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The Transgendered Scene
The following notes attempt a brief working definition of the different categories of cross-dressing and gender dysphoric behaviour.
They have been prepared as part of an extensive range of services and facilities by TransLiving International, the UK-based support network for transvestites, transsexuals and others with gender dysphoria.
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If you find the distinctions somewhat confusing between she-males, transgenderists, transsexuals, gender transients, drag queens, cross-dressers and transvestites, then you are not alone! There are differences that can sometimes be readily apparent, but the confusion is not helped by the fact that many people with some form of gender dysphoria (the medic-speak term used to denote those who feel there is a mismatch between the gender role they choose to adopt some or all of the time, and that which is apparently denoted by their sexual characteristics) will describe themselves in terms that are, at the very least, highly misleading.
Gender Dysphoria is a condition in which there is a mismatch between the preferred gender role and that which is apparently denoted by sexual characteristics. Or to put it rather more clearly --- it is a condition in which the patient believes that his/her brain sex is at variance with his/her physical sex. This does not necessarily mean the gender dysphoric person is transsexual.
She-males, transgenderists and gender transients, along with TVs for whom transvestism has become a major fixation, may all be considered as exhibiting some degree of gender dysphoric symptoms. The transsexual certainly has the condition.
The treatment regime of choice will be determined by the psychiatrist following a detailed interview with the patient. It should be noted that in its extreme form, transsexuality, this is a condition that is largely self-diagnosed.
It is important to understand that gender dysphoria requires specialist attention. Few GPs and general psychiatrists have much experience of dealing with these gender anomalies and only too frequently people who are deeply disturbed by their psycho-sexual problems are told ‘you’ll grow out of it’, ‘it’s just a passing phase’, ‘go and get yourself laid’ or given similar unhelpful advice.
The fact is that it is a big step for the gender dysphoric person to take to even acknowledge having a psycho-sexual problem. It is hard for someone who has been socialised as a male to have to admit that he believes himself to be fundamentally female or to have a need to express his female persona.
Gender dysphoria causes people to act in a way contrary to their upbringing and socialisation, a way at variance with their apparent sex, a way that may well lead them to their being socially ostracised and significantly disadvantaged in terms of housing, career etc. It deserves to be treated seriously.
The condition is psycho-sexual. This does not mean to say that gender dysphorics are mentally ill, they merely have a condition that affects their understanding of their gender.
In the case of the transsexual particularly, the condition can cause embarrassment to others, particularly at the early stages of her transition. After all, what people see is a person who looks quite mannish, who was brought up and treated as a male, who developed male habits and manners, who has a masculine physique and who says she is female, dresses as a woman and wants to be treated as a woman. And she expects to be taken seriously.
It’s all very difficult for her --- and quite a problem for everyone else. She is likely to be hyper-sensitive and, because she has a great deal to learn, will probably be terribly gauche and unfeminine. This is the time she is at her most vulnerable and most difficult. Fortunately it is a passing phase and with practice, the help of hormones and a growing feeling of confidence, she will gradually settle into her new life and become increasingly acceptable in it.
So let’s attempt a set of brief working definitions of the gender dysphoric sub-groups based on practical experience (and risk the wrath of all those who disagree).
The generic term cross-dresser is fairly used for any person who chooses to don the apparel appropriate to the other gender. In reality this is a behaviour almost exclusively restricted to males.
Cross dressing may be an occasional activity. It frequently manifests itself with greater frequency when the man is under stress and would thus seem to serve the useful function of alleviating some of that stress.
Some men indulge in cross-dressing in certain garments only (knicker fetishists could be an example). A good many become highly aroused by it, quickly changing back into their normal clothes beset by self-disgust and guilt following masturbatory ejaculation. Others simply derive a feeling of calm from their pseudo female persona, whilst others gain extreme sexual arousal.
Transvestites, she-males, gender transients, drag queens, gay queens and transgenderists can all be legitimately described as cross-dressers. It would be inappropriate to apply the term to a TS (even if she looks totally unconvincing).
Transvestites (TVs) are people who derive pleasure from wearing clothes appropriate to the other gender. The generic term Cross-dresser is equally valid.
In fact, transvestism is a virtually exclusive male behavioural trait. TVs differ widely in their choice of dress and their socio-economic backgrounds. The incidence of transvestism is virtually impossible to determine on account of the veil of secrecy surrounding it and the refusal of many men who routinely wear womens underwear to consider themselves TV.
They are generally secretive about their transvestism and, until they have ‘come out’, tend to feel very guilty about it. Their motives for cross-dressing are diverse too. Some clearly do it as a sexual turn-on, an aid to masturbation. Others appear to derive calm and solace from permitting a gentler, female side to their natures to be given a periodic airing.
There are some whose transvestism is allied to other sexual behaviours:- the adult babies, the sub-dom fetishists etc.
The majority of TVs claim to be strictly heterosexual. Many TV organisations will imply that over 90% are hetero. This figure must be regarded as suspect since many of these strictly hetero males thoroughly enjoy adopting a quasi-female sexual role when cross-dressed and thus there must be a significant number more accurately described as bi-sexual.
The TV may go to great lengths, and spend considerable sums, to create his female persona. Some would have no difficulty in going about their daily business masquerading as women. The majority need to use artifice to disguise or hide such things as heavy male features, beard growth, body hair, large muscular frames, male pattern baldness, coarse skin and tattoos. They can alter their perceived body shape by the use of breast-forms, hip and bum pads. They can use special make-up to conceal any unwanted six-o-clock shadow and wigs do wonders for the overall effect.
The TV is a male and generally happy to be so. Many have successful marriages. Some, are of course gay. Whilst enjoying ‘dressing’ and appearing ‘en femme’, they have no wish to lose their male sex organs and sex drive. Admittedly, many TVs fantasise about growing breasts and being ‘real women’, but in truth, the ‘real women’ they envisage are mere figments of their male imaginations and most would be horrified at the prospect of loss of libido and the even more daunting loss of their priceless possessions — prized penis and testicles.
The Lily Savage or Edna Everage image is far removed from the typical TV, even though the general public will tend to equate them. This is not to say that every TV dresses modestly and makes an effort to appear as a normal woman. On the contrary, some dress in a way they would condemn as alarmingly tarty in a real woman.
Why the apparent appeal of the tarty? Why the significant interest in dressing as schoolgirls, nurses or ‘French maids’? It is somewhat difficult to answer this question other than to surmise that each of these styles symbolises some aspect of the femininity that the TVs concerned particularly espouse:- provocative, innocent, caring or submissive.
Crucial issues affecting the TV include how (and whether) to tell a partner/children/relatives/friends. How to handle himself if he gets ‘read’ (i.e. spotted as a cross-dressed male) when venturing out and how to deal with the attention of males when cross-dressed. Another factor, which few realise, is that their transvestism can become an unhealthy fixation to the extent that they cross-dress at every opportunity and become morose and surly if prevented. These TVs need to understand that their ‘harmless little hobby’ has become a psycho-sexual problem needing expert attention. Gender psychiatrists understand the condition:- few GPs do and few general psychiatrists. Consultation with a gender psychiatrist can be arranged through a GP’s referral to a Gender Identity Clinic, by contacting a private clinic (e.g. The Albany Clinic or the Portland Clinic in Manchester), by referral via a GP or through introduction from a recognised group to one of the few psychiatrists specialising in this subject. TransLiving is able to effect introductions to one of the leading specialist psychiatrists.
Fortunately, the majority of TVs manage to balance their cross-dressing needs with the normal requirements of family life, maintaining it as a discreet activity that does not offend anyone.
The frequency of cross dressing can vary from occasional to full time and the primary motivations range from deriving a feeling of calm and comfort by expressing a pseudo female persona, through to extreme sexual arousal.
TVs are almost exclusively male, the majority traditionally being believed to be heterosexual. Typically they feel an affinity for things feminine and value what they perceive to be essentially female behavioural patterns. Few of them are effeminate in manner when dressed as males and the majority will go to great lengths to mask their transvestism, many feeling isolated and guilty.
One of the most frequently asked questions by wives is “Why does he do it?”. There is no simple answer. There are many reasons why men cross dress and any individual is liable to be affected by more than one behavioural influence.
However, there are some who will welcome attention from males when they are cross-dressed and their transvestism may thus serve to mask a repressed bi-sexuality or possibly homosexuality. Indeed, it is not uncommon amongst this group to find TVs explaining that when in the female persona they are attracted to men, but not when presenting as male.
The TV retains his male sex drive and is perfectly satisfied to be male, provided he is permitted the opportunity to indulge his need to cross-dress from time to time. This can obviously cause problems if he expects to cross-dress whenever possible. A TV may well be a gentle, caring guy who will enjoy shopping with his wife, helping in the house etc. That’s the positive side. He may also be selfish in his demands for clothing and make-up, unfair in his expectations that the only places the couple visit are TV venues and unreasonable in his demands to make love when cross dressed.
The female partner has every right to expect her man to stick to agreed guidelines when it comes to cross-dressing. She is under no obligation to accept this behaviour, but perhaps should remember that modern psychiatry considers it within the bounds of normality, provided it is kept within sensible control. A gay male partner may well find it difficult to accept a TVs cross-dressing need.
The TV has a need to cross dress. His transvestism is a compulsion and it is necessary for him to work out a coping mechanism that makes room for it whilst not risking damage to his marital, familial, social and working relationships.
A She-male is a man who presents as a woman thanks to having secured breast development (hormonally induced and/or through silicon implant). He retains his male sex-drive and may indulge in sexual activity with both males and females. The descriptor ‘she-male’ implies a sexually motivated positioning and is often applicable to those earning their living from prostitution:- whether gay sex with other males, a sort of simulated lesbian sex with women or conventional penetrative sex with women.
The she-male retains a complete working set of male genitalia and has no intention of losing the pleasurable sensations obtained. She needs to be careful not to overdo the feminising hormones (in order to avoid becoming impotent), but will readily take any other measures necessary to enhance her feminine image.
They are quite prominent on the gay, drag and fetishist circuits, some of them achieving stunning looks. A number of them have clearly been able to derive an income from pornography and some from prostitution. It seems that exhibitionism is quite characteristic. Unlike the transsexual, transgenderist and transvestite, the she-male in common with the drag queen may be indifferent as to whether she is accepted as female by the public. It is fair to add that such indifference is shown at one end of the spectrum, whilst at the other, the she-male may very well pass her days being accepted as, and treated as a woman, whilst all the time proudly preserving her fully functional male ‘hanging bits’.
Those who live and present as female simply as a matter of gender preference, without seemingly being sexually motivated,Â may perhaps better be described as transgenderists.
Transgenderists are people who choose to live full time in the gender role opposed to their physical sex. They retain their original genitalia, frequently have electrolysis to facilitate their passing properly in their chosen role and may have speech therapy too. A few add hormone treatment but with no intention of seeking gender reassignment. Such cases are difficult to distinguish from the She-males:- perhaps the only difference being with regard to their far less overt sexual display.
Many transgenderists will describe themselves as transsexual and, in so far as they may succeed in being socially accepted as women, they can be difficult to distinguish from TSs.Â Nevertheless, there are major distinctions:- the TS will take steps to ensure that her body is altered to fit her conception of her own sexual and gender identity. The transgenderist will acknowledge that he can never be a woman. The post-op TS knows that she is female and feels complete and whole, whilst the pre-op TS knows that she is a female awaiting some remedial surgery.
Transsexuals are people who feel a profound awareness of a mismatch between their physical sex and their brain sex. Many try determinedly to fulfil what seemed to be their allotted role and that to which they had been socialised from infancy. However, the only way their problem can be resolved is through the combined medical and surgical procedures associated with complete gender reassignment (the so-called sex-change).
Male to female transsexuals outnumber female to male and certainly have a somewhat easier time in terms of the amount and severity of surgery involved. On the other hand, the female to male TS generally finds the effects of hormone therapy produce a dramatic change of such significance that their effective transition to the point where they are readily accepted in their new gender role is likely to occur far sooner. Their voices break, they grow facial hair and develop masculine musculature.
However, the F-M seeking full reassignment must face a series of operations:- hysterectomy and bilateral mastectomy being daunting enough to start with. Surgical construction of a form of penis is not widely regarded as a particularly satisfactory procedure as yet:- it is not autonomously erectile and may not even offer the ‘hosepipe’ function of the extended male urethra. Nevertheless, whatever the functional limitations, the cosmetic effect can be excellent and many F-M TSs are deservedly proud of their well-hung tackle.
The benefit of medical and surgical intervention is quite simply that it enables the TS (whichever the way of transition) to physically conform to his/her own felt gender identity.
The transsexual (M-F) is more than likely to have passed through a transvestic phase before realising that her problem was less a desire to dress as a woman than to be a woman. Her malaise with her apparent masculinity is likely to have affected her from quite a young age. Typically she would try hard to suppress those feelings and, particularly amongst the older TSs, may have shown a great determination to prove overt masculinity.
Once she has overcome the first major hurdle of accepting that she has a problem needing expert psychiatric help, she finds herself embarking on a journey beset by a series of horrors.
She will need to be referred to a specialist gender psychiatrist, either private or at a NHS Gender Identity Clinic. An ordinary psychiatrist is unlikely to have an understanding of gender dysphoria and thus may not be qualified to be of assistance. To get this far, she will need to see her GP to secure a referral. Admittedly, a responsible group such as TransLiving is able to introduce TSs to various private gender psychiatrists and, if appropriate, counsellors.
Whilst some TSs benefit from counselling, it is often far more important for their families:- for these are the innocent third parties who will feel the impact of the transsexual’s change without sharing the compulsion that has driven her.
She must convince the gender psychiatrist that she is a genuine transsexual. He will question her closely and is not going to encourage her to go for gender reassignment. Indeed, some psychiatrists may well seem to be being obstructive and unsympathetic, preferring to fuel any doubts as early as possible and before the TS has to go public with her news.
The way treatment is handled depends on the modus operandi of the psychiatrist concerned. Some insist that those wishing to undergo gender reassignment must live and function in role for a couple of years before they will prescribe hormones. Others tend to adopt the view that any patient presenting as a TS and asking for feminising hormones should be so treated as it will removeÂ discontent. The action of the hormones (depression of libido) may prove to be a self-correcting therapy if the patient suddenly discovers that the cost of developing a little bust is the loss of valued male sex drive.
It is our view that the difficulties of a genuine TS are compounded if she is required to live in role without the development of the helpful secondary sexual characteristics that are attributable to hormone therapy. We support the view that pre-op TSs must be required to live in role for a period of at least a year in order to prove to themselves (and the real world) that they can function as, and be accepted as, women.
The TS needs to be aware that she is liable to face rejection by family and friends. Her job may well be placed in jeopardy (despite recent legislation) and she will, in all probability, encounter attitudes including outright unreasoning hostility, extreme bigotry and overt rudeness. Her social standing will probably take a severe nose-dive and she may find herself a sort of social outcast with no home, few prospects and being treated as a source of considerable embarrassment.
She will find this very confusing (“after all, I’m the same person --- just changing my gender”) and she may well pass through a highly over-sensitive phase. In the initial phases of her living ‘full-time’ she is liable to be acutely self-conscious and ill at ease with her new role. She is anxious to lose all traces of her past, yet not yet comfortable with the new self that she is discovering. In short, this period is difficult and she is at her most vulnerable and her most exposed to misunderstanding and ridicule.
Over the ensuing months she will hope to gradually settle into her female way of life despite having an intense focus on the change and all that goes with it:- voice therapy, electrolysis, grooming etc.
Sadly, not all TSs are blessed with the physical attributes that make the change credible. If you are six foot six tall, built like a main battle tank, are as hairy as the average ape, have tattoos all over, massive feet and a guttural voice of the sort that would make Lee Marvin sound feminine, then the chances of a successful transition would seem somewhat slight. Unfortunately, it is necessary to consider practicalities, for it is a sure recipe for disaster if a somewhat unsatisfactory life as a man is exchanged for an unbearable one as a woman.
Many people will comment that it takes a great deal of courage to do what a TS does. In truth, it is not a matter of courage, for she has scant option but to bite the bullet and give herself the chance of fulfilment. It takes much courage for a TS to recognise if she cannot hope to transition successfully and then to readjust her life. It also takes courage (and wisdom) for anyone who has started down the TS route only to realise that it was a mistake, to acknowledge the mistake and revert to the male role.
Being a TS should not be the ambition of a TV. Transsexuals are not TVs who have ‘graduated’ --- they are people who have had to cope with severe gender dysphoria; people upon whom Nature has played a cruel trick; people privilegedÂ to be able to understand their problem and to secure the help to resolve it.
Finally, the operation. Modern surgical techniques permit the construction of a vagina complete with labia and a clitoris constructed from the glans. The appearance, after healing, is for all practical purposes indistinguishable from that of a born female. If sufficient penile and scrotal tissue is available, the constructed vagina will offer ample depth to permit penetrative intercourse with a male. However, the vagina is not self-lubricating and the TS will need to take appropriate measures in order to avoid painful penetration.
For those with insufficient scrotal and penile tissue, a procedure can be adopted that involves using a section of the colon to provide additional depth to the vagina. A more complex procedure, it would normally only be adopted if really necessary.
TSs need a great deal ofÂ information on health and hygiene issues, legal matters and on changing their documentation and records.Â For these and a whole range of practical advice and support measures, they should seriously consider joining a self-help group such as TransLiving. Indeed, this group is unusual in that not only does it offer extensive support, but also the opportunity for TSs to socialise and to compare notes.
Drag queens are generally gay males who parody females. They do not identify with women and have no wish to be women. Over the top, outrageous and flamboyant, they are often believed by the general public to be TVs. If you go into a bar and see one very over the top guy dressed as a woman, and another cross-dressed male sitting quietly in the corner, you can bet your bottom dollar that the quiet one is the TV, the OTT one may be a drag queen. Many view themselves as entertainers, earning their living through drag performances for hen nights, gay clubs and pubs.
It is perhaps a little unfortunate for TVs that so many of the public automatically picture the drag queen when imagining anyone who is cross-dressed.
Indeed, many TSs too resent the erroneous but widely held impression that they are much the same as the drag queens.
Exhibitionist, aggressively effeminate and presenting a caricature of femininity, many of them contrive to be strikingly beautiful, wickedly witty and wonderfully amusing company.
It is also fair to point out that it was their devil may care open flouting of convention at a time (immediately pre - and post-War) when the word gay had a different connotation, when effeminacy was firmly frowned upon, when homophobia was widespread and when a man dare not admit to liking feminine clothes, manners etc., that has paved the way to today’s relatively tolerant attitudes towards transvestism and other expressions of different forms of sexuality.
Drag queens are performing artistes who take pride in their skill as entertainers. They should not be confused with gay queens who vie for the attention of men and may well be involved in gay prostitution. The gay queens are cross-dressed homosexual males actively seeking sexual liaisons with other males. Of course, there are some drag queens who need to supplement their incomes by being gay queens too.
Gender transients are people who will happily live in a betwixt and between world, living much of the time as women, some as men. They happily change role at will, selecting that which seems appropriate for the occasion.
A gender transient may be married or in an established relationship with a female partner.
The transient may well perceive him/herself as a third gender, refusing to acknowledge the normally accepted male/female divide. This differs from the TV who is well aware that he is male, but who simply owns up to ‘a slightly unusual little hobby.’ As far as the Transsexual is concerned, she cannot wait to leave the betwixt and between world of being neither the one nor the other. The whole idea of perpetuating that phase is horrific for her and she is impatient to achieve her sought after harmony between mind and body.
Female to male Transsexual
All patients who wish to have gender reassignment should first have a complete and thorough psychiatric evaluation
They must have a stable personality and have lived in the chosen gender for a least one year and ideally have been fully employed during this period. It is also the duty of the psychiatrist to determine whether the patient will be accepted in society in his new gender role. It is also important that the patient has reasonable expectations of the outcome of reassignment surgery to avoid any future disappointment.
Hormonal treatment with testosterone is initially given to deepen the voice, to increase muscle bulk and to increase body and facial hair growth. Patients have classically been administered Sustanon in subcutaneous injections but other preparations including patches and oral medication and six monthly depo preparations arere also available for testosterone replacement therapy.