissant de personnes transsexuelles opérées se plaignent du suivi médical qui leur a été prêté. Les recherches internationales suggèrent que de 3 à 18 % de ces personnes regrettent d'avoir changé de sexe.^[2]

Pour le moment, les causes du transsexualisme sont inconnues, et les estimations concernant la prévalence varient très substantiellement.

[modifier] Définir le transsexualisme

Le transsexualisme (que l'on appelle aussi la transsexualité) est une condition complexe définie de nombreuses manières par différentes personnes. De nombreux termes ont été proposés au fil des ans pour décrire les personnes transsexuelles et les processus qu'ils traversent. Comme c'est le cas en général avec la terminologie utilisée par un groupe restreint de personnes, certains de ces termes sont controversés, ou le sont devenus, et ce non pas seulement dans la société en général, mais même au sein de la "communauté transsexuelle".

La définition de la "transsexualité" est elle aussi débattue. Une définition courante énonce qu'une personne est transsexuelle si elle est convaincue que son corps ne correspond pas à son genre "intérieur". Une autre définition commune est qu'une personne transsexuelle est une personne qui a subi ou prévoit de subir des traitements chirurgicaux afin de changer son corps pour mieux ressembler à ce que cet individu est convaincu d'être en matière de genre. La première définition englobe plus de monde que la première (incluant les personnes transgenres, par exemple). La deuxième définition repose sur le statut opératoire des personnes, et est plus une étiquette extérieure qu'une définition que l'on peut appliquer à soi-même.

Quand on fait appel à la chirurgie dans ce cas, on parle de chirurgie de réassignation sexuelle au sein de la communauté médicale et parmi les personnes transsexuelles. Un autre terme, chirurgie de changement de sexe, peut être considéré irrespectueux.

Le Diagnostic and Statistical Manual of Mental Disorders accepte dans sa définition le désire d'être du sexe opposé, ou l'affirmation que l'on est du sexe opposé à celui qu'on nous a attribué à la naissance, comme des condition suffisantes pour qu'on soit qualifié de transsexuel^[3] L' ICD-10 dit de la même façon, que le transsexualisme est défini par "le désir de vivre et d'être accepté comme un membre du sexe opposé, accompagné habituellement du désir de rendre son corps le plus cohérent possible avec le sexe auquel on s'identifie à travers de la chirurgie et des traitements hormonaux.". On peut constater un contraste avec certaines personnes transgenres qui ne s'identifie pas comme étant de l'autre sexe mais d'un autre genre.

Le transsexualisme a été décrit comme une tendance,une maladie, un comportement, un désir, une maladie mentale, une perversion, une identité politique, un mode de vie ou un péché. Les termes perversion et péché sont souvent utilisés de manière méprisante (particulièrement par les wreligions occidentales). On peut considérer l'utilisation de telles étiquettes comme offensante que l'on soit soi-même une personne transsexuelle ou pas, ou un membre d'une religion occidentale.

Le transsexualisme est souvent inclus sous le terme plus générique trangenre, qui est généralement défini comme un qualificatif pour toutes les personnes n'acceptant pas leur genre social assigné. Par exemple, les cross-dressers, les drag queens et ceux et celles s'identifiant comme genderqueers. Toutefois, certaines personnes transsexuelles rejettent cette inclusion. Historiquement, la raison pour laquelle les personnes transsexuelles rejetaient une association avec les mouvements transgenre ou LGBT était que dans les années 1950 et jusqu'a la fin des années 1980 la communauté médicale encourageait (et souvent exigeait) ce rejet de l'assimilation aux minorités sexuelles afin d'être un (ou une) "bon(ne) transsexuel(le)", qui aurait ainsi accès à l'aide médicale et chirurgicale qu'il ou elle requérait. L'animosité de nos jours n'est plus causée par les mêmes pressions du monde médical (en effet, de nos jours un certain nombre de thérapeutes encouragent même leurs patients à rechercher du soutien parmi ces communautés). Toutefois, elle reste en séquelle de cette division historique. (Denny 176)

Quelle que puisse être la définition que l'on adopte, le transsexualisme ne doit en aucun cas être confondu avec le cross-dressing ou avec une attitude de drag king ou drag queen, attitudes pouvant être défines comme transgenres mais pas transsexuelles. De même, le travestisme fétichiste n'a en général que très peu (s'il en est) de rapport avec le transsexualisme. En règle générale, les personnes transsexuelles s'habillent et se comportent comme des membres du genre auxquels elles s'identifient. Les cross-dressers, eux, tendent à s'habiller (et parfois à se comporter) comme des stéréotypes de membres de l'autre genre. Les drag kings et drag queens se comportent quant à eux de manière flamboyante, parodiant plutôt qu'imitant le genre opposé.

[modifier] Terminologie concernant le genre des personnes transsexuelles

La majorité des personnes transsexuelles préfèrent qu'on s'adresse à elles avec les pronoms et termes correspondant au genre auquel elles s'identifient. Ainsi un homme transsexuel est une personne à qui on a assigné le genre féminin à la naissance en s'appuyant sur ses organes génitaux et qui, malgré cet assignement, se considère comme un homme et est en cours de transition (ou a effectué sa transition) vers un rôle de genre masculin, et possède (ou possèdera) un corps masculin. Les personnes transsexuelles sont souvent désignées sous la notation "genre_assigné-vers-genre_d'identification", en version française ou anglaise. On rencontre ainsi les termes "homme-vers-femme", "female-to-male", qui sont abrégés en "m2f","f2m","ftm","M to F", etc. Ces termes sont utiles afin d'éviter toute confusion, car pour certaines personnes une "femme transsexuelle" est une femme effectuant sa transition pour «devenir» un homme, et pour d'autres le contraire. Les anglophones utilisent les termes transman et transwoman pour synthétiser en un seul mot ces expressions.

Les personnes transsexuelles sont souvent considérées comme membres de la communauté LGBT, et bien que beaucoup s'y sentent en effet affiliées, d'autres considèrent n'avoir rien en commun avec cette communauté, ou préfèrent carrément ne pas utiliser la terminologie dédiée. Les personnes transsexuelles pensent en général qu'il faut absolument que les gens comprennent que le transsexualisme n'a rien à voir avec les préférences sexuelles.

Les hommes et les femmes transsexuels ont des préférences sexuelles très variées, tout comme les personnes ne l'étant pas (appellées parfois, par opposition, personnes cisgenres), et utilisent presque tous la terminologie relative au genre auquel ils s'identifient. Une femme transsexuelle (m2f donc) aimant les femmes se qualifiera ainsi de lesbienne et non pas d'heterosexuelle. Les personnes transsexuelles peuvent être, comme les autres, bisexuelles ou asexuelles.

Les textes médicaux datant un peu parlent des personnes transsexuelles en se référant à leur sexe assigné. Ainsi, une m2f était identifiée comme "un homme transsexuel". Ils décrivaient aussi l'orientation sexuelle en se référant au sexe assigné. Une m2f aimant les hommes était qualifiée d'"homme transsexuel homosexuel". Cet usage est considéré par beaucoup comme étant scientifiquement incorrect et socialement indélicat de la part des médecins, de nos jours. Ainsi, une personne étant qualifiée à l'époque d'"homme homosexuel transsexuel" serait plutôt qualifiée aujourd'hui comme une femme transsexuelle hétérosexuelle. L'ancien usage tombe en désuétude mais est encore trouvable dans certains ouvrages médicaux. Toutefois, on rencontre maintenant la plupart du temps la forme "genre-assigné vers genre-auquel-on-s'identifie".

Il y aura probablement toujours des gens peu au courant de la communauté transsexuelle qui se réfereront aux personnes transsexuelles selon le genre auquel on les a assignées à la naissance. Cette façon de parler, en général comprise comme insensible ou insultante (en particulier si elle est pratiquée intentionnellement), se base (bien que ce ne soit pas toujours le cas) sur des arguments biologiques, tels que le fait que le caryotype, qui en général (ce n'est pas toujours vrai, en particulier dans le cas des personnes intersexuées) correspond au sexe assigné à la naissance, n'est pas changé par les corrections apportées par la médecine. Ce peut aussi être justifié par le fait que les capacités reproductives sont absentes après la transition. D'autres arguments se réfèrent souvent à des dogmes religieux. La plupart des groupes conservateurs parlent ainsi des (et aux) personnes transsexuelles en utilisant les pronoms que ces personnes considèreront inadaptés.

[modifier] Terminologie alternative

La communauté transsexuelle utilise souvent la forme abrégée "trans", voire même "T" en substitution du mot "transsexuel(le)". Ainsi, on rencontre TS,mec trans, etc. Certaines personnes utilisent même des mots considérés comme insultants par d'autres, tels que trans tout court. Ceux qui utilisent ces termes affirment que c'est parce qu'ainsi le mot perd de sa force insultante, tout comme les membres des communautés gay ou afro-américaine utilisent les mots "pédé" et "nègre" ou "négro" entre eux. D'autres pensent que ces mots sont imprécis ou insultants quel que soit le contexte. D'autres pensent que ces mots posent problème car ils ne font pas la différence entre les personnes transsexuelles et celles qui jouent simplement avec le genre, comme les drag queens, ou les travestis.

Certaines personnes epèlent le mot transsexuel avec un seul s, l'écrivant donc transexuelle, ce qui est une erreur. Dans le monde anglo-saxon, cette tendance existe en particulier aux Etats-Unis, et est totalement inusitée au Royaume-Uni.

Certaines personnes préfèrent utiliser le terme transsexué plutôt que transsexuel ^[4] car elles pensent que le suffixe sexuel peut faire croire à tort que le transsexualisme est une préférence sexuelle. Une autre justification trouvée est qu'ils trouvent que ledit terme est ainsi plus proche de la situation intersexuée, les personnes transsexuelles se considérant en général comme des personnes intersexuées au niveau cérébral. Dans certaines définitions, il est possible d'être à la fois intersexué et transsexué. Il y a eu d'autres tentatives pour éviter le suffixe trompeur -sexuel, comme la croissance en popularité des termes transgenre ou transs* et parfois transidentité.

Certaines personnes préfèrent aussi le terme transgendérique plutôt que transsexuel parce que le problème est un problème de genre, pas de sexualité. Ils font un parallèle avec l'intergendérisme, qui est la situation dans laquelle une personne est entre (inter) les genres plutôt qu'intersexuées (une personne entre les deux sexes). Il est souvent admis, dans la communauté transsexuelle, que les personnes transsexuelles sont un sous-ensemble des personnes de condition intersexuée. "Intersexué" est un terme qui désignait auparavant uniquement les personnes dont les parties génitales n'étaient ni clairement mâles ni clairement femelles. (bien que les parties génitales humaines connaissent une grande variété, celles des personnes intersexuées sont particulièrement ambigües, ce qui peut empêcher de les classer comme mâles ou femelles). Toutefois, comme le sexe, chez les humains, est défini par de nombreux facteurs, comme les gènes, les chromosomes, des protéines, des hormones, des récepteurs hormonaux, la morphologie du corps, le sexe cérébral et l'identité de genre, toute variation inhabituelle dans l'un de ces facteurs peut être qualifiée d'intersexuation. Le transsexualisme, de ce point de vue, est une forme d'intersexuation neurologique. (Voir plus bas la section sur la recherche des causes physiologiques du transsexualisme)

Harry Benjamin était de l'avis du sexologue allemand Magnus Hirschfeld qui spécifiait que les personnes transsexuelles étaient atteintes d'une sorte d'intersexuation neurologique. ^[5]. Hirschfeld créa le terme travesti dans son ouvrage sur le sujet, Die Transvestitien. Dans cet ouvrage, il décrit à la fois ce qui est de nos jours connu sous le nom de travestisme fétichiste et le transsexualisme. En 1930, Hirschfeld supervisa la première opération de réassignation de sexe pratiquée sur Lili Elbe, une danoise.

Le terme neo-latin "psychopatia transexualis" et le mot anglais "transexual" (sic) ont été introduits par David Oliver Cauldwell en 1949 ^[6] qui utilisa plus tard (vers 1950) le terme "trans-sexual". ^[7] (En 1969, Harry Benjamin affirma avoir été le premier à utiliser le terme "transsexuel" lors d'une conférence qu'il donna en Décembre 1953 (^[8]). Ce terme est encore utilisé par le public et par le monde médical. Il fut introduit pour la première fois dans le DSM-III en 1980, puis de nouveau dans le DSM-III-R en 1987 où il se trouvait dans la section Disorders Usually First Evident in Infancy, Childhood or Adolescence (Troubles découverts en général durant l'enfance ou l'adolescence).

Les termes "Dysphorie de genre" et "Troubles de l'identité de genre" n'étaient pas utilisés avant les années 1970, quand Laub et Fisk^[9][10] publièrent plusieurs études sur le transsexualisme en utilisant ces expressions. Le mot "transsexualisme" a été remplacé dans le DSM-IV par "Trouble de l'identité de genre chez les adolescens et les adultes".

Certaines personnes préfèrent que l'on parle du Syndrome de (Harry) Benjamin plutôt de que transsexualisme, ^[11] car celà correspondrait mieux aux conventions de nommage des situations intersexuées. Ce terme tire son nom de celui du docteur Harry Benjamin, pionnier du réassignement de sexe et des recherches sur les personnes transsexuelles, dont les travaux dans les années 1950 et 1960 atteignirent leur point culminant avec l'ourage The Transsexual Phenomenon, publié en 1966. La plupart des personnes transsexuelles qui préfèrent qu'on utilise ce terme basent cette préférence sur le fait que les recherches scientifiques de ces dernières années tendraient à montrer que leur condition est biologique, et non pas psychologique. Ces personnes pensent aussi que le préfixe 'trans' est trompeur, étant donné qu'elles pensent que leur genre a toujours été présent dans leur cerveau, et n'a jamais changé. Ainsi, elles considèrent que rien de ce qu'elles font ne consiste à "traverser" une frontière, mais consiste plutôt à affirmer ce qu'elles ont toujours été. Une petite fraction de ces personnes ayant été opérées et vivent dans le rôle de genre qui selon elles leur correspond le mieux préfèrent s'appeler "neo-homme" ou "neo-femme", évitant ainsi l'usage du préfixe "trans" dont elles réfutent la pertinence.

Bien que les paragraphes précédents donnent une vue à peu près globale et exhaustive des terminologies employées, certaines personnes pensent que les deux composantes du mot "trans|sexuel" sont trompeuses, et ont forgé leurs propres termes. Toutefois, ceux-ci ne sont pas évoqués ici, la plupart de ces terminologies étant très controversées.

[modifier] Prevalence

There are no reliable statistics on the prevalence of transsexualism. The DSM-IV (1994) quotes prevalence of roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek sex reassignment surgery in the USA. The most reliable population based estimate of the incidence occurrence is from the Amsterdam Gender Dysphoria Clinic^[12] The data, spanning more than four decades in which the clinic has treated roughly 95% of Dutch transsexuals, gives figures of 1:10,000 assigned males and 1:30,000 assigned females. Other bodies report figures of between 1:1000 or even 1:500. No consensus has been agreed upon and interest groups maintain this is probably because of various governments' unwillingness to fund treatment accordinglyModèle:Fact.

[modifier] Causes du transsexualisme

Many psychological causes for transsexualism have been proposed, while research has been presented to suggest that the cause of transsexualism has its roots in biology. There remains no agreement, however, as to the cause of transsexualism.

Some transsexual people and professionals feel that research into causes of transsexualism assumes at face value the legitimacy of a normative gender identity, and/or that transsexualism is contrary to normal development, and could be considered a disease, or syndrome, which a transsexual may feel is stigmatizing. They usually consider such research to be unnecessary, and wonder if such studies might possibly be causing more harm than good for transsexual people.

Meanwhile, other transsexual individuals and professionals believe that transsexualism is, in fact, a syndrome with a physiological basis as a form of intersexuality. Those with this viewpoint generally support research as to the cause, believing that it will verify the theory of a biological origin and thereby reduce social stigma by demonstrating that it is not a delusion, a political statement, or a paraphilia.

Studies indicate that transsexualism is connected with a difference in the human brain called the bed nucleus of the stria terminalis. In one study, male-to-female transsexuals and cisgendered women were shown to have brains that were similar to each other in the BSTc area of the brain. Both heterosexual and homosexual men showed male brain structuring in this area. ^[13]

[modifier] Psychological treatment

Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex have typically been shown to be ineffective. Therefore, it is generally accepted that the only reasonable and effective course of treatment for transsexual people would be sex reassignment therapy.Modèle:Fact

The need for treatment is emphasized by the high rate of mental health problems, including depression, anxiety, and various addictions, as well as a higher suicide rate among untreated transsexual people than in the general population.^[14] Many of these problems, in the majority of cases, disappear or decrease significantly after a change of gender role and/or physical characteristics.^[15]

Many transgender and transsexual activists, and many caregivers, point out that these problems usually are not related to the gender identity issues themselves, but to problems that arise from dealing with those issues and social problems related to them. Also, many feel that those problems are much more likely to be diagnosed in transsexual people than in the general population, because transsexual people are usually required to visit a mental health professional to obtain approval for hormones and sex reassignment surgery. This exposes the transsexual community to a higher level of evaluation for mental health issues than the general populace.

A growing number of transsexual people are resenting or even refusing psychological treatment which is mandated by the Harry Benjamin Standards of Care, because they believe that gender dysphoria itself is untreatable by psychological means, and that they have no other problems that need treatment. Unfortunately, this can often cause them significant problems when they attempt to obtain physical treatment as health professionals expect such therapy to be occurring concurrently with physical treatment.

Therapists' records reveal that many transsexual people do not believe they need psychological counseling, but rather they will acquiesce to legal and medical expectations in order to gain rights which are thusly granted through the medical/psychological hierarchy. (Brown 103) Legal needs such as a change of sex on legal documents, and medical needs, such as sex reassignment surgery, are usually impossible to obtain without a doctor and/or therapist's approval. Because of this, many transsexual people feel coerced into affirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference, in order to overcome simple legal and medical hurdles. (Brown 107) Transsexual people who do not submit to this medical hierarchy typically face the option of remaining invisible, with no legal rights and possibly with identification documents incongruent with gender presentation.

[modifier] Diagnosing transsexualism

The current diagnosis for transsexual people who present themselves for psychological treatment is "gender identity disorder". As the DSM has changed its terminology, the diagnosis of "transsexualism" has become unused in recent years. This diagnostic label is often necessary to obtain sex reassignment therapy. However, some people diagnosed with gender identity disorder have no desire for sex reassignment therapy at all, particularly not genital reassignment surgery, and/or are not appropriate candidates for such treatment. While some feel that formal diagnosis helps to destigmatize transsexualism, others feel that it only adds stigma, essentially feeling that such a diagnosis is equivalent to saying something really is wrong with them. (Brown 105)

Some people who desire sex reassignment therapy do not have gender identity disorder, as the term is usually defined, and desire to transition for other reasons. This can include homosexual people who are unable to accept their homosexuality (or which were, up until the 1970s, encouraged by caretakers to change their gender role, including SRS), cross-dressers who feel more comfortable dressed as members of the opposite gender and may become confused (although, it may be important to realize that many transsexual women do go through a period where they self-identify as cross-dressers), and people with certain psychiatric disorders, such as schizophrenia, borderline personality disorder, dissociative identity disorder, and Munchausen syndrome. (Brown 106-107) Most professionals believe that sex reassignment therapy is not appropriate for such individuals. (Brown 107) If SRS is performed in such cases, the result is usually expected to be very negative for the individual, since it, unlike with patients with GID, typically does not alleviate issues for them, but rather leaves them with an intolerable body.^[16].

However, some transsexual people may suffer from co-morbid psychiatric conditions unrelated to their gender dysphoria. The DSM-IV itself states that in rare instances, gender identity disorder may co-exist with schizophrenia, and that psychiatric disorders are generally not considered contraindications to sex reassignment therapy, that is unless they are the primary cause of the patient's gender dysphoria. (Brown 108) Despite this permissiveness, the process of psychological treatment is usually much more complicated for transsexual people with co-morbid psychiatric conditions.

Some transsexual people have pressured the American Psychiatric Association to remove Gender Identity Disorder from the DSM. Many of these people feel that at least some mental health professionals are being insensitive by labeling transsexualism as "a disease", rather than as an inborn trait. Modèle:Fact Furthermore, many people express that some psychologists and psychiatrists in viewing transsexualism as "a disease" have sought to develop specific models of transsexualism, which they feel exclude many transsexual people, such as Ray Blanchard's model.

Andrea James in an article rejecting terminology and disease-models of transsexuality, has proposed the terms "interest in feminization" and "interest in masculinization" to refer to a desire for sex reassignment therapy, regardless of whether the person with the desire is transsexual.^[17] Although she herself admitted that there are numerous difficulties and issues with this terminology that she herself could easily list, she hasn't advanced this terminology as a finalized terminology, but rather a start towards finding terminology that avoids the traditional issues surrounding transsexuality which describe it as a "disease" or a "deviant" condition.^[17] Critics of her terminology would point out that she has swung the pendulum too far in the other direction, now equating transsexuality to a "life-style choice", which often offends those transsexuals who feel that their condition has a biological origin. Andrea herself agreed with this position that transsexuality is not a choice, but she was rather strong in rejecting any assertion that it should be classified as a disease rather than a part of typical human variance.^[17]

Other people, under the position that transsexual is a physical condition and not a psychological issue, assert that sex reassignment therapy should be given if requested, and may even align with those who feel that all body modification should be offered on demand. (Brown 103)

Additionally, the rules or requirements for diagnosis are almost always determined by non-transsexual medical gatekeepers who have the power to allow or deny a transsexual person's will to transition, based on their own perceptions of how a transsexual person should act and/or appear, which are sometimes prejudiced or based largely on cultural stereotypes. For example, they may reject the hair of a transsexual man as being "too long", even though many non-transsexual men like to wear long hair.

[modifier] Sex reassignment therapy

Sex reassignment therapy (SRT) is an umbrella term for all medical procedures regarding sex reassignment of both transgender and intersexual people. Sometimes SRT is also called gender reassignment, even though many people consider this term inaccurate as SRT alters physical sexual characteristics to more accurately reflect the individual's psychological/social gender identity, rather than vice versa as is implied by the term "gender reassignment."

Sex reassignment therapy can consist of hormone replacement therapy (HRT) to modify secondary sex characteristics, sex reassignment surgery to alter primary sex characteristics, and permanent hair removal for transwomen.

In addition to undergoing medical procedures, transsexual people who go through sex reassignment therapy usually change their social gender roles, legal names and legal sex designation. The entire process of change from one gender presentation to another is known as transition.

[modifier] Legal and social aspects

Many Western societies have procedures whereby an individual can change their name, and sometimes, their legal gender, to reflect their gender identity (see Legal aspects of transsexualism). Laws regarding changes to the legal status of transsexuals are different from country to country. Within the US, some state jurisdictions do allow amendments or complete replacement of the original birth certificates. Some jurisdictions may even seal earlier records against all but court orders in order to protect the transsexual's privacy.

In many other countries, it is still not possible to change birth records or other legal documents relating to ones gender status. Since many governments are revising the legal status of post-operative transsexuals, there are many individuals pioneering changes to these laws, such as Estelle Asmodelle whose book documents her struggle to change the Australian birth certificate and passport laws, although there are other individuals who are were instrumental in changing laws and thus attaining more acceptance for transsexual people in general.

Medical treatment for transsexual and transgender people is also available in most Western countries. However, transsexual and transgender people challenge the "normative" gender roles of many cultures and often face considerable hatred and prejudice. The film Boys Don't Cry chronicles the case of Brandon Teena, a transsexual man who was raped and murdered after his status was discovered. The project Remembering Our Dead, founded by Gwendolyn Ann Smith, archives numerous cases of transsexual and transgender people being murdered.^[18] In the United States, November 20 has been set aside as the "Day of Remembrance" for all murdered transgender people.

Some people who have switched their gender role enter into traditional social institutions such as marriage and the role of parenting. They sometimes adopt or provide foster care for children, as complete sex reassignment therapy inevitably results in infertility. Sometimes, they adopt children who are also transsexual or transgender and help them live according to their gender identity.Modèle:Fact Some transsexual people have children from before transition. Some of these children continue living with their transitioning/transitioned parent, or retain close contact with them. A recent study shows that this does not harm the development of these children in any way.^[19]

The style guides of many media outlets prescribe that a journalist who writes about a transsexual person should use the name and pronouns used by that person. Family members and friends, who are often confused about pronoun usage or the definitions of sex, are frequently instructed in proper pronoun usage, either by the transsexual person or by professionals or other persons familiar with pronoun usage as it relates to transsexual people. Sometimes, transsexual people have to correct their friends and family members many times before they begin to use the proper pronouns consistently.

[modifier] Coming out

[modifier] Employment issues

Transsexual people have historically had difficulty maintaining employment. Most transsexual people find it necessary to remain employed during transition in order to cover the costs of living and transition. However, employment discrimination against trans people is rampant and many of them are fired when they come out or are involuntarily outed at work.^[20] Transsexual people must decide whether to transition on-the-job^[21], or to find a new job when they make their social transition. The transsexual community usually regards this as a personal decision, though those who are fired during transition will have to find new jobs. Finding employment is often a challenge, especially for those in mid-transition.

Legal policies regarding name and gender changes in many countries make it difficult for pre-op transsexual people to conceal their trans status from their employers.^[22] Because the Harry Benjamin Standards of Care require a one year RLT prior to SRS, some feel this creates a Catch 22 situation which makes it difficult for transpeople to remain employed or obtain SRS.

In many countries, laws are providing increasing protection from workplace discrimination to transpeople, and an increasing number of companies are including "gender identity" in their non-discrimination policies.^[23] However, these laws and policies often have gaps, and they are not always fully implemented and enforced. California has strigent anti-discrimination laws to protect transsexual persons in the workplace and specifically prohibits employers from terminating or refusing to hire persons who are discovered to be transsexual. Member states of the European Union provide employment protection as part of gender discrimination protections following the European Court of Justice decisions in P v S and Cornwall County Council^[24]

[modifier] Stealth

After transsexual men and women are living full-time as members of their target gender, they may wish to blend in with other members of their new sex, and will avoid revealing their past. They do this believing that it will provide greater peace and security on the other side of a stressful and potentially dangerous transition, and/or because they wish to be seen only as members of their target sex, not as transsexuals.

This behaviour, known as stealth, is recognized by most people in the transsexual community as an individual decision that one must make. Some, however, within and outside the transsexual community, feel that one should be upfront about his or her past, and that stealth living is somehow dishonest. Some draw a parallel with a perceived need for lesbian and gay people to "come out", and may perceive a failure to do so as betrayal of a greater community, seeing hope for advancement of civil rights and public image in the visibility of greater numbers. However, most people within the community understand that revealing one's transsexual history is a deeply personal choice. Moreover, this is part of an individual's medical history, and as such should be his or hers alone to disclose.

The equating of "coming out" (whereby a transsexual person who has hidden their true gender identity while maintaining their originally assigned gender role, reveals their true self) with honesty or social activism has been countered by the explanation that, because of prejudice, sensationalism, and the triggering of unconscious personal feelings and emotions, knowledge of someone's transsexual past can prevent the average person from being able to see the transitioned person's true self.

The decision to live completely stealth is believed to present its own psychological difficulties. Many believe that post-transition transsexual people who have no one in which to confide may have tendencies towards anxiety and depression. The term deep stealth is sometimes used for those who have completely isolated themselves from their past, their birth families, the medical professionals directly involved in their treatment process, and from the support structures that may have helped them through transition. Several examples exist of people who have gone deep stealth and whose status was discovered only at their death. For example, the jazz musician Billy Tipton was deep stealth and his status was unknown, even by his wife and (adopted) children. Tipton's death illustrates one of the dangers of going deep stealth. This fear of discovery as being transsexual may often keep people from seeking needed medical care. Tipton bled to death from an ulcer that could have been readily treated at the time had he been able to seek medical care without fear of discovery.

However, many believe that fear of discovery, as mentioned above, is justifiable. Several examples also exist of people who have been denied medical treatment upon discovery of their trans status, whether it was revealed by the patient or inadvertently discovered by the doctors. For example, Leslie Feinberg was once turned away from a hospital emergency room where he had sought treatment for encephalitis. (Feinberg 2) Like Tipton, Feinberg was presenting as a man but had female genital anatomy. He nearly died after being denied treatment. Feinberg's case demonstrates one of the many dangers of actually being discovered. Additionally, Tyra Hunter died after being denied care by paramedics and emergency room physicians after she was injured in an automobile accident.

The majority of the transsexual and transgender community has learned to accept that people choose, for many reasons, including political beliefs, religion, family responsibilities, career, perception of how well they will be accepted by others, and personal psychology, to live at a certain place on the spectrum from 'out and proud' to 'deep stealth'. By this view, Billy Tipton's decision to live deep stealth was no more or less valid than Jamison Green's decision to be out and politically active, as detailed in his book 'Becoming a Visible Man'. There are risks and benefits associated with every point on the spectrum and the decision is widely considered a personal one.

[modifier] Regrets and detransitions

After transitioning, transsexual people sometimes regret their transition, or even choose to detransition to their original sex. However, every recent study done on the number of detransitions states that their number is well below 1%, and that the reasons for detransitioning are very diverse.^[25]

Although the incidence of regret is not known, there are many documented cases of regret. Evidence suggests Modèle:Fact that regret is more common among autogynephiles, transsexual people with co-existing psychiatric problems, patients with surgical complications, and patients having religious views that their transition was "wrong". In a 2001 study of 232 MTF patients who underwent GRS with Dr. Toby Meltzer, none of the patients reported complete regret and only 6% reported partial or occasional regrets.^[26] Minister and former transgender Jerry Leach, in association with Exodus International, includes stories from regretful trans patients as part of his "sexual addiction" ministry website.^[27]

These cases are often cited as reasons for the lengthy triadic process outlined in the Standards of Care, which specifies a treatment process combining psychological, hormonal, and surgical care. While many have criticized this process as being too slow for some, it is argued that without the safeguards within the Standards of Care, the incidence of unsuccessful surgical transitions would be much higher. This is also questioned by many critics, especially with regard to particular demands of some caregivers. The article above states that in some of these cases, transitioning could have been prevented if some demands made by caregivers, or demands perceived as coming from the caregivers, had been less rigid; particularly, if the patients had not felt that talking about any problems or doubts would jeopardize their further treatment. An unwavering demand for medical treatment and the absolute conviction of "doing the right thing" is often seen as a necessity for the diagnosis of transsexualism, and therefore the prerequisite for any further treatment; consequently, further treatment has been denied to people who uttered any doubts or even questions.

Critics claim that when patients cannot talk about problems or doubts, but have to present themselves as having neither, the patients, anxious to get treatment they perceive at this point to be absolutely necessary, will face these problems or doubts after transitioning, when dealing with them may be much more difficult, and this will often lead to social problems, depression, anxiety, or other problems. They believe that, in some cases, this may lead to a retransitioning. While there is no scientific study on the question, many trans*-organizations and groups claim that patients who feel less pressure to conform to any particular stereotype will have more satisfactory outcomes after transition. This does not preclude any screening for mental problems which might lead to pseudo-transsexualism, nor supportive psychological therapy, if necessary.

Additionally, some people detransition after SRS because their desire was to undergo SRS and continue living in the gender role assigned to them at birth.^[28] However, they transition temporarily in order to satisfy the requirement of a real-life test.

[modifier] Depictions of transsexualism in the media

Although many transsexual people are modest about their bodies, and are found in all walks of life and professions, transsexual women are commonly featured in pornographic works. When depicted without having undergone vaginoplasty, they are usually referred to as "shemales". While some pre-operative transwomen call themselves and others like them "shemales," the term is regarded as offensive by many transsexual people.^[29]

Films depicting transgender issues include The World According to Garp and The Crying Game. The film Different for Girls is notable for its depiction of a transsexual woman who meets up with, and forms a romantic relationship with, her former best friend from her all-male boarding school. Ma Vie en Rose portrays a six-year-old child who is gender variant.

Two notable films depict transphobic violence based on true events: Soldier's Girl (about the relationship between Barry Winchell and Calpernia Addams, and Winchell's subsequent murder) and Boys Don't Cry (about Brandon Teena's murder).

Transsexual people have also been depicted in some popular television shows. In Just Shoot Me!, David Spade's character meets up with his childhood male friend, who has transitioned to living as a woman. After initially being frightened, he eventually forms sexual attraction to his friend, but is scorned, as he is 'not her type'. In an episode of Becker Dr. Becker gets an out-of-town visit from an old friend who turns out to have undergone SRS, it plays out very similar to the situations in Just Shoot Me!. In a 1980s episode of The Love Boat, McKenzie Phillips portrays a transwoman who is eventually accepted as a friend by her old high school classmate, series regular Fred Grandy.

In the television show, "Ugly Betty", the character Alexis Meade (Portrayed by Rebecca Romijn), formerly Alex Meade, is a post-op transsexual who, before transitioning, faked his own death so he could start his life over as a woman. When Alexis realizes that she can get back at her father (who said he would rather see her dead than as a woman) she comes out of stealth and takes over their business after she tips the authorities off about how her father killed Fey Sommers (Another character on the show).

The series Law & Order and Nip/Tuck have had transsexual characters, but they were played by non-transsexual women or professional cross-dressers. The series Without a Trace featured an episode in which a transsexual woman went missing and is almost killed by her ex-wife's husband after visiting her family, which she abandoned before transtioning. CSI: Crime Scene Investigation had an episode dealing with a transsexual victim, Ch-Ch-Changes.^[30] Many transsexual actresses and extras appeared on the episode, including Marci Bowers and Calpernia Addams.^[31] The transwoman victim, Wendy, was played by Sarah Buxton, a cisgender woman. Addams has appeared in numerous movies and television shows, including the 2005 movie Transamerica, in which Felicity Huffman portrays a pre-op transsexual woman.^[32]

Recently, Candis Cayne, a transexual performer, appeared in CSI: NY as a transsexual character. Beginning in the fall 2007 TV season, Candis will also play a transsexual character (this time reoccurring) in the new ABC series, Dirty Sexy Money.

In fall 2005, the Sundance Channel aired a documentary series known as TransGeneration. This series focused on four transsexual college students, including two transwomen and two transmen, in various stages of transition.^[33] In February 2006, LOGO aired Beautiful Daughters, a documentary film about the first all-trans cast of The Vagina Monologues, which included Addams, Lynn Conway, Andrea James, and Leslie Townsend.^[34]

Thomas Harris' Silence of the Lambs included a serial killer who considered himself a transsexual. After being turned down for sex reassignment surgery due to not meeting necessary psychological evaluations, he then harvested female bodies to make a feminine suit. While the movie and novel initially sparked more intolerance toward transsexuals, it has since diminished from public criticism of transsexuality.^[35]

Modèle:See also

[modifier] Transsexualism in non-Western cultures

Modèle:Seealso

Transsexual people experience varying degrees of acceptance in non-Western societies.

Before the Islamic Revolution in 1979, the issue of transsexualism in Iran had never been officially addressed by the government. Beginning in the mid-1980s, however, transgendered individuals have been officially recognized by the government and allowed to undergo sex reassignment surgery. (See Transsexuality in Iran)

This stance is also seen in countries such as Brésil et Thaïlande. Thailand is thought to have the highest prevalence of transsexualism in the world. In Thailand, kathoey (who are often, but not always, transsexual) are accepted to a greater extent than in most countries, but are not completely free of societal stigma. Feminine transsexual kathoey are much more accepted than gay male kathoey; this may be seen as an example of heteronormativity. Due to the relative prevalence and acceptance of transsexualism in Thailand, there are many accomplished Thai surgeons who are specialized in sex reassignment surgery. Thai surgeons are a popular option for Western transpeople seeking surgery, largely due to the lower cost of surgery in Thailand.

Transsexual people are gaining acceptance in much of Latin America, and gender reassignment surgeries are on the rise in Mexico, Argentina and Brazil. Modèle:Fact

Transgender-related issues remain largely taboo in much of Africa and in developing countries around the world.^[36]

[modifier] References

[modifier] Bibliography

Modèle:Sourcesstart

• Burns, Christine: Why Phrasebook Diversity is not Enough (Press for Change)
• Brown, Mildred L.; Chloe Ann Rounsley (1996). True Selves: Understanding Transsexualism - For Families, Friends, Coworkers, and Helping Professionals. Jossey-Bass. ISBN 978-0787967024. 
• Feinberg, Leslie (1999). Trans Liberation : Beyond Pink or Blue. Beacon Press. ISBN 978-0807079515. 
• Standards of Care for Gender Identity Disorders, Sixth Version. - World Professional Association for Transgender Health (2001)
• Frank P. M. Kruijver, « Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus », dans Journal of Clinical Endocrinology & Metabolism, 2000, 85, p. 2034-2041 [texte intégral]. Consulté le 2007-02-25
• Harald J. Schneider, « Typical female 2nd-4th finger length (2D:4D) ratios in male-to-female transsexuals-possible implications for prenatal androgen exposure », dans International Society of Psychoneuroendocrinology, 2006, 31, p. 265-269 [texte intégral]. Consulté le 2007-02-25
• Xavier, J., Simmons, R. (2000) - The Washington transgender needs assessment survey, Washington, DC: The Administration for HIV and AIDS of the District of Columbia Government
• Rathus, Spencer A.; Jeffery S. Nevid, Lois Fichner-Rathus (2002). Human Sexuality in a World of Diversity. Allyn & Bacon. ISBN 978-0205406159. 
• Denny, Dallas, (2006); Transgender Communities in Transgender Rights.

Modèle:Sourcesend

[modifier] See also

• List of transgender-related topics
• List of transgender-rights organizations
• List of LGBT-related organizations
• List of transgendered people

[modifier] External links

• Basic TG/TS/IS Information - including Successful Transwomen and Successful Transmen
• FTM International - Female To Male International: practical and medical information
• FTM Australia - Comprehensive information for all men identified female at birth in Australia.
• Hudson's FTM Resource Guide - Comprehensive information for female to male trans men and allies - USA-based
• Gender.org - The home of Gender Education & Advocacy, a nonprofit corporation using the web to provide education and advocacy for transsexual and transgender issues.
• Definition and Synopsis of the Etiology of Adult Gender Identity Disorder and Transsexualism - prepared by 24 internationally recognized experts, published by the Gender Identity Research and Education Society (GIRES)(See: http://www.gires.org.uk)
• How to Respect a Transsexual Person
• The International Journal of Transgenderism - The Official Journal of the World Professional Association for Transgender Health (formerly HBIGDA)
• Transsexuality - Jennifer Diane Reitz's Help & Support Site. Home of the COGIATI gender test, a controversial assessment of gender identity and transsexuality.
• Lynn Conway - her goal is to "illuminate and normalize the issues of gender identity and the processes of gender transition."
• Dr Becky's Website - List of therapists, physicians, medical info, etc.
• TransParentcy - Organization to support transgender parents and their advocates (lawyers, mental health professionals, friends, family) by providing information and resources to diffuse and/or disspell the myths about any adverse impact being transgendered/transsexual might have on ones children.
• Transsexual Road Map - practical and medical information for those interested in finding out more
• TS Transsexual Chat Community - Online community for TS friendships and support

Modèle:Sexual Identities

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