Are Transsexuals Mentally Ill?

[Jragon]

Link

I actually wish I knew which thread this was referring to (though I don't know the average turnaround time between question and answer, for all I know this letter was sent a year ago and the thread is loooong dead).

I used to be (as in, before 5 minutes ago before I read this) a very, very staunch supporter of transsexuals. And to a degree, I am, I'm casually acquainted with a couple post-ops, I refer to them as "she" (both MtF), never gave them a degree of shit about it and I never will.

However, this point has kind of got me stuck and I'm starting to become shaken. At least as far as transitioning between "transsexuals are mentally okay, you bigot!" To "I'm so sorry about your severe body dysmorphia with regards to your genitals, what a terrible affliction!" I'll never start hating transexuals or anything. Heck, even if it is a "mental illness" I'll still vote to support trans rights.

But either way, what say you, Dopers? What is the flaw here? I can't really figure out what the difference is between somebody who wants to alter their penis because they feel like a woman and a person who wants to chop off the bottom half of their legs because they're totally a hobbit. Or that guy I know from college who had a dragon fleshlight and wouldn't shut up about his "draconic habits" (sexual and non-sexual) because he's a dragon "inside". Or maybe this just means there's absolutely nothing wrong with the hobbit and the guy who is convinced he's a giant lizard trapped in a human's body and I should accept them.

Heck, after reading this, an apt comparison almost seems like anorexia. Where they just don't feel right in their body because it's NOT THIN ENOUGH. And they HAVE to stop eating because they MUST become thinner.

I'm really having a crisis of... something here, can anyone help me out?

[adaher]

For me the issue isn't body modification. It's believing something that is just not true.

Sex is a defined biological characteristic. You are male or you are female, or you have a birth defect that leaves you with something else. If you are male, however, you are male. If you are male and you think you are female, you unquestionably have a mental disorder.

Not only that, but isn't the very concept sexist? Genders don't have defined roles anymore. How would one know if they should be one or the other in the absence of such roles?

This story here drives me nuts:

http://abcnews.go.com/2020/story?id=...1#.UC4RrcX4JM0

Richard refused to swim topless, always wearing a shirt in the pool. By age two, he became clearly jealous of his sister's "girl" things -- her toys, her pink drinking cups, and especially her clothing.


"We were getting dressed, and he wanted to wear a dress. He wanted to be pretty like his sister," said Stephanie. "He was saying, 'I want a dress. I'm a girl, Mommy, I'm a girl.' And I'd say, 'No, honey, you're a boy. You have a penis, you're a boy. Allie's a girl.'"


No, RICHARD, you are a boy who likes dresses and pink. There's nothing wrong with that. So stop trying to cut off your own penis!

[Grumman]

Originally Posted by Jragon

I'm really having a crisis of... something here, can anyone help me out?

I'm guessing "you are now right, and were previously wrong" isn't the kind of help you were looking for, but that would be my response.

Personally, I have no problem whatsoever with people who do not conform to gender sterotypes. If a man likes pink and raising kids and is sexually attracted to men, more power to him.

I disagree with transsexuals (and the otherkin you mention) for the same reason I disagree with the religious. If you make statements of fact about the world that are at odds with reality, I'm not going to agree with you just because you want me to.

I dislike transsexuals who view it as my obligation to act in accordance with their incorrect worldview. If an otherkin was offended every time I referred to him as a person and not a dragon, or a religious person was offended because I do not show proper subservience to his god, I would view them with contempt.

[Jragon]

Originally Posted by Grumman

I'm guessing "you are now right, and were previously wrong" isn't the kind of help you were looking for, but that would be my response.

Now that I've calmed down a bit, perhaps you're correct. I've been in an environment where it's heavily, er... suggested that you see trans people as the same as homosexuals. No problems. But I just can't poke a hole here.

That doesn't mean they're not still people deserving of respect, that doesn't mean a boy can't like pink and dresses, it just means that their mind is in conflict with reality in a way that is very sad, and can be very damaging to their psyche. This still kind of sounds to me like Christians who say "look, I still love gay people like Christ wants, I just think they're sinners, but it's okay, everybody is! And they can fix their sin by thinking right!" But I don't know, the comparison to the guy who thinks he's Napoleon is just too strong.

And I was trying to avoid using the term "otherkin" for the dragon guy, but I guess there was really no reason to in hindsight.

[Mijin]

Originally Posted by adaher

For me the issue isn't body modification. It's believing something that is just not true.

Sex is a defined biological characteristic. You are male or you are female, or you have a birth defect that leaves you with something else. If you are male, however, you are male. If you are male and you think you are female, you unquestionably have a mental disorder.

Huh. Really thought you were going to go the opposite way with that argument.

Believing you're a hobbit, as in the OP, is something that's clearly untrue.

In terms of gender, I doubt that there are many transsexuals that are under any illusion about the gender of their bodies.

Not only that, but isn't the very concept sexist? Genders don't have defined roles anymore. How would one know if they should be one or the other in the absence of such roles?

Because such "roles" are not entirely a product of society. Also note roles is a bit loaded here as it implies what someone should be doing. It's less loaded to just talk about dispositions and what someone wants to do.

There's plenty of evidence that certain behaviours are, instinctively, more prevalent in one gender than the other, as with pretty much every two gendered species.
Indeed there are differences in thought patterns (on average) that can be seen using techniques such as functional MRI. And I've seen studies that have indicated the "wrong" gender's thought patterns in transsexuals. I'll google it later (when I'm not technically at work).

[Blake]

Originally Posted by Jragon

I actually wish I knew which thread this was referring to

That is easily established for members by simply doing a search on the quote. Here is the post in question.

But either way, what say you, Dopers? What is the flaw here? I can't really figure out what the difference is between somebody who wants to alter their penis because they feel like a woman and a person who wants to chop off the bottom half of their legs because they're totally a hobbit. Or that guy I know from college who had a dragon fleshlight and wouldn't shut up about his "draconic habits" (sexual and non-sexual) because he's a dragon "inside". Or maybe this just means there's absolutely nothing wrong with the hobbit and the guy who is convinced he's a giant lizard trapped in a human's body and I should accept them.

Heck, after reading this, an apt comparison almost seems like anorexia. Where they just don't feel right in their body because it's NOT THIN ENOUGH. And they HAVE to stop eating because they MUST become thinner.

I'm really having a crisis of... something here, can anyone help me out?

I don't quite see the problem. There isn't really any significant difference difference. The only minor difference is that getting a sex change won't stop you from holding down a job or doing whatever you like aside from sexual acts. Transgenders aren't considered physically handicapped. Chopping your legs off does tend to have an effect on other areas of your life.

But yeah, the main point is obviously true. When the ideas in your head don't match consensus reality, the problem is with your head, not in reality: you have a mental problem. The difference between someone who thinks they are another sex and someone who thinks they are a space man is practically non-existent.

What always mystifies me is that it is such a huge issue. It's impossible to say of course, but I have always thought that if I woke up tomorrow and found out that, as a result of a well studied biological process, I was in a woman's body I would come to accept it. I would be freaked out to hell initially of course, and the doctors may have to explain to me what has happened and that there is no way to change it a lot of times before I would believe it.

But I also totally believe that I would come to accept that as the simple truth. I am sure I would be a lesbian because I have no sexual interest in men, but i can't imagine that I would possibly "reject" my body as being rightfully mine because it had become something that I didn't want it to be.

And by that I don't mean thinking it's unfair or being unpleased. I am sure I would feel that way, just as I would feel that way if my body were to develop some disfiguring illness or quadriplegia or similar. But people with cancer or paralysis don't normally reject their bodies. They may be angry with their bodies or depressed with what has happened, but I have never heard of someone with quadriplegia or psoriasis making the claim that their body isn't theirs.

And that to me is the most mystifying thing about BID, and the clearest sign that it is primarily a mental illness, albeit one with a likely biological cause. People's bodies become things that they don't want them to be all the time. People get disfigured, they get paralysed, they get old. But people don't go around declaring their body to be "wrong" and "not theirs" just because it doesn't fit with their mental image of how they think their body ought to be and what it ought to be able to do.

Yet that attitude is at the core of BID. The attitude that, despite the objective fact that in the reality you have a perfectly functional body of sex A, you can not accept that fact and must have a body of sex B. Even if the best you can do is a weak impersonation that fools nobody. Even if you have to have parts amputated and render yourself sterile an unable to achieve orgasm in order to do make a more realistic impersonation that is still just an impersonation, not a functioning body.

To me that is as clear an indication of mental illness as a person who is 4'9" insisting that their "real" body is 7'5", and walking around on stilts for years in an attempt to "pass" for a tall person, and then eventually having their legs chopped off and having the stilts surgically bolted to their stumps.

[adaher]

Originally Posted by Mijin

In terms of gender, I doubt that there are transsexuals that are under any illusion about the gender of their bodies.

However, they think that inside they are something else, and desire society to view them as something they are not. If this is something society should do, then shouldn't we also honor people's wishes to be a different race than they are, since race is a much less well defined characteristic?

Now personally I think everyone should just be who they want to be, but much as my right to swing my arm ends at another person's face, your right to pursue a different identity ends where it requires another person to accept something that is false. We have 100% freedom to view ourselves as we wish, but by the same token everyone else has the freedom to view you as you actually are.

[Jragon]

Originally Posted by adaher

However, they think that inside they are something else, and desire society to view them as something they are not. If this is something society should do, then shouldn't we also honor people's wishes to be a different race than they are, since race is a much less well defined characteristic?

Now personally I think everyone should just be who they want to be, but much as my right to swing my arm ends at another person's face, your right to pursue a different identity ends where it requires another person to accept something that is false. We have 100% freedom to view ourselves as we wish, but by the same token everyone else has the freedom to view you as you actually are.

Yes, it's not as if the person I mentioned who thinks he's a dragon inside is under any strange hallucinations that he's a dragon outside, and yet I don't think I'm going to get many calls to humor him. I mean, I guess there is a difference to be made that dragons aren't real, and people of <opposite gender> are, but then if some guy from Maine was walking around insisting that inside he was really German, despite his thoroughly American geneaology, we wouldn't be starting a movement to give Transgermanics native German citizenship, regardless of country of origin, so they can finally be who they REALLY are.

[Blake]

Originally Posted by adaher

If this is something society should do, then shouldn't we also honor people's wishes to be a different race than they are, since race is a much less well defined characteristic?

Society does do that, doesn't it? I mean, if a fair skinned blonde man told you that he was a Negro, you wouldn't tell him he wasn't, would you?

This woman says she is an Aborigine. Would you seriously tell her that she isn't?

I really think that height or weight are much better traits to use as a comparison, rather than race.

If I as a 6' tall 75kg man were to claim to be 350kg and 4'3" tall, the police or my employer would still put my biological height and weight on any records. They would not be obliged to provide me with access to facilities reserved for midgets or the morbidly obese. And nor should they.

But if I want to be called a woman, for some reason everybody, including the police and my employer are obliged to act as though my mental divergence from reality was true. They are obliged to provide me with access to all the facilities and programs reserved for women. They are obliged to record my sex as female on all paperwork.

It's bizarre. If my mental state is incongruent with reality, I don't see why anyone should be obliged to provide reinforcement to my divergence. No do I see why I should be offended when someone point out the fact that I am a tall, skinny man and not an obese female dwarf.

[Mijin]

Originally Posted by adaher

However, they think that inside they are something else, and desire society to view them as something they are not. If this is something society should do, then shouldn't we also honor people's wishes to be a different race than they are, since race is a much less well defined characteristic?

Now personally I think everyone should just be who they want to be, but much as my right to swing my arm ends at another person's face, your right to pursue a different identity ends where it requires another person to accept something that is false. We have 100% freedom to view ourselves as we wish, but by the same token everyone else has the freedom to view you as you actually are.

Let me put it this way:

Imagine everyone is given a cat or dog to look after. And say virtually all men prefer dogs and virtually all women prefer cats so historically they've been distributed on gender grounds.

Now, if you were a man in this society, but liked cats more, does that make you mentally ill? No, of course not by any conventional definition of the term.

What about if you inform society: you request to be given a cat rather than a dog? No, still not mentally ill.

Now say in this society it is not just a matter of cats and dogs but what colour pen you write with, whether you have tea or coffee, whether you paint or wallpaper your walls etc. And for whatever reason many of your affinities line up with what is expected of the other gender.
Would it be wrong to say "Hey society, by default treat me like the other gender please"?

Now obviously our society and our treatment of gender is not as black and white as in this hypothetical. But it's also far from the case that our society treats both genders the same.
And in any case, if we did treat both genders the same "Treat me like a woman" would still not be sexist; it would just be a pointless request.

[adaher]

However, gender roles are loose enough that there's nothing wrong with being a girl who likes to play football and toy guns and a boy who likes to play with dolls and watch Hannah Montana.

Society should accept that boys and girls will do whatever they want. What society cannot accomodate is boys wanting to use female facilities even though they have a penis. At some point, you're just denying reality. Even if you insist you are a female inside, if you've got male parts then you need to use facilities made for your parts. And use them with people who also have your parts.

[Blake]

Originally Posted by Mijin

Would it be wrong to say "Hey society, by default treat me like the other gender please"?

Which is where it all falls down of course.

Firstly, transgenders don't say "Treat like a man/woman". They say "I am a man/woman". And they (or the ones I have met or heard of) become offended and irate if anyone says "Sure I'll treat you like a woman, but you're really a man with his penis amputated."

Secondly, most people don't specifically treat women/men in any way. "Society" may do that, but "people" treat an 18 year old woman very differently to an 18 year old man. They treat a conservative professional man very differently to the way they treat Charlie Sheen. The point being that people don't treat people "as women" they treat them as a type of woman. But transgenders, especially younger ones, very often don't fit into any type for obvious reasons. As such it's impossible to actually treat them "as women". All anyone can do is treat them as a type of woman which they are not, rather than treating them as a transsexual man.

Thirdly, you are asking people to go out of their way to reinforce your divergent view of reality. You aren't asking people to treat you as a transsexual male, which you are and what they will naturally treat you as. You are asking them to constantly check the behaviour they are comfortable with and that conforms with reality in order to reinforce your fantasy that is at odds with reality. That is pretty damn rude.

If I asked people to treat me like a fat person by, for example, not walking within 6 inches of my skin because they will be bumping into me, I would be told to go take a jump. Nobody is going to constantly go through mental gymnastics of that sort just to cater to my delusions. Yet by asking people to pretend you are a woman when they can see you are a man, that is precisely what you are doing.

And finally, while it is not wrong to say "Hey society, by default treat me like the other gender please", it is also not wrong to say "Hey, individual, accept your biological sex please". Neither of these positions is inherently more right or wrong. They are both just asking people to act in a certain way. Whether people will agree to the impost is entirely a personal choice. Under some circumstances it would be reasonable for wither party to say "No, sorry, I wont".

[Mijin]

Originally Posted by adaher

However, gender roles are loose enough that there's nothing wrong with being a girl who likes to play football and toy guns and a boy who likes to play with dolls and watch Hannah Montana.

Nor is there anything wrong with asking to be treated like the other gender, unless we're holding transsexuals to a higher standard of gender-less language than the rest of us. I presume you'd have no objection to someone saying "Many of my affinities / dispositions would be typical for a woman, but atypical for a man. Where differences exist, please treat me like the other gender".

Society should accept that boys and girls will do whatever they want. What society cannot accomodate is boys wanting to use female facilities even though they have a penis. At some point, you're just denying reality. Even if you insist you are a female inside, if you've got male parts then you need to use facilities made for your parts. And use them with people who also have your parts.

Someone wandering into the mens toilets in women's clothes, maybe with makeup, fake boobs etc is going to get a lot of funny looks and may feel uncomfortable.
Depending on their specific appearance they may get funny looks in the womens toilet too, but they've got to go somewhere.

And it sounds to me like it irks you that this might happen.
Why is it so important that they go to the right toilet?

[adaher]

Funny looks is one thing. Actually causing females to feel threatened by a male is a case where women's rights and transgendered rights come into conflict.

[Una Persson]

I disagreed with Cecil's conclusions in this column. He and I had very many conversations over how to interpret the problem of high drop-out rates. I believe there is a preponderance of evidence, despite the dropout rates, to err on the side of "hormones/SRS are good and proper treatment." Later on I intend to post some of my citations to support my position.

[Mijin]

Originally Posted by Blake

Firstly, transgenders don't say "Treat like a man/woman". They say "I am a man/woman".

If it affects your sensibilities so much, maybe we should publically request that they say "I feel as though I am a woman; my affinities are typical for a woman but atypical for a man".

But personally I don't care. The distinction seems clear cut now while we don't have clear models for how this works in the brain. If we later find a gender identity switch in the brain, and find some people have the wrong switch, then for at least one aspect of gender their gender is the opposite one: the aspect of which gender identity switch.

Secondly, most people don't specifically treat women/men in any way. "Society" may do that, but "people" treat an 18 year old woman very differently to an 18 year old man. They treat a conservative professional man very differently to the way they treat Charlie Sheen. The point being that people don't treat people "as women" they treat them as a type of woman. But transgenders, especially younger ones, very often don't fit into any type for obvious reasons. As such it's impossible to actually treat them "as women". All anyone can do is treat them as a type of woman which they are not, rather than treating them as a transsexual man.

Agreed. But this still doesn't invalidate the request "treat me like a woman". It's asking you to try to treat me like a woman, rather than having any expectation that you can 100% succeed.

Thirdly, you are asking people to go out of their way to reinforce your divergent view of reality. You aren't asking people to treat you as a transsexual male, which you are and what they will naturally treat you as. You are asking them to constantly check the behaviour they are comfortable with and that conforms with reality in order to reinforce your fantasy that is at odds with reality. That is pretty damn rude.

Yeah they're so in your face with it. The number of times I've had a transsexual get me in a headlock and refuse to let go before I acknowledge that they are biologically the other gender, it's appalling.

And finally, while it is not wrong to say "Hey society, by default treat me like the other gender please", it is also not wrong to say "Hey, individual, accept your biological sex please". Neither of these positions is inherently more right or wrong. They are both just asking people to act in a certain way. Whether people will agree to the impost is entirely a personal choice. Under some circumstances it would be reasonable for wither party to say "No, sorry, I wont".

I don't know what accepting one's biological sex actually means in this context. If you mean accept what your chromosomes and physiology are then the vast majority of transsexuals are there already.

[Mijin]

Originally Posted by adaher

Funny looks is one thing. Actually causing females to feel threatened by a male is a case where women's rights and transgendered rights come into conflict.

Agreed.

If you're transsexual and have dressed like the other sex, have hormone treatment and maybe some of the ops, then you've got quite a problem when it comes time to use the toilet. I doubt many relish the prospect.

And when I said funny looks I actually meant feeling threatened also. So you've got a choice between feeling threatened and making someone else feel threatened. I guess you could say that one difference is that the transsexual knows that they are not going to harm anyone, whereas they do not know that someone in the gents toilet will not harm them; so they choose the physically safer option.

[Blake]

Originally Posted by Mijin

. I presume you'd have no objection to someone saying "Many of my affinities / dispositions would be typical for a woman, but atypical for a man. Where differences exist, please treat me like the other gender".

I have no problem with someone saying that.

Do you have a problem with someone saying "Many of my reactions / dispositions towards you would be typical of my reaction to a a man and atypical for your identity as a a woman. Where differences exist please respect my socially and biologically derived reactions."

This is, IMO, the heart of the matter. The respect has to go both ways. While its fine to ask someone to treat you in a manner that is at odds with reality, it is must also be fine for them to treat you in a manner consistent with reality. Nobody should be obliged to reinforce someone else's fantasy or be labelled a bigot.

Someone wandering into the mens toilets in women's clothes, maybe with makeup, fake boobs etc is going to get a lot of funny looks and may feel uncomfortable. Depending on their specific appearance they may get funny looks in the womens toilet too, but they've got to go somewhere.

Wouldn't good manners dictate that they not make others feel uncomfortable by breaking social mores if it can be avoided?

Imagine, for example, I took a plastic bucket into the toilets and shit into it in the middle of the floor rather than in a cubicle, all the while proclaiming in a loud monotone "They live in the sewers. The horror, the horror". That would be perfectly legal, but you would sure feel uncomfortable if I did it. You would have every right to ask me not to, and while I could certainly say "no", I think we'd all agree I was being rude for doing so.

Humans aren't machines. People breaking cultural norms in an attempt to deny reality makes us feel uncomfortable. It's not the mark of a jerk to ask one individual not to do something that makes a majority feel uncomfortable.

While I certainly have every right to say "I've gotta shit-in-a-bucket-while-muttering-about-the-eldricth-horrors-in-the-sewers somewhere", it's not really much of a response for what is a purely volountary action.

[Broomstick]

Assuming for the sake of this discussion that transsexality is a mental illness, for me the question then becomes how can we best alleviate this person's suffering?

Can we cure this mental illness? No.

Can we dispense some medication that will put this mental illness into remission? No.

Then the question becomes "does sexual reassignment treatment result in happier/more functional mentally ill human beings?" Note I said treatment, not surgery. While the surgical treatments tend to attract a lot of attention a lot of transsexuals stop at hormone treatments or something else.

I honestly don't know if this results in happier long term results. It seems to in many cases, but perhaps those happiest talk most about it and those who it doesn't help don't talk much, attempt to get it reversed, commit suicide, or something.

It seems from my very much an outsider's viewpoint that SRT (sexual reassignment treatment) that is successful enough that society starts to react to/view the person as their believed gender is what is most important for the transsexual. They want to be regarded as that gender in social contexts as much (or perhaps more) than a sexual context. If that actually improves outcomes - as I said, people happier, more functional, less depressed, etc. - then it would be cruel to deny it to these people for which we can no nothing else to alleviate their condition.

Getting back to believed-to-be-Napoleon: if the wannabe Napoleon, when deigned his costume, hat, etc. is a very unhappy, agitated person, attempts suicide on occasion, etc. but when allowed to dress as Napoleon becomes calmer, happier, more cooperative, able to hold down a steady job, stops self-harm then I would argue it's less harmful to allow the costume and call the person "Nappy" than to force the person to live in a continually agitated and miserable state. It may not be the ideal situation but we don't live in an ideal world.

So I would argue that SRT is needed for harm reduction.

That said, I'm not entirely convinced this is a mental illness. I've known several transsexuals who were born intersex, but weren't in the habit of informing everyone they met that they were born with ambiguous gender. Nor should someone be forced to issue a full disclosure of any and all medical problems/issues every time they meet someone. It's no one else's business. I'm aware not ALL transsexuals were born intersex but it one reason some people want SRT and you can't tell at a glance who falls into that group.

I also want to point out that a boy/man who likes to dress as a woman is NOT automatically a transsexual. He's a transvestite. He may be straight or gay. Most of them are perfectly happy being men and have no desire to be a woman.

[Blake]

Originally Posted by Mijin

If it affects your sensibilities so much, maybe we should publically request that they say "I feel as though I am a woman; my affinities are typical for a woman but atypical for a man".

Nobody mentioned offended sensibilities, but hey, if you need to find some snarky way to imply that I'm a prude for refusing to agree with statements of fact about the world that are at odds with reality, go for it.

When a poster has to resort to this sort of ad hominem, his position has become pretty damn weak,

Agreed. But this still doesn't invalidate the request "treat me like a woman". It's asking you to try to treat me like a woman, rather than having any expectation that you can 100% succeed.

Agreed, and the request is precisely as valid as my request that you live according to the word of God. It's asking you to try to accept Jesus, rather than having any expectation that you can 100% succeed.

I think we all agree that people have the right to make requests of this type.

Where the disagreements starts is that some will immediately label me a bigot if I respond to the request with "No, your beliefs are at odds with reality and I have no intention of acting as if they are real."

Yeah they're so in your face with it. The number of times I've had a transsexual get me in a headlock and refuse to let go before I acknowledge that they are biologically the other gender, it's appalling.

Yep, your position is so weak that you have to resort to this sort of garbage in response to perfectly cogent arguments.

I point out that it requires effort for people to pretend that someone who they know is a man-in-a-dress is really a woman. No reference whatsoever to anyone being "n your face ". And you come up with this crap.

Nice. Well done.

I don't know what accepting one's biological sex actually means in this context. If you mean accept what your chromosomes and physiology are then the vast majority of transsexuals are there already.

So you believe that most transsexuals with XY chromosomes and a penis and testicles accept that they are men?

Cite! Because the link adaher posted earlier, the story here and thousands of other stories all say differently.

[bup]

Originally Posted by Una Persson

I disagreed with Cecil's conclusions in this column. He and I had very many conversations over how to interpret the problem of high drop-out rates. I believe there is a preponderance of evidence, despite the dropout rates, to err on the side of "hormones/SRS are good and proper treatment." Later on I intend to post some of my citations to support my position.

Well, admittedly it's a tough issue. I respect Cecil and staff's addressing the issue, and being willing to go where the truth leads them, not where prevailing social beliefs say.

The more evidence you present, the better.

[Learjeff]

Originally Posted by adaher

For me the issue isn't body modification. It's believing something that is just not true.

Sex is a defined biological characteristic. You are male or you are female, or you have a birth defect that leaves you with something else. If you are male, however, you are male. If you are male and you think you are female, you unquestionably have a mental disorder.

This is a mistake. It's like saying a car is either blue or green. But a car can have a green body and blue doors.

Sexual development is *extremely* complicated, especially concerning brain development. It's quite possible to have male genitalia but, during brain development, for female characteristics to be emphasized.

So, it's not as simple as "believing something that's not true." It's being internally inconsistent (which is definitely a disorder). Of course, people with disorders can live happy, healthy, fulfilling lives, either by adjusting or by treatment.

I dislike transsexuals who view it as my obligation to act in accordance with their incorrect worldview.

I bet you'd feel quite differently if you had experienced this internal conflict. I hope you don't feel contempt for transsexuals who wish to be treated according to their mental roles.

Again: this is not a case of "the mind conflicting with reality". It's a case of an internal conflict between mind and body. To call one right and the other wrong is meaningless, objectively. But IMHO we should give the mind precedence, not the body.

Originally Posted by Blake

but I have always thought that if I woke up tomorrow and found out that, as a result of a well studied biological process, I was in a woman's body I would come to accept it. I would be freaked out to hell initially of course, and the doctors may have to explain to me what has happened and that there is no way to change it a lot of times before I would believe it.

I'd still look at good-looking men and women very differently. No question of where my eyes would be drawn, and who I'd want to chat up. Would I want to be treated like a man? I really can't say ... but I wouldn't be surprised to find myself dressing and acting like a man.

There's an implicit assumption in many posts above that the mind state is more plastic than the body state, that the genitalia is CORRECT and the mind is arbitrary. I don't believe that; I think that most men's minds are biologically different than most women's minds, and in most cases, it's biology making someone "feel" like a man or a woman. If this is true, it's easier to "fix" the body than the mind. Furthermore, our mental state is a far bigger factor in our identity than our body state. How many of us want to change who we are? In any case, if we could "fix" either mind or body, it should be the person's choice which to fix.

Regarding drivers' licenses etc., it does seem odd to me that it's based on preference rather than observable criteria. As mentioned above, we can't choose our height. (We can, for hair and eye color ... but can we say we're blond even if the hair in the picture is raven black?) It's a goofy world we live in!

BTW, there are people with brain disorders that make it feel like a part of their body is not theirs. (cf., Ramachandran's book, The Tell-Tale Brain) Many of them want the offending limb removed. Ramachandran provides good arguments that this isn't a simple matter of someone being "nuts", but of brain miswiring during fetal development.

Someone wandering into the mens toilets in women's clothes, maybe with makeup, fake boobs etc is going to get a lot of funny looks and may feel uncomfortable.
Depending on their specific appearance they may get funny looks in the womens toilet too, but they've got to go somewhere.

Right. We can't have a bathroom for every possibility. Perhaps we should have just one bathroom for all. Meanwhile, we have F and M, and people with ambiguities just have to work that out for themselves. The rest of us should show reasonable tolerance.

Originally Posted by adaher

Actually causing females to feel threatened by a male is a case where women's rights and transgendered rights come into conflict.

True, but transgender isn't the only possible cause for this. I'm sure there are people with female bodies who can scare the crap out of the other women in the women's room! (Of course, in the men's room, we men never admit to any sort of fear, unless firearms are involved. Or maybe gays.)

Originally Posted by Mijin

Yeah they're so in your face with it. The number of times I've had a transsexual get me in a headlock and refuse to let go before I acknowledge that they are biologically the other gender, it's appalling.

Hah! Yeah, me too! I wish they'd quit that!

I only knew one transsexual very well. He was originally a very robust, barrel-chested manly man, fierce handshake, very likeable. Then Mike became Michelle. Michelle overdid trying to be feminine, and it was a bit pathetic, especially given her masculine visage. But that was her choice, and I honored it, and she was no less friendly, intelligent, and likeable.

Originally Posted by Blank

it is must also be fine for them to treat you in a manner consistent with reality

Absolutely! And the reality is that someone who feels like a woman is in the body of a man (or vice versa). They should be treated accordingly, but according to which side? I say, honor their choices.

There's a difference between transsexuals and people who think they're dragons. We don't actually have any cases where the mind of a human developed into the mind of a dragon.

Bottom line: it's not just a MENTAL ILLNESS. It's an internal conflict disorder. Genitals are one sex, brain is another. Which is right?

Finally, what do we do about hermaphrodites? I say we let them decide, and treat them accordingly, rather than treating them as some "3rd sex".

[Una Persson]

Originally Posted by Blake

Wouldn't good manners dictate that they not make others feel uncomfortable by breaking social mores if it can be avoided?

By that token interracial marriage would never have been made legal, because it sure as heck made a majority of the populace in many States, perhaps the entire nation, uncomfortable with breaking the social mores.

I wager there are a hundred other examples. Women wearing trousers and cutting their hair short in the 1920's? How about women voting? Black children who want to go to school with white children?

OK, you can argue that being black or being female is unquestionably a physical thing, not a mental one. How about hippies with long hair in the 1960's? Jews who want to be treated like Christians when hiring time comes? And of course the elephant in the room, all those lesbians, gays, and bisexuals out there - why should society accommodate them one iota more than a transsexual? After all, isn't it "crazy" for a woman to sexually love another woman?

All of these things broke social mores. Social mores change. They will keep changing, and some day, probably long after I'm dead, transsexuals will be welcomed as sisters and brothers in society.

Overall, you appear to be starting from the assumption that transsexuals are so incredibly and unstably mentally ill that to perform the minimum, insignificant accommodation of using the proper pronouns and giving them the right to work, love, and live in society is some burden for all the sensitive cisgendered people out there. Surely that's not your intention...?

[Mijin]

Originally Posted by Blake

Nobody mentioned offended sensibilities, but hey, if you need to find some snarky way to imply that I'm a prude for refusing to agree with statements of fact about the world that are at odds with reality, go for it.

When a poster has to resort to this sort of ad hominem, his position has become pretty damn weak,

Yikes overreact much?
I only (briefly) mentioned sensibilities because I don't get why some people are apparently so angry about someone wanting to call themselves male or female.
If my neighbour wears a red t-shirt and wants to call it blue, so what, I don't give a crap.

And that's an example of something demonstrably false whereas the gender identity thing is different. There does appear to be an instinctive gender identity, it's not simply a conscious choice, so there is a concrete meaning to saying that inside you're female or whatever.

I think we all agree that people have the right to make requests of this type.

Where the disagreements starts is that some will immediately label me a bigot if I respond to the request with "No, your beliefs are at odds with reality and I have no intention of acting as if they are real."

You're shifting this to make it as though transsexuals are requiring you to do some action. I've seen no example of this.

If a transsexual really did want you to force you to make some public acknowledgement, I'd be on your side. But I've never seen it.

Yep, your position is so weak that you have to resort to this sort of garbage in response to perfectly cogent arguments.

Your argument is repeatedly trying to shift this on to transsexuals as though you're being persecuted. That they are "pretty damn rude" for forcing their beliefs on you. Other than having to call someone with broad shoulders and an Adam's apple "brenda" exactly what have they forced you to do?

So you believe that most transsexuals with XY chromosomes and a penis and testicles accept that they are men?
Cite! Because the link adaher posted earlier, the story here and thousands of other stories all say differently.

Physiologically, yes, of course. Your cite says exactly that.

That's why people go through hormone therapies, operations etc. They are aware that their body's gender and their gender identity are at odds. It's weird that I even need to say this.

[TriPolar]

I find it hard to believe that a lot of people who undergo surgical changes to their body to indulge their fantasies aren't mentally ill. But that isn't a good description of everyone who does it. Some of them must be perfectly sane and realize they are making cosmetic changes that don't change their chromosomes. We allow people to have all sorts of other body modifications for stupid reasons but don't call them mentally ill. Like most questions concerning sexuality, things don't reduce to one or two correct answers.

[Una Persson]

OK.

The following is my opinion, backed up with a lot of studies. I helped Cecil with research on this, and that requires doing a lot of legwork. You have to when you work for the Big Guy.

In defense of Cecil’s column, one point Cecil makes which is very important is that in most of these studies, the follow-up rate is very poor. Transsexuals are a difficult population to track on a long-term basis after they undergo SRS. This really is unfortunate, but it also corresponds to my personal experience working with the trans community for more than a decade. Once a transsexual transitions, they usually do not want to do anything other than lead the rest of their life and be left alone. They often break off contact with physicians, excepting for continuing hormone use, and they often do not continue psychological counseling because, IME, their gender dysphoria is addressed so well they no longer have grief from it. They had a misalignment, they fixed the problem, time to move on with life and put the old behind you.

Cecil is responsible for the Straight Dope, and as such he needs harder evidence to draw the conclusion that hormones/SRS are beneficial for transsexuals. Long-term changes due to hormones, the social crises which arise during most (if not all) real-life presentation transitions, and SRS, are all so serious life-changing measures that my understanding is that he feels we need better studies before we can conclusively say it works. There is no smoking gun which says they do not work and do not improve the lives of transsexuals, but lack of a negative is not proof of a positive.

I however am a heavily biased researcher on this subject. I admit that the follow-up rate on most of the studies is poor, nonetheless I feel that the lack of much negative evidence to speak of, coupled with what positive evidence there is, is more than enough to err on the side of hormones and SRS being a success.

In addition, I have direct personal experience working with transsexual counselors and transsexuals, and I have never met anyone who regretted their surgery or hormone treatment (although I have met a couple who did have unsatisfactory surgical results). One counselor I know has helped more than 300 individuals fully transition and to the best of her knowledge, not a single one regretted hormones, surgery, or the entire process.

But that’s anecdote, and although I argued this point to Cecil, Cecil can’t go on anecdote – “anecdote does not equal data.”

But here’s my opinion, alright?

I reviewed more than 30 studies and found one common theme – SRS has a high rate of success for improving the lives of transsexuals. Regrets after SRS are uncommon, and the vast majority of transsexuals are happy with the results of their transition. Study 1 found that sexual experience improved for 83.3% after SRS, and was rated as poor or very poor (but not necessarily worse) by 11.2%. The number of transsexuals who had a partner increased from 52.6% to 73.7% after SRS. Some 26.3% reported improved family relations, and none reported worse. Note that this study only examined 19 transsexuals, a very small sample size.

Study 2 looked at 55 transsexuals to evaluate physical and mental health after SRS, and again found promising results. It found only one person was dissatisfied with their surgical results, and none of the patients regretted the surgery. More than 75% reported improved sex lives, and the overall expectations of the transsexuals was met on physical, emotional, and social levels with rates of 81.5%, 94.4%, and 90.7%, respectively. Study 18, examining the quality of life of F2M patients found that hormone treatment significantly improved their quality of life, and breast removal surgery improved matters further.

Study 17, which compared transsexual adolescents who underwent SRS with those who didn’t found that SRS appeared to improve mental attitudes in many, but not all areas; however, none of the SRS patients regretted their decision. It was noted that the population was very well-selected, and it was the opinion of the authors that many of the non-SRS patients simply were not suited to deal with SRS, and depending upon how you choose to weigh that, that either skews the study, or else emphasizes that with proper screening, SRS success rates can be quite high indeed.

Study 3 was a meta study covering more than 2,000 transsexuals and found that 80% of post-SRS transsexuals reported a significant improvement in their quality of life, examining several hundred transsexuals who underwent SRS found that 91% of transmen and 83% of transwomen were satisfied with their decision. When regret after SRS occurs it is typically short-term regret, related to post-operative pain, job loss, departure of a partner, or family disputes. Serious, long-term regrets are rare, typically under 2%, and is typically due to misdiagnosis of a psychosis, lack of a real-life trial, poor family support, or poor surgical results. (Study 4 backs up two of these points) Age is also a factor, with younger transsexuals having a more positive outcome. (see Study 5)

Study 6, an academic dissertation, says that for all transsexuals studied therein there appears to be a steady improvement in their quality of life as the level of treatment increases. This study of 95 Munich transsexuals found overall that psychotherapy alone yielded satisfactory results for the patient 76% of the time, hormone treatment 81% of the time, and SRS 84% of the time. When the study focused on psychological factors, transsexuals showed a strong and steadily increasing trend at different levels of treatment, from psychotherapy through SRS. In terms of physical factors, a similar but much slower trend was seen, save for the case of transmen, who had more success with hormone therapy than SRS. Transmen tend to be more satisfied by the social results of their transition, and this is possibly due to it being much easier for a woman to be masculine in modern society (this is backed up by Study 3 and Review Study 7) – a woman can wear blue jeans and flannel shirts, and eschew jewelry and makeup, drink beer and watch NASCAR, and no one bats an eye. Whereas a man suddenly showing up at the office in a dress and pearls is likely to witness their co-workers metaphorically gathering pitchforks and lighting torches.

In terms of overall health, transsexuals have some other problems which complicate matters. Study 8 is a very long-term follow-up of 1,331 transsexuals (1,177 having had SRS) with an average time on hormones of 18.5 years, and found transwomen had a 51% higher mortality rate than the general population, primarily due to suicide, drug use, and AIDS. Transmen did not have a significantly higher than average mortality rate. Completed and attempted suicides are serious concerns for transsexuals, and although numerous studies showed SRS greatly reduced the risk of suicide, post-SRS suicide rates were still much higher than the general population.(See Studies 9 and 10) Two studies suggest high suicide attempt rates before SRS, 19-33% (Study 3 and Study 11). Review Study 7, a study of 141 Dutch transsexuals who underwent SRS showed a majority had a successful outcome, although suicide attempts were still abnormally high, with 1 in 7 transwomen and 1 in 36 transmen attempting such. The large meta-study 3 found rates of just over 1% post-SRS - compared to the general rate of 11.5 in 100,000 (Study 11) the situation is very sobering. However, Study 8 noted that before SRS, transsexual subjects have much higher rates of attempted suicides and drug use, most likely due to the psychological burden of living with gender dysphoria and social ostracism.

Some bones are made of the findings in a study by the National Center for Transgender Equality (Study 16), where there is a quote which says “Those who have medically transitioned (45%) and surgically transitioned (43%) have higher rates of attempted suicide than those who have not (34% and 39% respectively).” This is often taken out of context to mean that SRS is harmful. Here's the problem, though. The survey did not ask *when* the suicide attempts occurred. "Our questionnaire did not ask at what age the respondents made suicide attempts and therefore it is difficult to draw conclusions about the risk of suicide over their life spans." The actual survey is back on page 183, and I read it and found that ONLY question 54 asks about suicide, and it just asks "Have you ever attempted suicide?". It does NOT ask "did you attempt before or after treatment." All the study tells us is that someone who feels strong enough to undergo SRS really has difficulty with their gender dysphoria.

Many express concern over the long-term impacts of taking large doses of hormones, but the risks appear to be low. Study 9, one of the largest studies conducted to date on the subject, consisting of 816 transwomen and 293 transmen over more than 10,000 patient-years showed the overall mortality rates were not significantly different than the general population. A 20-fold increase in blood clots was seen for transwomen, but almost all cases were due to oral ethinyl estradiol intake, which is no longer advised for patients at risk (endocrinologists I’ve interviewed who specialize in transsexual patients say they stopped prescribing ethinyl estradiol a long time ago). Study 12, a recent 10-year study of 95 transsexuals showed no evidence of significant health effects from hormones, and Study 13, a larger 20-year survey showed no significant differences in mortality, but for transwomen who had taken ethinyl estradiol, again there was a significant increase in blood clots. Study 14 claims that despite fears of breast, pituitary, and prostate cancer, transsexual hormone-related tumors are rare. A more recent study, which (caveat) I have not fully reviewed, claims that the risk of deep vein thrombus for transwomen is even less than previously thought, on the order of about a 7% relative risk increase.

It’s important to remember that psychotherapy, hormones, and SRS are not cures, they’re treatments. Gender dysphoria can continue long after SRS, and transsexuals face a world where they are subjected to employment discrimination, loss of family and friends as a support group, and troubled romantic and sexual relationships. Study 11 contains a non-scientific survey of 6,500 transgendered persons which reported 97% experienced workplace harassment or mistreatment, and Study 15, another survey, found 60% of transsexuals had directly experienced violence or harassment as a result of their status, with a sobering 1 in 7 being raped or sexually assaulted, and 1 in 10 being assaulted with a weapon.

I don’t want to cast this as a rebuttal to Cecil, as he and I work closely together on this issue and many others, and I support the validity of his conclusions for erring on the side of caution, even though I would most certainly have chosen to optimistically err on the side of success. This is just my personal opinion on how an optimistic viewpoint could be backed by many of the available facts.


1) Lobato, Maria Ines Ines et al. “Follow-Up of Sex Reassignment Surgery in Transsexuals: A Brazilian Cohort” Arch Sex Behav 35 (2006): 711–715.

2) Cuypere, Griet De et al. “Sexual and Physical Health After Sex Reassignment Surgery” Archives of Sexual Behavior 34.6 (December, 2005): 679–690.

3) Michel, A. et al. “The transsexual: what about the future?” Eur. Psychiatry 17 (2002): 353-362.

4) Landen, M. et al. “Factors predictive of regret in sex reassignment” Acta Psychiatr Scand 971 (1998): 284-289.

5) Murad, Mohammad Hassan et al. “Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes” Clinical Endocrinology 72 (2010): 214–231.

6) Bazarra-Castro, Maria Angeles (2009). Etiological Aspects, Therapy Regimes, Side Effects and Treatment Satisfaction of Transsexual Patients. Dissertation. Aus dem Max Planck Institut für Psychiatrie, Klinisches Institut, München. Director: Prof. Dr. Dr. Florian Holsboer.

7) Snaith, P., Tarsh, M.J., and Reid, R. “Sex reassignment surgery. A study of 141 Dutch transsexuals” British Journal of Psychiatry 68 (1993): 681-685.

8) Asscheman, Henk et al. “A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones” European Journal of Endocrinology 164 (2011): 635–642.

9) Kesteren, Paul J.M. van and Asscheman, Henk. “Mortality and Morbidity in Transsexual Subjects Treated with Cross-sex Hormones” Clinical Endocrinology 47 (1997): 337-342.

10) Murad, Mohammad Hassan et al. “Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes” Clinical Endocrinology 72 (2010): 214–231.

11) Haas, Ann P. et al. “Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations” Journal of Homosexuality 58 (2011): 10–51.

12) Bazarra-Castro, Maria Angeles et al. “Comorbidities in Transsexual Patients under Hormonal Treatment Compared to Age- And Gender-Matched Primary Care Comparison Groups” Reproductive Sys Sexual Disord 1.1 (2012).

13) Gooren, Louis J. et al. “Long-Term Treatment of Transsexuals with Cross-Sex Hormones: Extensive Personal Experience” J Clin Endocrinol Metab 93.1 (January, 2008): 19–25.

14) Mueller, Andreas and Gooren, Louis “Hormone-related tumors in transsexuals receiving treatment with cross-sex hormones” European Journal of Endocrinology 159 (2008): 197–202.

15) Kidd, Jeremy D. and Witten, Tarynn M. “Transgender and Transsexual Identities: The Next Strange Fruit—Hate Crimes, Violence and Genocide Against the Global Trans-Communities” Journal of Hate Studies 6 (2008): 31-63.

16) Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.

17) Smith, Yolanda L.S. et al. “Adolescents With Gender Identity Disorder Who Were Accepted or Rejected for Sex Reassignment Surgery: A Prospective Follow-up Study” J. Am. Acad. Child Adolesc. Psychiatry 40:4 (April, 2001): 472-481.

18) Newfield, Emily et al. “Female-to-Male Transgender Quality of Life” Quality of Life Research 15.9 (Nov., 2006): 1447-1457.

[tim314]

Originally Posted by adaher

For me the issue isn't body modification. It's believing something that is just not true.

Sex is a defined biological characteristic. You are male or you are female, or you have a birth defect that leaves you with something else. If you are male, however, you are male. If you are male and you think you are female, you unquestionably have a mental disorder.

I think you're oversimplifying. Yes, we can look at your genitalia or your chromosomes and say "You are male" in a well-defined way. But there are many other biochemical differences between males and females, including differences that affect the brain.

So a transgender person might very well be correct in thinking that they have a brain that is in some way biochemically more typical for a woman, even if their body is physically male. When someone says "My body is wrong", of course what they mean is that there's a mismatch between their body and their brain. But our brain contains the essence of our identity; it's not surprising that this mismatch would be perceived as their body not matching who they "really are", and I certainly can't blame them for wanting to change their body over wanting to change their mind.

Besides, they've got to go with what works, and if sex-reassignment surgery is more likely to produce a positive outcome (in terms of happiness) than therapy or mind-altering drugs, then that makes a lot of sense. It may be that, even if someone would be just as happy to correct the mind/body mismatch by changing the mind, we just don't have the ability to do that effectively.

At any rate, I won't be convinced that this is analogous to a person thinking they shouldn't have a left arm, unless there's such a thing as a "biochemically one-armed brain". Males and females have different hormone levels (some of which are known to affect the brain), and many other well documented differences. I don't know if that's true for things like missing an arm, and at the very least I doubt it's true to the same degree.

[John W. Kennedy]

Seems to me I’ve seen quite a few reports of transsexuals who turned out to be hermaphrodites “corrected” in infancy, sometimes without anyone but the doctor knowing.

[Chipacabra]

Originally Posted by John W. Kennedy

Seems to me I’ve seen quite a few reports of transsexuals who turned out to be hermaphrodites “corrected” in infancy, sometimes without anyone but the doctor knowing.

It's not a huge proportion of transexual people, but it definitely happens enough to throw a wrench in the idea that biological sex is absolutely binary.

[CJJ*]

I just wanted to say that the original question, Cecil's article, and this follow-up thread have been one of the most fascinating discussions I've seen on this site in a long time--and as we all know that's a high bar to cross.

This goes way beyond "fighting ignorance"; in my case at least, it's more like "improving thought"--and I still haven't come to a satisfactory conclusion. Thx.

[Learjeff]

Originally Posted by tim314

At any rate, I won't be convinced that this is analogous to a person thinking they shouldn't have a left arm, unless there's such a thing as a "biochemically one-armed brain".

You might find the work of [url=http://en.wikipedia.org/wiki/Vilayanur_S._Ramachandran] S Ramachandran[/quote] enlightening. See the section on Apotemnophilia, or read his very interesting book, "The Tell-Tale Brain." Oversimplified, he has evidence that in addition to areas of the brain dedicated to sensations from body areas, and dedicated to motions of body areas, we also have brain areas dedicated to our concept or internal image of body areas. In cases where the sensory and motor areas exist but the "image" doesn't, people feel like those parts "aren't theirs". Note that these are people who behave very oddly regarding the missing part, but are otherwise quite normal.

However, I don't think that contradicts any of your points above, which I agree with.

Una, Thanks, very interesting. It doesn't contradict his post, but shows that he's setting the bar fairly high for what he considers evidence.

[tim314]

Originally Posted by Learjeff

You might find the work of S Ramachandran enlightening. See the section on Apotemnophilia, or read his very interesting book, "The Tell-Tale Brain." Oversimplified, he has evidence that in addition to areas of the brain dedicated to sensations from body areas, and dedicated to motions of body areas, we also have brain areas dedicated to our concept or internal image of body areas. In cases where the sensory and motor areas exist but the "image" doesn't, people feel like those parts "aren't theirs". Note that these are people who behave very oddly regarding the missing part, but are otherwise quite normal.

Thank you for the link and book recommendation. That does sound interesting.

[Irishman]

To me, I am much less concerned with whether we consider them mentally ill or not, and much more concerned with how do we deal with it. But I understand how defining the condition helps us pick a course of action.

I am very much in agreement with tim314 when he says:

So a transgender person might very well be correct in thinking that they have a brain that is in some way biochemically more typical for a woman, even if their body is physically male. When someone says "My body is wrong", of course what they mean is that there's a mismatch between their body and their brain. But our brain contains the essence of our identity; it's not surprising that this mismatch would be perceived as their body not matching who they "really are", and I certainly can't blame them for wanting to change their body over wanting to change their mind.

We are still trying to define what it means to have an identity, much less where gender identity comes from. Suppose there is some biological arrangement or switch or whatever that can show sexual identity, the way chromosomes tie to physical sex. At that point, it becomes much more clear to see how a person's sexual identity is at odds with the physical one.

And I think it is inherent in the concept of identity that we choose our mental one over our physical one. After all, the "me" I experience is the internal one, only mostly linked to the exterior one of this body. But "me" is the "me" inside. So why should this be different if I were somehow teleported to a woman's body? And wouldn't I be rightfully upset that everyone now sees and treats me as a woman, when I'm still a "man" inside?

Originally Posted by adaher

For me the issue isn't body modification. It's believing something that is just not true.

Sex is a defined biological characteristic. You are male or you are female, or you have a birth defect that leaves you with something else. If you are male, however, you are male. If you are male and you think you are female, you unquestionably have a mental disorder.

You seem certain that sexual identity is not a real concept, that there is no biological basis for it. But the sexual makeup of our bodies is defined not simply by our genetic code - the Xs and Ys of our chromosomes - but also by a string of hormone activations that are triggered during our development, including fetal development. And those hormone triggers can be thrown out of sequence or otherwise activated in mismatch to the chromosomes. Not only for odd chromosome mixes (XXY, etc), but even within nominal XX or XY sets. So why are you certain that transsexuals are not the result of some odd mismatch in hormonal triggers defining the mental state differently, flipping one switch male and the other female, as it were?

And if that's the case, then it is not a clear case of the person being something at odds with reality. It's a case with their specifics not matching the standard case of all M or all F, but getting a mismatched set of states. So they are not ad odds with reality, the are merely choosing from their two options which best represents how they feel over how they look, because feeling is more important than looking.

Not only that, but isn't the very concept sexist? Genders don't have defined roles anymore. How would one know if they should be one or the other in the absence of such roles?

It's not strictly true that there are not gender defined roles. Sure, job markets are much more egalitarian, but society still does have some social hangups. For example, those roles about who can wear pink frilly dresses and who can play football (the kind with pads and tackling, not the kind where you only use your feet).

But regardless of that, your question is staggeringly ill-informed. Gender identity is less about "I like to wear dresses" or "I want to play with trucks and guns", and far more about "I don't feel right". It's easiest to see through the physical choices demonstrated, like choice in clothing and activities, but the internal experience is where the real issue is.

"We were getting dressed, and he wanted to wear a dress. He wanted to be pretty like his sister," said Stephanie. "He was saying, 'I want a dress. I'm a girl, Mommy, I'm a girl.' And I'd say, 'No, honey, you're a boy. You have a penis, you're a boy. Allie's a girl.'"


No, RICHARD, you are a boy who likes dresses and pink. There's nothing wrong with that. So stop trying to cut off your own penis!

What makes you qualified to tell Richard what he/she actually experiences inside his/her head?

Originally Posted by Blake

That is easily established for members by simply doing a search on the quote. Here is the post in question.

You mangled that link.
http://boards.straightdope.com/sdmb/...php?p=15258563

But yeah, the main point is obviously true. When the ideas in your head don't match consensus reality, the problem is with your head, not in reality: you have a mental problem. The difference between someone who thinks they are another sex and someone who thinks they are a space man is practically non-existent.

As far as I am aware, there are not a string of hormonal triggers that activate during development that define whether you are a space man (or a dragon or Napoleon). So that is one solid distinction for transgenders.

Originally Posted by adaher

Now personally I think everyone should just be who they want to be, but much as my right to swing my arm ends at another person's face, your right to pursue a different identity ends where it requires another person to accept something that is false. We have 100% freedom to view ourselves as we wish, but by the same token everyone else has the freedom to view you as you actually are.

And how are they, actually? They have a physical male body, but a female identity. Sure, it's easier to see the body, and thus it primes our reactions, but their experience is less how they look and more how they feel.

And the reaction to transgenders seems to be saying that they shouldn't pursue actions to change their physical body to meet their mental one, so that your observation is more in line with their experience. If you want to view people as they actually are, then why all the hangups over SRS? Why do transgenders getting hormones and SRS still get treated as freaks for not complying with "reality"? They're doing their best to shape reality to a consistent set, not a mismatch between outward and inward.

Originally Posted by adaher

Society should accept that boys and girls will do whatever they want. What society cannot accomodate is boys wanting to use female facilities even though they have a penis.

Why not? You state that as a fact, but it's just an assertion.

The whole problem appears to be discomfort at what someone else is doing. You are experiencing personal discomfort at what that individual over there is doing, how they are protraying themselves. You wish they wouldn't intrude their behaviors that you find odd into your space.

The thing is, this discomfort is not an inherent thing of nature, forever bound to men in a dress or women with facial hair. It is, rather, the reaction that comes from lack of familiarity. The lack of social familiarity leaves you without a defined category of where to put them and how to react to them. It is exactly the social discomfort that comes from dealing with other races outside your common experience, or dealing with dwarfs, or dealing with people with severe burn scars, etc. Those things are unusual enough to stand out and leave you not knowing how to fit them into your social patterns. With transgenders, it is slightly worse, because they trigger your desire to fit them in one category but that category is at odds with they way they wish to be perceived. Thus that disconnect is the source of social discomfort.

But what if we approached this from a different direction? Instead of freaking out about it, we as a society learned to categorize them as "transsexuals" and then accept them for the way they wish to be perceived? What if we innundated our culture with this message of acceptance, the way we are trying to shift culture to accept homosexuality, the way we are doing so with interracial relationships and marriage? What if everyone got their "Mommy what is that thing?" out of the way as children, the way many of us do with race and other things? It's no different than seeing a man with a beard for the first time, or someone in a wheelchair, or those funky piercings all over the face and face tattoos. "That's just people being different."

Originally Posted by Blake

Firstly, transgenders don't say "Treat like a man/woman". They say "I am a man/woman". And they (or the ones I have met or heard of) become offended and irate if anyone says "Sure I'll treat you like a woman, but you're really a man with his penis amputated."

But why do you have to perceive them that way? Why can't you perceive them as a woman that was accidentally born with a penis?

The point being that people don't treat people "as women" they treat them as a type of woman. But transgenders, especially younger ones, very often don't fit into any type for obvious reasons. As such it's impossible to actually treat them "as women". All anyone can do is treat them as a type of woman which they are not, rather than treating them as a transsexual man.

And how should you treat a transsexual man? Why not treat them as a type of woman, a woman who was born in a male body?

Thirdly, you are asking people to go out of their way to reinforce your divergent view of reality. You aren't asking people to treat you as a transsexual male, which you are and what they will naturally treat you as. You are asking them to constantly check the behaviour they are comfortable with and that conforms with reality in order to reinforce your fantasy that is at odds with reality. That is pretty damn rude.

And how should one treat a transsexual male? Like a man who wants to wear a dress and talk funny? Or like a woman who has an adam's apple and maybe looks a little too masculine for you to be attracted to her?

Originally Posted by Broomstick

Assuming for the sake of this discussion that transsexality is a mental illness, for me the question then becomes how can we best alleviate this person's suffering?

Can we cure this mental illness? No.

Can we dispense some medication that will put this mental illness into remission? No.

Then the question becomes "does sexual reassignment treatment result in happier/more functional mentally ill human beings?" Note I said treatment, not surgery. While the surgical treatments tend to attract a lot of attention a lot of transsexuals stop at hormone treatments or something else.

I certainly agree we need to look at the treatment and measure it's effectiveness. I don't think, for those purposes, we should lump all kinds of modalities together. What kind of therapy is effective? What kind of SRTs are effective? Is surgery necessary? How well does it work?

And just to throw a monkey wrench into the topic, what about cases like the East German athlete from the 80's? A female athelete that part of the East German Olympic training regimine was subjected to high doses of anabolic steroids during childhood and puberty, and she became an Olympic winner in IIRC shot put. Of course, she had all sorts of identity issues, and later went on to complete transformation to male. Various other women given similar treatment but to lesser degrees remained female, but have had a host of health issues since then. That case appears to be less a case of internal hormonal signals during development creating sexual identity, and more a case of the injected hormones causing enough changes that the person's psychological state was affected.

[DocCathode]

First

A number of you are using "sex" and "gender" as synonyms. They are not the same. Sex is biological. Gender is social.

http://jcem.endojournals.org/content/85/5/2034.long

TLDR version- The human brain is sexually dimorphous. Transsexuals have a brain that is much closer to the sex they 'feel inside'. The differences in their brains are not caused by hormone therapy. Gay men and lesbians showed no such differences.

[namatad]

For example, one study found that of 727 subjects who had undergone male-to-female SRS, 539 had a known address, 420 of those had a correct known address, 417 of those were still alive, 355 of those agreed to participate, and 232 of those returned their forms. Of the last group, 86 percent rated their “happiness with result” at 8 or higher on a 10-point scale, and only four percent said 5 or below.

86% of respondents were happy. 200 out of 232. That is a significant percentage.
All surveys have the problem of respondents versus total subjects. Most surveys would kill to get 232 respondents out of 727 subjects!!

In the end, survey researchers would look at a 30% response rate and be happy.
86% report being happy! That is much higher than I would have guessed and even if biased, still probably indicative that most people who get surgery are happy about it.

[namatad]

Originally Posted by Una Persson

I disagreed with Cecil's conclusions in this column. He and I had very many conversations over how to interpret the problem of high drop-out rates. I believe there is a preponderance of evidence, despite the dropout rates, to err on the side of "hormones/SRS are good and proper treatment." Later on I intend to post some of my citations to support my position.

You would think by now that you would have beaten Cecil with the stat stick enough that he would at least sort of, kind of understand that stats are mystical and strange and worse, counter intuitive at times.

The fact the some studies are showing the low respondent rates might be more accurate than high respondent rates is even crazier.

[Martin Hyde]

Originally Posted by DocCathode

First

A number of you are using "sex" and "gender" as synonyms. They are not the same. Sex is biological. Gender is social.

http://jcem.endojournals.org/content/85/5/2034.long

TLDR version- The human brain is sexually dimorphous. Transsexuals have a brain that is much closer to the sex they 'feel inside'. The differences in their brains are not caused by hormone therapy. Gay men and lesbians showed no such differences.

Here you go again, citing a study that says a certain part of the brain in a very small sample size of transsexual men have characteristics more similar to female brains than male brains, it does not ever conclude what you want it to.

The research done in that article is good research, but you've misrepresented it multiple times on these boards now to satisfy a bias that you have.

The simple fact is, transsexuality or gender identity disorder if you will is a recognized mental illness. No science has ever shown that MtF GID patients have overall brains more similar to females than males, what we've instead shown is that in a small sampling of MtF GID patients the central subdivision of the bed nucleus of the stria terminalis (or BSTc as they say) is more akin to a healthy female sample than a healthy male sample. Specifically there were two studies, the first study by Zhou showed a sampling of MtF GID patients undergoing hormone treatment and showed their BSTc was similar in size to that of a healthy female. The second study which you link to and misrepresent here for at least the second time on these forums had a large sampling of around 40 brains and included MtF GID patients who were not undergoing hormone therapy. The second study demonstrated the difference in size of a MtF GID patient's BSTc was on account of a different count of neurons, and wasn't the result of something else like a possible side effect of hormone treatment in the group in Zhou's study.

I also most say, it was quite the surprise to see a quote of mine end up in a question someone asked. I am glad my post from that original thread got someone thinking about things, and I'm also glad "Cecil" looked at the evidence without bias and correctly answered the question to the best consensus of current science.

[Una Persson]

Originally Posted by Martin Hyde

The simple fact is, transsexuality or gender identity disorder if you will is a recognized mental illness.

A psychologist who talked to me about this today commented that just being the DSM does not in itself mean it is a "mental illness." The DSM includes things which are not mental illnesses, such as brain/cognition/affect disfunctions. These range from head trauma to substance tolerance to reading disorders to relationship issues to mental health issues.

No science has ever shown that MtF GID patients have overall brains more similar to females than males, what we've instead shown is that in a small sampling of MtF GID patients the central subdivision of the bed nucleus of the stria terminalis (or BSTc as they say) is more akin to a healthy female sample than a healthy male sample.

And what is the level of similarity needed? What percentage, or what regions, must be similar in order for an assessment of an M2F brain to yield support for a claim of similarity to an XX brain?

I also most say, it was quite the surprise to see a quote of mine end up in a question someone asked. I am glad my post from that original thread got someone thinking about things, and I'm also glad "Cecil" looked at the evidence without bias and correctly answered the question to the best consensus of current science.

It's your opinion he looked at it without bias. My opinion is he was overly pessimistic. I offered 18 citations in a post up above which provide support for my opinion.

[AHunter3]

Transsexuals may or may not be mentally ill have a less than fully accurate model of reality inside their heads.

In my experience a rather formidable number of non-transsexual people are pretty badly twisted in the heads when it comes to gender, sex, morphology, and sexuality, and a good portion of what they consider to be inviolably true about gender and sex is less than fully accurate by an even larger margin.

On top of all the other considerations and issues, I'd like to point out that many people's erotic sensibilities are such that they have an eroticized interest in seeing certain things about either themselves or their partner NOT as they necessarily objectively are but as desire and desirability demand that they be. "I am a person with male bits whose nature and preferences and personality and tastes are more akin to what you'd most often find among people with female bits" may not have the right emotional impact for them and how they need to feel about themselves as "I'm a woman" or even "I'm a seductress" or whatever.

I can't relate firsthand to being truly at odds with the bodily plumbing itself, it's just not where my experience lies. I'll grant that sexual reassignment surgery is several steps more significant a body modification than what most people do to feel attractive and sexy and appropriately configured, but it's not like no one does body mods. And it's really NOT like chopping off your legs. It doesn't create huge disabilities and deficits. There are lesbians who have their breasts removed NOT in order to transition to maleness but "just because". Does that make THEM sick? How about breast implants?

[Powers]

Originally Posted by Blake

But if I want to be called a woman, for some reason everybody, including the police and my employer are obliged to act as though my mental divergence from reality was true.

You are presuming that gender is determined solely by physiological sexual development. That is an unwarranted presumption.

Gender is a mental construct; sex is a physical construct. When the two don't match, who is to say that the physical one is right and the mental one is wrong?


Powers &8^]

[Martin Hyde]

Originally Posted by Una Persson

A psychologist who talked to me about this today commented that just being the DSM does not in itself mean it is a "mental illness." The DSM includes things which are not mental illnesses, such as brain/cognition/affect disfunctions. These range from head trauma to substance tolerance to reading disorders to relationship issues to mental health issues.

Mental illness is a fine term here on the forums but has no real meaning technically. I don't bring it up typically in discussions like this because I don't have any specialist knowledge but after retiring from the Army I worked for the Virginia DBHDS for five years (Department of Behavioral Health and Developmental Services), I worked more at a program / operations management level mostly dealing with things like resource allocation and Federal grant writing. To do that I had to get familiar with the lingo but I'm totally not a specialist with any special knowledge in that field.

I only bring it up now because in terms of treatment, my department and similar departments in most States have by and large mapped major treatment service groupings into AXIS I and AXIS II diagnoses. By and large people with AXIS I diagnoses receive "mental health services" and AXIS I diagnoses are mapped typically to the sort of thing random people think of when they hear the word "mental illness." (Basically psychotic disorders like paranoid schizophrenia, mood disorders like bipolar disorder, anxiety disorders like OCD, sleep disorders like narcolepsy etc.)

You can quibble about whether a given AXIS I disorder is a mental illness or not, for purposes of services that distinction is not made and the DSM-IV doesn't distinguish some AXIS I disorders as "mental illness" and others as "something else." The DSM-IV to my knowledge (and while I've never read it cover to cover I have probably read every page in multiple times) never defines the term either.

Technically, gender identity disorder falls under the category of "sexual disorders" although even in my time no one really knew if it better fit there or fit under "somatoform disorders" with things like body dysmorphia. If you read the definitions of those categories and the definition of the diagnoses you can easily make the argument either way. I actually was not surprised to hear the DSM-V was moving GID to be more akin to a body dysmorphia disorder since the criteria for being classified as a sexual disorder is supposed to include sexual dysfunction and lots of people with GID do not actually have sexual dysfunction at all, but all of them have dysmorphia.

And what is the level of similarity needed? What percentage, or what regions, must be similar in order for an assessment of an M2F brain to yield support for a claim of similarity to an XX brain?

I'd need multiple scientists across a large number of studies with significant peer review that handle a large sample size of persons stating that holistically they found no significant deviations in an M2F brain and a normal, healthy female brain. Anything else and you're just talking garden variety brain abnormalities or deformity which aren't so uncommon that we need to throw out biology 101 and start denying the biologic reality of someone's genitals.

Hell, even if you prove the M2F brain is identical to a healthy female brain (which I do not believe it is, and don't act like we're even close to that, do you know how small the BSTc is? A lot more is going on in your head than the stuff in that little speck) I'm still not sure that what makes you male or female really has anything to do with your brain, to me it seems that biologically it is all about your reproductive system.

It's your opinion he looked at it without bias. My opinion is he was overly pessimistic. I offered 18 citations in a post up above which provide support for my opinion.

I am confused here, it is definitely the scientific consensus that gender identity disorder is an AXIS-I DSM-IV diagnoses and falls under the category of "sexual disorders." We can quibble over the term "mental illness" but most people would use that term for most AXIS I diagnoses in the DSM-IV. When I said I was happy that Cecil had reflected this, I meant I was happy he acknowledge that (however you use the term mental illness) GID is basically accepted as a mental illness.

He went on to basically say he was unsure about the efficacy of SRS and long term happiness rates, which seems reasonable if the studies he was able to scrounge together had low participation rates etc. I see the eighteen cites you posted appear (based only on their titles) to basically deal with treatment of GID. Do any of them actually make conclusions about whether GID is a "psychiatric disorder" or not? If so let me know and I'd be happy to look into that specific citation. But it seems to me the citations you listed, at least based on their titles, aren't relevant to my point that I was glad to see Cecil reflect scientific consensus on whether or not GID is a mental illness.

[dzeiger]

Eh, if a study came out tomorrow that the bad effects of certain kinds of depression could be eliminated by removing the subject's appendix, everyone would be happy and all for the surgery.

But somehow, removing a penis makes everyone go all weird.

[C K Dexter Haven]

Originally Posted by Jragon

I actually wish I knew which thread this was referring to (though I don't know the average turnaround time between question and answer, for all I know this letter was sent a year ago and the thread is loooong dead).

Here's the prior thread: http://boards.straightdope.com/sdmb/...d.php?t=656958 -- the quoted post is #173 in that (lonnnng) thread.

Originally Posted by dzeiger

Eh, if a study came out tomorrow that the bad effects of certain kinds of depression could be eliminated by removing the subject's appendix, everyone would be happy and all for the surgery.
But somehow, removing a penis makes everyone go all weird.

The question raised by Cecil's column is, I think, whether removing the penis does, in fact, cure a certain kind of depression. And the answer seems to be: unclear.

[gamerunknown]

Here is the proposed revision in DSM-5.

Of particular note:

Originally Posted by DSM

We also debated and discussed the merit of placing this condition in a special category apart from (formerly Axis-I) psychiatric diagnoses to reflect its unusual status as a mental condition treated with cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired gender (particularly with regard to adolescents and adults). We chose not to make any decision between its categorization as a psychiatric or a medical condition and wished to avoid jeopardizing either insurance coverage or treatment access (Drescher, 2010).

In other words, the appropriate treatment for these individuals is to allow them to transition socially and legally and empower them with the medical resources they consider sufficient to do so.

Something tells me Martin Hyde is unconcerned with what qualifies as a mental illness or the latest iterations of DSM:

Originally Posted by Martin Hyde

I believe homosexuality is a mental illness.

Keep in mind, something abnormal isn't necessarily a mental illness.

[Jragon]

Originally Posted by C K Dexter Haven

The question raised by Cecil's column is, I think, whether removing the penis does, in fact, cure a certain kind of depression. And the answer seems to be: unclear.

Also, I'm pretty sure if it was removing a hand, or grafting some strange alien appendage onto their forehead a lot of people would still be saying "woah woah woah... are we sure there's not something better here?" The appendix<->penis comparison isn't really apt, IMO.

Though people have made a good point that the physiological brain is closer to the other gender in trans cases. And that hey, if it works as treatment (which is up in the air), why knock it?

[Broomstick]

Originally Posted by Martin Hyde

I'd need multiple scientists across a large number of studies with significant peer review that handle a large sample size of persons stating that holistically they found no significant deviations in an M2F brain and a normal, healthy female brain. Anything else and you're just talking garden variety brain abnormalities or deformity which aren't so uncommon that we need to throw out biology 101 and start denying the biologic reality of someone's genitals.

Surgery to correct a deformity, or make a person more functional if it can't be corrected, has a long history. We don't tell someone born with misshapen feet they must accept the reality of being deformed, we attempt to either give them functional feet or, in some cases, perform an amputation to make it possible for them to use a prosthesis. We don't tell someone born with a metabolic disorder they must accept the reality of a dysfunctional body chemistry, we attempt to help them.

So yes, there is a "basic reality" of someone's genitals, but a person is more than just their reproductive organs. If gender is all about reproductive organs then a woman who has a hysterectomy is not longer female - and that would be outrageous to the overwhelming majority of people in our society.

Originally Posted by dzeiger

Eh, if a study came out tomorrow that the bad effects of certain kinds of depression could be eliminated by removing the subject's appendix, everyone would be happy and all for the surgery.

But somehow, removing a penis makes everyone go all weird.

Castration anxiety.

That's why some many arguments about this subject get littered with phrases like "amputation" and "cutting off the penis" when, as I have pointed out, many transsexuals never get the genital-alteration surgery. Transsexuals seem much more concern with altering their appearance to trigger a response socially and can be content with looking like their "brain gender" in clothing than what is or isn't in their pants. Cissexuals focus in on OMG GENITAL SURGERY!!!!

Also, saying "chop off his penis" is ignorance at work. These days, it's much more like they turn the penis inside out, retaining as much of the sexual nerves as possible so the transsexual can potentially enjoy having sex.

On top of which - you can see the fear because this all focuses around the penis - no mention of breast implants, feminizing the face with surgery, and so on. Nor do these folks seem overly concerned with the "bearded ladies"/transmen. Apparently no one gives a damn if a woman "turns into" a man, but it's the horror of a man becoming a woman!....

Let's just say lots of people have some issues about sexuality, and not just transsexuals.

[Una Persson]

Originally Posted by Broomstick

On top of which - you can see the fear because this all focuses around the penis - no mention of breast implants, feminizing the face with surgery, and so on. Nor do these folks seem overly concerned with the "bearded ladies"/transmen. Apparently no one gives a damn if a woman "turns into" a man, but it's the horror of a man becoming a woman!....

Let's just say lots of people have some issues about sexuality, and not just transsexuals.

Julia Serano writes about this and other things in detail in her book Whipping Girl, a nearly 400-page transwoman's manifesto. Summarizing her arguments about why men find transsexuals icky and scary and threatening:

1) Masculinity is the greatest thing in the world. It's awesome to be a man and cloak yourself in the majesty of manhood. MEN are the most sacred creature ever to grace the earth with the imprint of their size-13 foot.

2) Transwomen, being (most of them) born XY, have also been granted this gift of manhood from God or Nature.

3) Transwomen have directly and contemptuously insulted God, Nature, and all men on the planet by rejecting this gift, throwing it to the ground and digging their stiletto heel into it.

4) In addition, the rejection of the superhuman gift of manhood by an XY male makes other men question the value of this awesome manhood and its associated God-given penis, and it terrifies them.

5) The fact that a MAN would reject manhood means that they are either crazy, or contemptuous towards men, and either way they should be ostracized or punished. Punishments for transwomen should include verbal abuse, economic and social exclusion, sexual abuse, beatings, "corrective rape", and murder.

The second line of reasoning why men hate transwomen goes:

1) Transsexuals might just pass "too well", and it's possible that a MAN would be attracted to one of these "freaks."

2) This causes the man to question his heterosexuality, and most men are terrified of doing that. Thus, punishment is needed for the transwoman. See above for punishment suggestions!

Gay men dislike transwomen for similar but not the same reasons.

Of course while straight and lesbian women tend to be more accepting of transsexuals, some (many?) have a specific hate towards transwomen. The two prongs of that hate, from Serano, are:

1) Women have had to form a sisterhood in society to provide them the benefits of emotional, moral, and physical support as an oppressed majority under the thumb of the MAN. Transwomen are a way for MEN to intrude into that last bastion of privacy and support which women have formed. In short, men not only have everything else, they want to take from women one of the last bits of exclusivity that they have. They are interlopers who are stealthily exerting their male dominance over women in their most personal societal constructs, and thus must be opposed.

2) Transwomen are sexual deviants who could not have a normal relationship or be close to women in a normal way, and thus they are abusing medicine to try to satisfy their deviant urges to be near women in lavatories, etc.

IME everyone I've met who is transphobic has ultimately had their argument fall into the above lines. They are no more concerned about the physical or mental well-being of a transsexual and surgical outcomes than they are about what dental floss to buy. Opposition to transsexuals as I've witnessed it focuses on either hysteric phallocentric homophobia, or in the case of women fear of "men" in their toilets.

[Una Persson]

Originally Posted by Martin Hyde

Mental illness is a fine term here on the forums but has no real meaning technically. I don't bring it up typically in discussions like this because I don't have any specialist knowledge but after retiring from the Army I worked for the Virginia DBHDS for five years (Department of Behavioral Health and Developmental Services), I worked more at a program / operations management level mostly dealing with things like resource allocation and Federal grant writing. To do that I had to get familiar with the lingo but I'm totally not a specialist with any special knowledge in that field.

That fact that you believe homosexuality is a mental illness (quoted above), despite what the current DSM-IV says, means that you are in opposition to established practice in the psychological field, doesn't it?

I'd need multiple scientists across a large number of studies with significant peer review that handle a large sample size of persons stating that holistically they found no significant deviations in an M2F brain and a normal, healthy female brain.

Why does it have to be so similar? You seem to be placing male and female brains into binary physical states, which I not believe is true even if transsexuals never existed. There isn't a template for a brain which you can hold up to an MRI or dissection and say "male" or "female."

I am confused here, it is definitely the scientific consensus that gender identity disorder is an AXIS-I DSM-IV diagnoses and falls under the category of "sexual disorders."

And the DSM has been wrong in the past, changing the classification of homosexuality. Relying on the DSM for this argument is starting on a shaky foundation.

I see the eighteen cites you posted appear (based only on their titles) to basically deal with treatment of GID. Do any of them actually make conclusions about whether GID is a "psychiatric disorder" or not?

I already did the legwork and forked out the cash and conducted more than 40 hours of research on this subject. Perhaps you should read the subset I posted above before we go any further.

[Curiosity Kills Her]

I have nothing to add but I would like to thank Una Persson for her contributions to this thread. A lot of well presented information information here. Thanks.

[Doctor Why]

Originally Posted by Powers

You are presuming that gender is determined solely by physiological sexual development. That is an unwarranted presumption.

Gender is a mental construct; sex is a physical construct. When the two don't match, who is to say that the physical one is right and the mental one is wrong?
Powers &8^]

That's fair enough, but why assume that the mental one is right? Why is clinical depression an issue of errant brain chemistry, but gender dysphoria isn't?