The objective of this paper was to gain answers to various questions in regards to transgenders that I personally have been interested in knowing for the last few years.  I was interested in finding out if a transgender person is always attracted to the opposite sex or not after they complete their transition.  I also was interested in finding out what was involved in sex-reassignment surgery.

            Various ideas and thoughts were presented for this project, including terminology, transgender children, transgender adolescence, suicide, religion and laws.  Much of what is presented in this research is minimal in regards to the vast amount of information obtained from various organizations, web sites, and books that are available.



In order to conduct the research for this project, there were two methods used.  Two different surveys were used to ask both transgender people and people who are not transgender a series of unrelated questions.  Both surveys were different in their aspects with one pertaining to questions regarding the transgender themselves (Tanis, 2008) and the other pertaining to religious aspects that people believe (Hoffman et al, 2008), in regards to transgender individuals.  I also consulted various transgender organizations, web sites and books, along with consulting a couple of experts in the field of transgender studies.




            When talking about a transgender person, one usually thinks of only a transsexual; however, transsexuals are not the only individuals who use this term to identify themselves.  In a personal communication on October 15, 2008, Lydia A. Sausa, Ph.D., M.S. Ed., Curriculum Development and Training Administrator for the Center of Excellence for Transgender HIV Program at the University of California, San Francisco, stated that transgender is an umbrella term that includes approximately 100 various sexual identities; this includes transsexual, intersex, two-spirit, and androgynous, just to name a few.  The definition of transgender is described as:

“An umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth.  The term may include but is not limited to: transsexuals, cross-dressers, and other gender variant people” (Transgender Glossary of Terms, 2008).

The individuals that identify most with this term are the individuals who were known for many years simply as transsexuals.  Although this term is still used, it is an older term which originated in the medical and psychological communities (2008).  Many of these individuals have participated in sex-reassignment surgery and are now transitioned male-to-female (MTF) or female-to-male (FTM).  Of the six transgender respondents that participated in the transgender survey, three individuals stated that they have already undergone their transition, one has yet to under go their transition, and the other two respondents answers were unable to be accessed due to technical difficulties. 

The American Psychological Association, in their pamphlet “Answers and Questions about Transgender Individuals and Gender Identity” explains:

Transgender persons have been documented in many Western and non-Western cultures and societies from antiquity until the present day. However, the meaning of gender variance may vary from culture to culture.

There is no one generally accepted explanation for why some people are transgender. The diversity of transgender expression argues against any simple or unitary explanation. Many experts believe that biological factors such as genetic influences and prenatal hormone levels, early experiences in a person’s family of origin, and other social influences can all contribute to the development of transgender behaviors and identities.

It is difficult to accurately estimate the prevalence of transgender people in Western countries. As many as 2-3% of biological males engage in cross-dressing, at least occasionally. Current estimates of the prevalence of transsexualism are about 1 in 10,000 for biological males and 1 in 30,000 for biological females. The number of people in other transgender categories is unknown (Schneider et al., 2008).

One of the most enduring debates of the human sciences… is the controversy over the roles played by biological and social factors in determining human traits and behaviors, including several characteristics (Kelly, 2006).  Ask any transgender person if they believe when they first recognized they were “different” in terms of their gender if this was due to biological factors or environmental influences, the majority will answer you with biological factors.  In this way, we can apply biological essentialism theory to transgender persons and gender expression as well as the gender role differences between sexes, which was brought about by the application of evolutionary theory in sexuality.  Biological essentialism is defined as “a theory that holds that human traits and behaviors are primarily formed by inborn biological determinants such as genes and hormonal secretions, rather than by environmental influences (Kelly, 2006). 

While researching transgenders on the internet, the topic of transgender children arose numerous times.  This brought a whole new light to this topic and brought light to many underlying questions.  The four of my transgender survey participants who responded stated that they felt that they were “different” in terms of gender at the ages of four, five, seven, and eight.  Jean Piaget observed his own children as they grew up and noticed that they approached learning situations at different ages and differently.  This observation led him to formulate a model of intellectual development in learning style (Walker-Hirsch, 2007).  In Piaget’s concrete operational stage, he determined that children in this stage were fairly good at the use of inductive logic.  This means that children who feel that they are a different gender than their biological gender assigned to them at birth, have come to a fundamental truth about who they believe they are.

Although many transgenders start recognizing that they are different in terms of gender during Erik Erikson’s Industry versus Inferiority stage, many are unable to do anything about who they are until they are at least in the Identity versus Role Confusion stage.  Erikson believed that at this stage one emerges in life with a strong sense of self and they are secure in their thinking at this age.  This means many children who feel they have been born in a different body will not realize their true identity until they reach this stage of life.

So what causes transgenderism?  Transgenderism is the medical terminology used for one who is transgender and is defined in ‘Sexuality Today: The Human Perspective’ as a crossing of traditional gender lines because of discomfort and nonconformity with gender roles generally accepted by the society (Kelly, 2006).  In the December 2001 issue of Neuroendocriniology Letters, Dr. Günter Dörner and his colleagues outlined two probable causes of transexualism: 1) genetic enzyme mutations and 2) epigenetic effects which can include stressful prenatal situations and fetal exposure to endocrine disruptors, i.e. the breakdown products of DOT (DDE which is estrogen in nature) (Dörner et al, 2001, as cited in Stewart, 2005).

There are six distinct stages of homosexual identity formation presented by M. Cass which, in theory could also be applied to transgenders.  These include: identity confusion, identity comparisons, identity tolerance, identity acceptance, identity pride, and identity synthesis (Franken, 2007).  Although after the sex-reassignment surgery (SRS), many transgender people still are attracted to the opposite sex, this does not mean that all transgender people are heterosexual.  Many times their sexual orientation can change, even though it does not always do so.  After viewing numerous hours of documentaries, it has been determined that although a Male-to-Female (MTF) transsexual may have been sexually attracted to women before their transition, not all stay attracted to women.  Then there are some MTF transsexuals that were homosexual before their SRS that find out that after their transition they are attracted to females.

The participants of the transgender survey who were able to complete their questionnaire also identified in this pattern.  Marcus, the only FTM transsexual says that he identifies his sexual orientation as bisexual.  Amanda and Lauren also identified their sexual orientation as bisexual after their transition as MTF transsexuals.  Caroline stated that she is heterosexual in her sexual orientation; however, the question of sexual orientation was not asked in regards to their sexual orientation prior to their transitions.  Each one of these individuals has gone through their personal stages of identity formation in both their transition and in their sexual orientation.  Raymond Charles Barker wrote in his book The Power of Decision:

Columbus decided to cross the ocean.  The American Colonies decided to become a free nation.  The Wright Brothers decided to create a flying machine (p 146, 1968/1991). 

Every transsexual has made the decision to take that step into the shoes they feel most comfortable in.

            The process to become an FTM or MTF transsexual requires much work and a deep thought process.  First there are the numerous counseling sessions over a period of several months.  Second, each individual needs to make the choice, which is highly recommended, to tell their family and friends that this is who they are as a transgender person.  Next, the first steps in the physical change begin with hormone treatments that will have to continue for the rest of their lives.  The side effects to this are that they will sterile after beginning hormonal treatments, so it is recommended that if they desire to have children, they may want to make a deposit at a sperm bank for later options.  Fourth is the Gender Reassignment Therapy.  This is the last process for the transsexual prior to going through the SRS.  This is a training period to learn how to live as their new gender.  There are numerous sex reassignment therapists that work with people all around the world during this stage of the transsexual’s life.  Finally, the individual undergoes Gender Reassignment Surgery or Sex-Reassignment Surgery.

            The next topic presented is in regards to the various laws in regards to harassment and discrimination.  Through new laws, transgender adolescents are gaining better opportunities for employment and education.  This will assist in the reduction of suicide rates among transgender teens.  At the beginning of 2002, only 6.5 percent of the country (by population) was covered by anti-discrimination laws with language clearly covering the transgender community.  As of fall 2004, four states and more than 70 cities and counties have transgender protections clearly written into law, with another five states providing strong transgender protections.  This brings the percentage up to 35 percent (Mottet, 2004).  Although these various states, counties/parishes, and cities may have their own anti-discrimination laws, the United States government wrote into act H.R. 3685: The Employment Non-Discrimination Act (ENDA) of 2007.  This act was written to stop discrimination based upon a person sexual orientation, including homosexuality, heterosexuality, and bisexuality; however, it did not include transgender persons.  This is a project many members of the International Court System, International Court Council, the National Center for Transgender Equality, and many other lesbian, gay, bisexual, transgender organizations are working to have revised.

Beginning in 2006, Gender Public Advocacy Coalition (GPAC) of Washington, DC, began working around the country with the Gender Equality National Index for Universities and Schools (GENIUS) Index in order to assist in GenderSAFE™ schools.  In their GENIUS Index released September 2008:

Ø       88% of “Top 25” colleges and universities now include gender identity and expression and sexual orientation in their non-discrimination policies (up from 65% in 2007); and

Ø       Over 4.25 million K-12 students now attend public schools in districts covered by anti-bullying policies that address gender identity and expression and sexual orientation (GenderPAC, 2008).

In a personal communication on October 15, 2008 with Edward Monge, Human Resources Specialist for Chapman University, he stated that Chapman University is looking to rewrite their Harassment and Discrimination policy to now include gender-identity and gender-expression.  Currently the University’s policy states:

Chapman University is committed to providing an environment which is free of any form of harassment and discrimination based upon an individual’s race, color, religion, ancestry, national origin, gender, marital status, sexual orientation, age, disability, veteran status, or any other classification protected by law, so that all members of the community are treated at all times with dignity and respect. It is the University’s policy, therefore, to prohibit all forms of such harassment or discrimination among University faculty, students, staff, and administration (chapman.edu, 2007).

A second possible factor for the high rate of transgender suicides is religion.  Although the Bible never speaks of transsexuals, or transgenderism, many religions and cultures believe that it is wrong.  In Hong Kong, China, transgender people are referred to as “human monsters” (Chui-yan, 2008).  In 2000, the Vatican’s Congregation of the Doctrine of the Faith sent out a confidential document authoritatively concluding that “sex-change” operations are invalid – they do not change a person’s sex (LifeSiteNews.com, 2003).  One website said that Mormon Prophets claim transsexuals are sent from the devil (Amato, 2005).  When adolescents feel that they are not loved for whom they are, they start to believe that life is not worth living if they are classified as outcasts. 

Because of this thinking it can cause guilt and shame and the adolescent then begins to feel unworthy of living.  This goes back to Erikson’s Autonomy versus Shame and Doubt stage.  The adolescent, like any person, can easily turn against himself/herself if denied autonomy and shame could now develop in the self-consciousness.  This also causes them to contemplate suicide or even attempt it.  Many transgender adolescents deal with this process more difficulty.  Since they are unable to go through hormone treatment and the SRS, usually until they are of adult age, they will not always be able to cope with who they are as a person.  When one rejects himself, he is rejecting life (Addington, 1971/1994). 

According to the Journal of Homosexuality, the prevalence of attempted suicide was 32 percent (Clements-Nolle, Marx, Katz, 2006).  The rate of attempted suicide in transgender youth is higher than that of homosexual non-transgender youth and much higher than heterosexual non-transgender youth.  It has been estimated that more than 50 percent of transgender youth attempt suicide according to the National Center for Transgender Equality (via phone conversation).  It has been established that transgender youth are at increased risk for suicide and psychiatric disorders when compared to their heterosexual peers (Fergusson, 1999; as cited in Reilly, 2006).

There are organizations and churches that are starting to realize the impact that discrimination and hatred has on these young people.  The International Centers for Spiritual Living, formerly known as Religious Science International (RSI), and Metropolitan Community Churches (MCC) have been opening their doors to people of all faiths, gender, sexual orientation and gender-identities or gender expression, for years, to let everyone know that they are loved no matter who they are.  Rev. Lauren René Hotchkiss says that somewhere during the course of the last three or four thousand years the whole subject of transgenderism was blown out of proportion and transformed into a societal taboo (Hotchkiss, 1995).  The growing literature addressing the identity development and psychological health of lesbian, gay, bisexual, and transgender individuals has largely ignored religious and spiritual issues (Hoffman et al, 2008).  While doing the research in regards to religion, a survey was given to twenty various people asking them questions in regards to transgender individuals.  Although the results were inconclusive, the survey is attached as Appendix B (survey developed by Hoffman et al, 2008).

Finally, our transgender youth struggle with the fact that the psychology world describes them as abnormal.  Transsexualism as an axis-I diagnosis was first introduced into the Diagnostic Statistics Manual of the American Psychiatric Association in its third edition (DSM-III, APA, 1980). In DSM-III-R (APA, 1987) it was re-categorized as an axis-II diagnosis (as cited in Kessler, 2006).  In the DSM IV, transgenderism is listed as Gender Identity Disorder (GID) for which it has two separate identifying codes, one for children, Code 302.6, and one for adolescents and adults, code 302.85 (American Psychiatric Association, 2000).  The definition of Gender Identity Disorder is that it denotes a strong and persistent desire to be of the other sex (or the insistence that one is of the other sex), together with persistent discomfort about one’s own sex or a sense of inappropriateness in the role assigned to one’s own sex (APA, 1994; as cited in Cook, 2004).  When receiving the responses from the transgender surveys, three of the participants responded that they have been diagnosed with GID.  When a person is told that their personality has a disorder, it is not very settling to them.  Therefore it is no wonder that adolescents look to suicide as the answer to a problem that needs to be addressed.

If we as a society of professionals condemn transphobic and otherwise bigoted research as we are challenged to do so by Joan Roughgarden (as cited in “The Bailey Affair:” 2008), then we may possibly be able to assist in these adolescent transgenders, as well as adult transgenders in learning to accept themselves more.  Suicide is such a threat to transgender individuals more so than it is to their peers.  As a society, we need to find a way to assist these individuals in overcoming this danger to their lives.  There is no more beautiful experience than when the world expands beyond its accustomed limits (Chopra, 1989/1990). 



            In summary, it is fortuitous that we as a society and as professionals be able to rehabilitate our thinking to support the betterment of life for the transgender individual by stopping and taking into consideration the damage that we are invoking on these individuals who are unable to simply change their feelings about being a transsexual.  By adjusting our conceptual ideas that we are doing more harm than good by giving such a diagnosis, and changing our mentality to believe that in so doing we can be causing tremendous mental harm, it is my opinion that we as psychologists, sociologists, and psychiatrists, we need to find a way to dissolve the DSM-IV-TR categorizing of transgenders and transsexuals as a disorder. I believe the APA needs to consider disassociating GID as a mental disorder from the DSM-V when released in 2012. 

            Although, gender identity is not firm until sometime in adolescence, or later, it is the belief of Dr. Gregory Ramey, Ph.D., a child psychologist at Dayton Children’s Hospital, in Dayton, OH (Ramey, 2007).  As we lend a hand to our transgender communities and help them understand that they are perfectly normal and not diseased or disordered, we will most likely see a tremendous decline in not only suicide rates among transgender, but also the amount of suicide attempts among them will go down as well.  This will ultimately help each transgender individual feel more comfortable in their lives.  According to Tony Zandvliet, transgender people tend to become much more comfortable in their lives when they stop focusing on ‘passing,’ realizing that even passing convincingly is no guarantee for qualifying as a man or a woman (Neal, 2000).

            It is in my opinion, that gender reassignment therapy should also be improved, to no longer include a psychiatrist or psychologist that will identify the individual with GID.  When we stop assigning transsexuals the damaging terminology of Gender Identity Disorder or Transsexual, 302.85, and the moment we stop conveying verbiage such as gender identity, gender expression, and gender role, we may actually see a society that comes to understand transgenders and transsexuals and accepts them as normal instead of calling them freaks or monsters. 





For information on references please contact the author.