Vol. 135 November 1, 2015 “He, She, or It?”

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People tend to confuse sexuality and identity, and often want to conflate these things, but being transgender has nothing to do with sexuality.

— Norman Spack, Director Emeritus and Founder of the GeMS Program, Boston Children’s Hospital

Last week one of our five-man book-and-lunch club started our monthly gathering with, “Before we start can you tell me if an infant with unclear genitalia is called transgender?” It quickly became clear during the ensuing conversation that most of us not only knew someone with gender identity issues, but also that we (all over 60 y.o) had blurry, often overlapping, and quite different understandings of gender definitions and terms.  I suspected that we might not be the only ones confused, and thought that researching a blog on the subject might be clarifying for me and others.

What’s the difference between“transsexual”  and “transgender”?
“Transsexual” was coined by a German surgeon in the 1930’s for people (usually males) who wished to have sexual reassignment surgery (SRS) and change from male to female (M2F, MTF). “Transgender” was coined in the 1960’s, was much more about who the person thought they should be rather than about sexual orientation, and was not usually associated with the desire for SRS. In 1979 Christine Jorgensen rejected “transsexual” and insisted on “transgender” (even though he/she underwent SRS). Transgender seems to be the most PC term today, and transsexual, still implying an interest in SRS, is considered to be a subset of transgender. There is a World Professional Association for Transgender Health  as well as a blue/pink/white striped Transgender Pride flag that “will always be correct, no matter which way you fly it.”Screen Shot 2015-11-01 at 5.17.07 PM

A over-simplified, and not always correct, way to remember the differences is:
“Transsexual usually implies sexual orientation, ‘who you go to bed WITH’.
Transgender usually implies gender orientation, “who you go to bed AS?’ ” (1)

An excellent illustration of the complex interplay of these two terms is the Amazon Prime video “Transparent” for which Jeff Tambour won a 2015 Emmy for Lead Actor (a term, by the way, that is now often used for both male and female). In the series of 12 episodes we met several transgender characters, some of whom appeared to have had SRS and hormone therapy and some who have not.

What’s the difference between cross-dressers, drag queens, and transvestites?
Transvestites  are people who like to dress and act like those of the opposite sex. In the 1970‘s “cross dressers” was coined by such people who disliked the implications of fetishism or homosexuality in being called “transvestite”. Cross dressers can be private and have any kind of sexual orientation (J. Edgar Hoover?). Drag queens are theatrical cross dressers who are mostly male homosexuals with great pride in their flamboyant entertainment value.

Is a hermaphrodite the same as an infant with ambiguous genitalia?
Rarely an infant may be born with genitalia that appears to be neither clearly male or female (now called “intersex”). It is important for physicians and family to quickly forge ahead in checking chromosomes, internal anatomy, external physical appearance, parental wishes, and other factors to decide quickly which sex the child shall be raised as. Surgically, it is much easier to create a functional female than a male, but many factors are involved. Even rarer is the hermaphrodite who is born with both male and female genitalia. Unlike lesser species, these human hermaphrodites can not self-impregnate, but can apparently have a future career in adult porn.

In recent years our recognition of and services for gender identity confusion in children has increased. In 2007 Boston Childrens Hospital started a Disorders of Sexual Development and Gender Management Service (GeMS). Since then that multi-disciplinary team of 12 professionals have evaluated and treated over 160 pre-pubertal teen agers for gender identity confusion; 75% of whom lived within 150 miles of Boston. (1)  GeMS considers gender identity confusion as potentially life-threatening because of the higher than expected suicide rate among those adolescents not treated. Evaluations are initiated in “gender non-conforming” children  as soon as 10 or 11 years of age. Puberty is delayed by hormonal therapy, and later the child’s gender appearance can be changed to match the child’s mental gender identity through hormones and surgery.

Even a cursory review of these terms, what they used to mean and what they mean today, suggests many PC/sensitivity potholes dotting the road of their practical use. One Boston suburb middle school teacher started the first day of school this fall with a request to her class to indicate “by which pronoun each wished to be called”.  In addition to the grammatically traditional gender neutral terms like “it”, “one”, and “they”, invented gender neutral pronouns exist and include “zhe” and “zher” and “zhem”. (2000). The medical term “gender identity disorder”, disliked by many because it implies a disease condition, is being replaced with “gender dysphoria”.

References: 1. Norman Spack, MD TED talk

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