A
transgender (or
trans) person is someone who has a
gender identity or
gender expression that does not correspond with their
sex assigned at birth.
[1][2] Many experience
dysphoria from this incongruence, and seek to alleviate it through
transitioning,
[3] often adopting a
different name and set of
pronouns in the process. Additionally, some undergo
sex reassignment therapies such as
hormone therapy and
sex reassignment surgery to more closely align their
primary and
secondary sex characteristics with their gender identity, though not all desire these treatments, and others cannot access them for financial or medical reasons.
[3][4] Those who do desire to medically transition to another sex may identify as
transsexual.
[5][6]Transgender is an
umbrella term. In addition to
trans men and
trans women, it may also include people who are
non-binary or genderqueer.
[7][8][9] Other definitions of
transgender also include people who belong to a
third gender, or else conceptualize transgender people as a third gender,
[10][11] and the term may be defined very broadly to include
cross-dressers.
[12] The term does not have a universally accepted definition, including among researchers.
[13]
Being transgender is distinct from
sexual orientation.
[14] Transgender people may have any sexual orientation. The opposite of
transgender is
cisgender, which describes people whose gender identity matches their assigned sex.
[15]Statistics on the number of transgender people vary widely,
[16] in part due to differing definitions of
transgender.[13] Some countries, such as Canada, collect
census data on transgender people.
[17] Transgender identity is generally found in less than 1% of the worldwide population, with figures ranging from <0.1% to 0.6%.
[18][19][20]Many transgender people
face discrimination in the workplace
[21] and in accessing public accommodations
[22] and healthcare.
[23] In many places, they are not legally protected from discrimination.
[24]Psychiatrist John F. Oliven of
Columbia University coined the term
transgender in his 1965 reference work
Sexual Hygiene and Pathology,
[31] writing that the term which had previously been used,
transsexualism, "is misleading; actually, 'transgenderism' is meant, because sexuality is not a major factor in primary transvestism."
[32][33] The term
transgender was then popularized with varying definitions by various transgender, transsexual, and transvestite people, including
Virginia Prince,
[5] who used it in the December 1969 issue of
Transvestia, a national magazine for cross-dressers she founded.
[34] By the mid-1970s both
trans-gender and
trans people were in use as
umbrella terms,
[note 1] while
transgenderist and
transgenderal were used to refer to people who wanted to live cross-gender without
sex reassignment surgery (SRS).
[35] By 1976,
transgenderist was abbreviated as
TG in educational materialsBy 1984, the concept of a "transgender community" had developed, in which
transgender was used as an umbrella term.
[37] In 1985, Richard Elkins established the "Trans-Gender Archive" at the University of Ulster.
[34] By 1992, the International Conference on Transgender Law and Employment Policy defined
transgender as an expansive umbrella term including "transsexuals, transgenderists, cross dressers", and anyone
transitioning.
[38] Leslie Feinberg's pamphlet, "Transgender Liberation: A Movement Whose Time has Come", circulated in 1992, identified
transgender as a term to unify all forms of
gender nonconformity; in this way
transgender has become synonymous with
queer.
[39] In 1994, gender theorist
Susan Stryker defined
transgender as encompassing "all identities or practices that cross over, cut across, move between, or otherwise queer socially constructed sex/gender boundaries", including, but not limited to, "transsexuality, heterosexual transvestism, gay drag, butch lesbianism, and such non-European identities as the Native American
berdache or the Indian
Hijra".
[40]Between the mid-1990s and the early 2000s, the primary terms used under the transgender umbrella were "female to male" (FtM) for men who transitioned from female to male, and "male to female" (MtF) for women who transitioned from male to female. These terms have now been superseded by "
trans man" and "
trans woman", respectively.
[41] This shift in preference from terms highlighting biological sex ("transsexual", "FtM") to terms highlighting gender identity and expression ("transgender", "trans woman") reflects a broader shift in the understanding of transgender people's sense of self and the increasing recognition of those who decline medical reassignment as part of the transgender community.
[41]Transfeminine is a term for any person, binary or non-binary, who was assigned male at birth and has a predominantly feminine gender identity or presentation;
transmasculine is the equivalent term for someone who was assigned female at birth and has a predominantly masculine gender identity or presentation.
[42]
Transgendered is a common term in older literature; many within the transgender community now deprecate it on the basis that
transgender is an adjective, not a verb.
[43] Organizations such as
GLAAD and
The Guardian also state that
transgender should never be used as a noun (e.g., "Max is
transgender" or "Max is a
transgender man", not "Max is
a transgender").
[8][44] However,
transgender is also used as a noun equivalent to the broader topic of transgender identity and experience.
[45]
Although the term "transgenderism" was once considered acceptable, it has come to be viewed as offensive, according to
GLAAD.
[46] In 2020 the
International Journal of Transgenderism changed its name to the
International Journal of Transgender Health "to reflect a change toward more appropriate and acceptable use of language in our field."
[47]
Health-practitioner manuals, professional journalistic
style guides, and LGBT advocacy groups advise the adoption by others of the name and pronouns identified by the person in question, including present references to the transgender person's past.
[48][49]
In contrast, people whose sense of personal identity corresponds to the sex and gender
assigned to them at birth – that is, those who are neither transgender nor non-binary or genderqueer – are called
cisgender.
[50]Transgender people are known to have existed since ancient times. A wide range of societies had traditional third gender roles, or otherwise accepted trans people in some form.
[85] However, a precise history is difficult because the modern concept of being transgender, and gender in general, did not develop until the mid-1900s. Historical understandings are thus inherently filtered through modern principles, and were largely viewed through a medical lens until the late 1900s.
[86]
Ancient Greek
Hippocrates (interpreting the writing of
Herodotus) discusses transgender individuals briefly. He describes the "disease of the
Scythians" (regarding the
Enaree), which he attributes to impotency due to riding on a horse without stirrups. Hippocrates' reference was well discussed by medical writings of the 1500s–1700s.
Pierre Petit writing in 1596 viewed the "Scythian disease" as natural variation, but by the 1700s writers viewed it as a "melancholy", or "hysterical" psychiatric disease. By the early 1800s, being transgender separate from Hippocrates' idea of it was claimed to be widely known, but remained poorly documented. Both MtF and FtM individuals were cited in European insane asylums of the early 1800s. The most complete account of the time came from the life of the
Chevalier d'Éon (1728–1810). As cross-dressing became more widespread in the late 1800s, discussion of transgender people increased greatly and writers attempted to explain the origins of being transgender. Much study came out of Germany, and was exported to other Western audiences. Cross-dressing was seen in a pragmatic light until the late 1800s; it had previously served a satirical or disguising purpose. But in the latter half of the 1800's, cross-dressing and being transgender became viewed as an increasing societal danger.
[86]
William A. Hammond wrote an 1882 account of transgender
Pueblo shamans (
mujerados), comparing them to the Scythian disease. Other writers of the late 1700s and 1800s (including Hammond's associates in the
American Neurological Association) had noted the widespread nature of transgender cultural practices among native peoples. Explanations varied, but authors generally did
not ascribe native transgender practices to psychiatric causes, instead condemning the practices in a religious and moral sense. Native groups provided much study on the subject, and perhaps the majority of all study until after WWII.
[86]
Gender, gender identity, and being transgender are distinct concepts from
sexual orientation.
[89] Sexual orientation is an individual's enduring pattern of attraction to others (being
straight,
lesbian,
gay,
bisexual,
asexual, etc.), whereas gender identity is a person's innate knowledge of their own gender (being a
man,
woman,
non-binary, etc.).
[46] Transgender people can have any orientation, and generally use labels corresponding to their gender, rather than assigned sex at birth. For example, trans women who are exclusively attracted to other women commonly identify as
lesbians, and trans men exclusively attracted to women would identify as straight.
[46] Many trans people describe their sexual orientation as
queer, in addition to or instead of, other terms.
[90][91][92]
For much of the 20th century, transgender identity was conflated with
homosexuality and
transvestism.
[93][94] In earlier academic literature,
sexologists used the labels
homosexual and heterosexual transsexual to categorize transgender individuals' sexual orientation based on their birth sex.
[95] Critics consider these terms "
heterosexist",
[96] "archaic",
[97] and demeaning.
[98] Newer literature often uses terms such as
attracted to men (
androphilic),
attracted to women (
gynephilic),
attracted to both (bisexual), or
attracted to neither (asexual) to describe a person's sexual orientation without reference to their gender identity.
[99] Therapists are coming to understand the necessity of using terms with respect to their clients' gender identities and preferences.
[100]
Most mental health professionals recommend therapy for internal conflicts about gender identity or discomfort in an assigned gender role, especially if one desires to transition.
[102] People who experience discord between their gender and the expectations of others or whose gender identity conflicts with their body may benefit by talking through their feelings in depth; however, research on gender identity with regard to psychology, and scientific understanding of the phenomenon and its related issues, is relatively new.
[103] The term
gender incongruence is listed in the
International Statistical Classification of Diseases (ICD) by the
WHO. In the American
Diagnostic and Statistical Manual of Mental Disorders (DSM), the term
gender dysphoria is listed under code F64.9.
[104]
France removed gender identity disorder as a diagnosis by decree in 2010,
[105][106] but according to French trans rights organizations, beyond the impact of the announcement itself, nothing changed.
[107] In 2017, the Danish parliament abolished the F64 Gender identity disorders. The
DSM-5 refers to the topic as
gender dysphoria (GD) while reinforcing the idea that being transgender is not considered a mental illness.
[108]
Transgender people may meet the criteria for a diagnosis of gender dysphoria "only if [being transgender] causes distress or disability."
[109] This distress may manifest as depression or inability to work and form healthy relationships with others. This diagnosis is often misinterpreted as implying that all transgender people suffer from GD, which has confused transgender people and those who seek to either criticize or affirm them. Transgender people who are comfortable with their gender and whose gender is not directly causing inner frustration or impairing their functioning do not suffer from GD. Moreover, GD is not necessarily permanent and is often resolved through therapy or transitioning. Feeling oppressed by the negative attitudes and behaviors of such others as legal entities does not indicate GD. GD does not imply an opinion of immorality; the psychological establishment holds that people with any kind of mental or emotional problem should not receive stigma. The solution for GD is whatever will alleviate suffering and restore functionality; this solution often, but not always, consists of undergoing a gender transition.
[103]
Clinical training lacks relevant information needed in order to adequately help transgender clients, which results in a large number of practitioners who are not prepared to sufficiently work with this population of individuals.
[110] Many mental healthcare providers know little about transgender issues. Those who seek help from these professionals often educate the professional without receiving help.
[103] This solution usually is good for transsexual people but is not the solution for other transgender people, particularly non-binary people who lack an exclusively male or female identity. Instead, therapists can support their clients in whatever steps they choose to take to transition or can support their decision not to transition while also addressing their clients' sense of congruence between gender identity and appearance.
[111]
Acknowledgment of the lack of clinical training has increased; however, research on the specific problems faced by the transgender community in mental health has focused on diagnosis and clinicians' experiences instead of transgender clients' experiences.
[112] Therapy was not always sought by transgender people due to mental health needs. Prior to the seventh version of the
Standards of Care (SOC), an individual had to be diagnosed with gender identity disorder in order to proceed with hormone treatments or sexual reassignment surgery. The new version decreased the focus on diagnosis and instead emphasized the importance of flexibility in order to meet the diverse health care needs of transsexual, transgender, and all gender-nonconforming people.
[113]
The reasons for seeking mental health services vary according to the individual. A transgender person seeking treatment does not necessarily mean their gender identity is problematic. The emotional strain of dealing with stigma and experiencing
transphobia pushes many transgender people to seek treatment to improve their quality of life, as one trans woman reflected: "Transgendered individuals are going to come to a therapist and most of their issues have nothing to do, specifically, with being transgendered. It has to do because they've had to hide, they've had to lie, and they've felt all of this guilt and shame, unfortunately usually for years!"
[112] Many transgender people also seek mental health treatment for depression and anxiety caused by the stigma attached to being transgender, and some transgender people have stressed the importance of acknowledging their gender identity with a therapist in order to discuss other quality-of-life issues.
[112] Others regret having undergone the procedure and wish to
detransition.
[114]
Problems still remain surrounding misinformation about transgender issues that hurt transgender people's mental health experiences. One trans man who was enrolled as a student in a psychology graduate program highlighted the main concerns with modern clinical training: "Most people probably are familiar with the term transgender, but maybe that's it. I don't think I've had any formal training just going through [clinical] programs ... I don't think most [therapists] know. Most therapists – Master's degree, PhD level – they've had ... one diversity class on GLBT issues. One class out of the huge diversity training. One class. And it was probably mostly about gay lifestyle."
[112] Many health insurance policies do not cover treatment associated with gender transition, and numerous people are under- or uninsured, which raises concerns about the insufficient training most therapists receive prior to working with transgender clients, potentially increasing financial strain on clients without providing the treatment they need.
[112] Many clinicians who work with transgender clients only receive mediocre training on gender identity, but introductory training on interacting with transgender people has recently been made available to health care professionals to help remove barriers and increase the level of service for the transgender population.
[115] In February 2010, France became the first country in the world to remove transgender identity from the list of mental diseases.
[116][117]
A 2014 study carried out by the
Williams Institute (a
UCLA think tank) found that 41% of transgender people had attempted suicide, with the rate being higher among people who experienced discrimination in access to housing or healthcare, harassment, physical or sexual assault, or rejection by family.
[118] A 2019 follow-up study found that transgender people who wanted and received
gender-affirming medical care had substantially lower rates of suicidal thoughts and attempts.
[119]
Autism is more common in people who are gender dysphoric. It is not known whether there is a biological basis. This may be due to the fact that people on the autism spectrum are less concerned with societal disapproval, and feel less fear or inhibition about coming out as trans than others.
[120]
The 2015
U.S. Transgender Survey reported that of the 27,715 transgender and
non-binary respondents, 21% said
queer best described their sexual orientation, 18% said
pansexual, 16% said
gay,
lesbian, or
same-gender-loving, 15% said
straight, 14% said
bisexual, and 10% said
asexual.
[91] A 2019 Canadian survey of 2,873 trans and non-binary people found that 51% described their sexual orientation as queer, 13% as asexual, 28% as bisexual, 13% as gay, 15% as lesbian, 31% as pansexual, 8% as straight or heterosexual, 4% as
two-spirit, and 9% as unsure or
questioning.
[92]
Critical studies first began to emerge in the late 1800s in Germany, with the works of
Magnus Hirschfeld. Hirschfeld coined the term "transvestite" in 1910 as the scope of transgender study grew. His work would lead to the 1919 founding of the
Institut für Sexualwissenschaft in Berlin. Though Hirscheld's legacy is disputed, he revolutionized the field of study. The Institut was destroyed when the Nazis seized power in 1933, and its research was infamously burned in the May 1933 Nazi book burnings.
[87] Transgender issues went largely out of the public eye until after World War II. Even when they re-emerged, they reflected a
forensic psychology approach, unlike the more
sexological that had been employed in the lost German research.
[86][88]
