Transgender is an umbrella term for persons whose gender identity,
gender expression or behaviour does not conform to that typically associated
with their sex at birth. The transgender community is incredibly diverse. There
is a spectrum of terminologies under the transgender umbrella, ranging from
those who cross-dress to transsexual people. The term also encompasses other
gender variant people, including individuals who are androgynous and those who
identify themselves as non-gendered. According to the Office of National
Statistics (2009) The estimated figures for the trans community in the UK range
from 65,000 (Johnson, 2001, p.7) to 300,000 (GIRES, 2008).
There are three elements to gender: Biological sex, gender
expression and gender identity. People are accustomed to recognising two
genders male and female. Usually, by the age of three a child has formed a
clear sense of their gender identity, most of the time their gender conforms to
their biological sex. Society gradually programs the mind on how one should
conform according to their birth sex. Most transgender people know they are
uncomfortable with their gender from an early stage. Some people may come to
realise later in life but even then, many of them have experienced other gender
nonconforming behaviours from much earlier such as occasional cross dressing. A common experience among transgender people is that
they feel trapped in an incorrect body. According to the NHS (2016 online) A survey of 10,000 people undertaken in 2012 found that 1% of the
population surveyed was gender variant, to some extent. Although this is a rare
condition the number of people being diagnosed with gender dysphoria is increasing
due to growing awareness.
transgender identities were considered abnormal and unacceptable therefore,
although they have always existed there is very little mention of this type of
population throughout different countries and cultures. People will risk so
much to represent a gender that they feel is theirs, yet very difficult to the
social, cultural and legal expectations of their birth sex. In India trans
women are recognised as “Hijra”, men raised as females in Samoa are called Fa’afafine.
There is significant stigma and discrimination around being transgender in
society and more so during the period of Michael Dillon as mentioned
previously, this may be the reason why many people suppress the feeling for so
long resulting in delayed treatment.
Flanagan (2009) suggests psychologists believe that the DSM diagnosis of gender
dysphoria is a mental illness which may arise from childhood trauma or
maladaptive upbringing. They outline the case study of Coates et al (1991) of a
boy developing gender dysphoria which was a result of a defensive reaction to
his mother’s depression following an abortion. They suggest that the trauma
which occurred at the age of three (when a child is gender sensitive) may have
led to a cross-gender fantasy as a means of resolving anxiety. This case study
explains reasons in which an individual may develop gender dysphoria however,
it ignores the role of biology, cannot be generalised and may not be reliable.
Flanagan also report an opposing study of Cole et al (1997) of 435 individuals
experiencing gender dysphoria and reported that the range of psychiatric
conditions displayed was no greater than found in a ‘normal’ population. This
suggests that gender dysphoria is generally unrelated to trauma or pathological
(2016 online) refers to Guillamon quotes: “Trans people have brains that are
different from males and females, a unique kind of brain. It is simplistic to
say that a female-to-male transgender person is a female trapped in a male
body. It’s not because they have a male brain but a transsexual brain.”
Behaviour and experience shape brain anatomy, so it may be impossible to say if
these subtle differences are inborn. At birth an examination of the brain in
impractical and inconclusive with current medical technology to distinguish the
The biological explanation suggest that most
transgender people are born with a pre-disposition to being transgender that
was formed prenatally which directly drive’s development.
According to Williams (2016 – online) there are three major factors in
development; Chemical/Hormonal, Genetic and Environmental. Men and women have
different brains according to size and proportion, these differences are small
yet specific and identifiable. The brain of a transgender consistently matches
the brain structure of their adopted gender and not the birth sex. These
changes are understood to be caused due to chemical imbalances that causes the
wrong hormones to be expressed prenatally. Although there is a growing
consistent trend in these studies, the sample sizes are small due to the number
of transgender persons brain used for medical purposes. He also outlines that when the brain is
developing a cross of the wrong hormones leads to transgender issues. He
outlines a study conducted with animals which had shown that an animal was
given the wrong hormones during the brain development stage, the animal
subsequently exhibited mating behaviours of the opposite sex even when the
genitals match their genetic sex. The
biological approach is valid and based on scientific findings, they predict
behaviour according to heredity which is a strength. The limitations are that
it is a reductionist, offers a few suggestions for the change in personality
not taking into account feelings and thoughts.
According to the NHS (2016 online) gender dysphoria
may be the result of congenital adrenal hyperplasia (CAH) when a high level of
male hormones is produced in a female foetus which causes the genitals to
become more male in appearance and in some cases, the baby may be thought
to be biologically male when she is born.
continues between the medical and transgender communities about whether “Gender
Dysphoria” is a mental illness and therefore should it remain in the DSM. Not
all transgender people report experiencing distress related to identifying with
a gender different from the one assigned at birth. But for those who do,
medical intervention can be a great relief.
are various treatment options available to manage this discontent including
mental health services, hormonal treatments, and surgery. Psychological interventions
may help refrain from any physical treatments.
can begin in adolescent age with puberty blockers, these can buy time before a
surge of unwanted hormones which can prevent physical changes such as breast
development and facial hair. Puberty
blockers are completely reversible and can be stopped at any time, but they also
contain risks including effects on bone development and height. The medical second
step is the cross-sex hormones such as breast growth from oestrogen and facial
hair growth brought on by testosterone. Hormone therapy helps by changing the physical
appearance into more of the adopted gender and therefore improvs the feeling of
oneself. They usually need to be taken indefinitely and the effects are
irreversible. Some risks involved are weight gain, sleep apnoea, blood clots
and can also make trans men and trans women less fertile. Not all transgender people
choose to have surgery, it can be costly and therefore unaffordable. Some
people may not see surgery to be an important way to express their gender and
some may not be discontent with their genitals.
is usually performed in adulthood. It aims to create a functioning vagina/penis
with an acceptable appearance allowing to pass urine and retain sexual
sensation. Most trans men and trans women after surgery are happy with
their new sex and feel comfortable with their gender identity. NHS reports 96% satisfaction
rate for genital reconstructive surgery. Surgical interventions are
irreversible and may require more than one operation to achieve satisfactory results.
Risk of post-operative complications. Despite surgery people may still face
prejudice and discrimination because of their condition.