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Transsexual people experience a gender identity that is inconsistent with, or not culturally associated with, their assigned sex , and desire to permanently transition to the gender with which they identify, usually seeking medical assistance including hormone replacement therapy and other sex reassignment therapies to help them align their body with their identified sex or gender.

Transsexual is a subset of transgender , [1] [2] [3] but some transsexual people reject the label of transgender. Norman Haire reported that in , [10] Dora R of Germany began a surgical transition, under the care of Magnus Hirschfeld , which ended in with a successful genital reassignment surgery. In , Hirschfeld supervised the second genital reassignment surgery to be reported in detail in a peer-reviewed journal, that of Lili Elbe of Denmark. In , Hirschfeld introduced the German term "Transsexualismus", [11] after which David Oliver Cauldwell introduced "transsexualism" and "transsexual" to English in and Cauldwell appears to be the first to use the term to refer to those who desired a change of physiological sex.

True transsexuals feel that they belong to the other sex, they want to be and function as members of the opposite sex, not only to appear as such. For them, their sex organs, the primary testes as well as the secondary penis and others are disgusting deformities that must be changed by the surgeon's knife.

Benjamin suggested that moderate intensity male to female transsexual people may benefit from estrogen medication as a "substitute for or preliminary to operation. Gregory Hemingway. Beyond Benjamin's work, which focused on male-to-female transsexual people, there are cases of the female to male transsexual, for whom genital surgery may not be practical. Benjamin gave certifying letters to his MTF transsexual patients that stated "Their anatomical sex, that is to say, the body, is male.

Their psychological sex, that is to say, the mind, is female. Around the same time as Benjamin's book, in , the term transgender was coined by John Oliven. Historically, one reason some people preferred transsexual to transgender is that the medical community in the s through the s encouraged a distinction between the terms that would only allow the former access to medical treatment.

Another reason for objecting to the term transsexual is the concern that it implies something to do with sexuality , when it is actually about gender identity. Like other trans people, transsexual people prefer to be referred to by the gender pronouns and terms associated with their gender identity. For example, a trans man is a person who was assigned the female sex at birth on the basis of his genitals , but despite that assignment, identifies as a man and is transitioning or has transitioned to a male gender role; in the case of a transsexual man, he furthermore has or will have a masculine body.

Individuals who have undergone and completed sex reassignment surgery are sometimes referred to as transsexed individuals; [35] however, the term transsexed is not to be confused with the term transsexual , which can also refer to individuals who have not yet undergone SRS, and whose anatomical sex still does not match their psychological sense of personal gender identity. The terms gender dysphoria and gender identity disorder were not used until the s, [27] when Laub and Fisk published several works on transsexualism using these terms.

Male-to-female transsexualism has sometimes been called "Harry Benjamin's syndrome" after the endocrinologist who pioneered the study of dysphoria. The use of homosexual transsexual and related terms have been applied to transgender people since the middle of the 20th century, though concerns about the terms have been voiced since then.

Harry Benjamin said in What would be the situation after corrective surgery has been performed and the sex anatomy now resembles that of a woman?

Is the "new woman" still a homosexual man? Many sources, including some supporters of the typology, criticize this choice of wording as confusing and degrading. Biologist Bruce Bagemihl writes ".. These labels thereby ignore the individual's personal sense of gender identity taking precedence over biological sex, rather than the other way around. Use of androphilia and gynephilia was proposed and popularized by psychologist Ron Langevin in the s.

Wegener writes, "Langevin makes several concrete suggestions regarding the language used to describe sexual anomalies. For example, he proposes the terms gynephilic and androphilic to indicate the type of partner preferred regardless of an individual's gender identity or dress. Those who are writing and researching in this area would do well to adopt his clear and concise vocabulary. Psychiatrist Anil Aggrawal explains why the terms are useful in a glossary:.

The term, along with gynephilia, is needed to overcome immense difficulties in characterizing the sexual orientation of transmen and transwomen.

For instance, it is difficult to decide whether a transman erotically attracted to males is a heterosexual female or a homosexual male; or a transwoman erotically attracted to females is a heterosexual male or a lesbian female.

Any attempt to classify them may not only cause confusion but arouse offense among the affected subjects. In such cases, while defining sexual attraction, it is best to focus on the object of their attraction rather than on the sex or gender of the subject. Psychologist Rachel Ann Heath writes, "The terms homosexual and heterosexual are awkward, especially when the former is used with, or instead of, gay and lesbian.

Alternatively, I use gynephilic and androphilic to refer to sexual preference for women and men, respectively. Gynephilic and androphilic derive from the Greek meaning love of a woman and love of a man respectively. So a gynephilic man is a man who likes women, that is, a heterosexual man, whereas an androphilic man is a man who likes men, that is, a gay man.

For completeness, a lesbian is a gynephilic woman, a woman who likes other women. Gynephilic transsexed woman refers to a woman of transsexual background whose sexual preference is for women. Unless homosexual and heterosexual are more readily understood terms in a given context, this more precise terminology will be used throughout the book.

Since homosexual, gay, and lesbian are often associated with bigotry and exclusion in many societies, the emphasis on sexual affiliation is both appropriate and socially just. Michael Bailey , and Martin Lalumiere , who she says "have completely failed to appreciate the implications of alternative ways of framing sexual orientation.

Several terms are in common use, especially within the community itself relating to the surgical or operative status of someone who is transsexual, depending on whether they have already had SRS, have not had SRS but still intend to, or do not intend to have SRS.

They are, post-op, pre-op, and non-op, respectively. A pre-operative transsexual person, or simply pre-op for short, is someone who intends to have SRS at some point, but has not yet had it. A post-operative transsexual person, or post-op for short, is someone who has had sexual reassignment surgery. A non-operative transsexual person, or non-op , is someone who has not had SRS, and does not intend to have it in the future. There can be various reasons for this, from the personal to the financial.

The World Professional Association for Transgender Health WPATH , and many transsexual people, had recommended this removal, [57] arguing that at least some mental health professionals are being insensitive by labelling transsexualism as a "disease" rather than as an inborn trait as many transsexuals believe it to be.

The previous version, ICD, had incorporated transsexualism , dual role transvestism, and gender identity disorder of childhood into its gender identity disorder category.

It defined transsexualism as "[a] desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex. With the DSM-5 , transsexualism was removed as a diagnosis, and a diagnosis of gender dysphoria was created in its place.

Principle 18 of The Yogyakarta Principles , a document of international human rights law , [62] opposes such diagnosis as mental illness as medical abuse. The current diagnosis for transsexual people who present themselves for medical treatment is gender dysphoria leaving out those who have sexual identity disorders without gender concerns.

The causes of transsexuality have been studied for decades. The most studied factors are biological. Certain brain structures in trans women have been found to be similar to cisgender women's as opposed to cis men's, and trans men's have been found to be similar to cis men's, even controlling for hormone use , which can also cause trans people's brains to become closer to those of cis people of the same gender.

However, these studies are limited as they include a small number of tested individuals. Studies have also found that both androphilic and gynephilic trans women's brain function and responses are like cis women's and unlike cis men's, or are intermediate between the two. Likewise, studies such as Rametti's have found that trans men have male-like white matter patterns even before using hormones , regardless of sexual orientation.

With regard to genetic factors, a study by Hare reported that trans women have a longer androgen receptor gene than cis men, which is less effective at binding testosterone, potentially preventing complete masculinization of the brain prenatal androgen exposure or sensitivity, or lack thereof, is an often cited mechanism to explain observed brain-structure differences.

Environmental factors have also been proposed. The failure of an attempt to raise David Reimer from infancy through adolescence as a girl after his genitals were accidentally mutilated is cited as disproving the theory that gender identity is determined by upbringing. Ray Blanchard developed a taxonomy of male-to-female transsexualism that proposes two distinct etiologies for androphilic and gynephilic individuals that has become highly controversial, supported by J.

Sex reassignment therapy SRT is an umbrella term for all medical treatments related to sex reassignment of both transgender and intersex people. Individuals make different choices regarding sex reassignment therapy, which may include female-to-male or male-to-female hormone replacement therapy HRT to modify secondary sex characteristics , sex reassignment surgery such as orchiectomy to alter primary sex characteristics , chest surgery such as top surgery or breast augmentation , or, in the case of trans women, a trachea shave , facial feminization surgery or permanent hair removal.

To obtain sex reassignment therapy, transsexual people are generally required to undergo a psychological evaluation and receive a diagnosis of gender identity disorder in accordance with the Standards of Care SOC as published by the World Professional Association for Transgender Health.

The SOC are intended as guidelines, not inflexible rules, and are intended to ensure that clients are properly informed and in sound psychological health, and to discourage people from transitioning based on unrealistic expectations. After an initial psychological evaluation, trans men and trans women may begin medical treatment, starting with hormone replacement therapy [64] [69] or hormone blockers.

In these cases, people who change their gender are usually required to live as members of their target gender for at least one year prior to genital surgery, gaining real-life experience , which is sometimes called the "real-life test" RLT. Some people posit that transsexualism is a physical condition, not a psychological issue, and assert that sex reassignment therapy should be given on request. Brown Like other trans people, transsexual people may refer to themselves as trans men or trans women.

Transsexual people desire to establish a permanent gender role as a member of the gender with which they identify, and many transsexual people pursue medical interventions as part of the process of expressing their gender. The entire process of switching from one physical sex and social gender presentation to another is often referred to as transitioning, and usually takes several years. Transsexual people who transition usually change their social gender roles, legal names and legal sex designation.

Not all transsexual people undergo a physical transition. Some find reasons not to; for example, the expense of surgery, the risk of medical complications, or medical conditions which make the use of hormones or surgery dangerous.

Some may not identify strongly with another binary gender role. Others may find balance at a midpoint during the process, regardless of whether or not they are binary-identified. Many transsexual people, including binary-identified transsexual people, do not undergo genital surgery, because they are comfortable with their own genitals, or because they are concerned about nerve damage and the potential loss of sexual pleasure, including orgasm. This is especially so in the case of trans men, many of whom are dissatisfied with the current state of phalloplasty , which is typically very expensive, not covered by health insurance, and commonly does not achieve desired results.

For example, not only does phalloplasty not result in a completely natural erection, it may not allow for an erection at all, and its results commonly lack penile sexual sensitivity; in other cases, however, phalloplasty results are satisfying for trans men. By contrast, metoidioplasty , which is more popular, is significantly less expensive and has far better sexual results. Some transsexual people live heterosexual lifestyles see heteronormative , while some identify as gay, lesbian, [23] or bisexual.

Many transsexual people choose the language of how they refer to their sexual orientation based on their gender identity, not their birth assigned sex , [23] though some transsexual people still find identification with a physical-sex-based community: Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex are typically ineffective. The widely recognized Standards of Care [64] note that sometimes the only reasonable and effective course of treatment for transsexual people is to go through sex reassignment therapy.

The need for treatment of transsexual people is emphasized by the high rate of mental health problems, including depression , anxiety , and various addictions , as well as a higher suicide rate among untreated transsexual people than in the general population. Many transgender and transsexual activists, and many caregivers, note that these problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-variant individuals.

Some transsexual people reject the counseling that is recommended by the Standards of Care [64] because they do not consider their gender identity to be a cause of psychological problems. Because of this, some transsexual people feel coerced into affirming outdated concepts of gender to overcome simple legal and medical hurdles Brown People who undergo sex reassignment surgery can develop regret for the procedure later in life, largely due to lack of support from family or peers, with data from the s suggesting a rate of 3.

A meta-study, based on 28 previous long-term studies of transsexual men and women, found that the overall psychological functioning of transsexual people after transition was similar to that of the general population and significantly better than that of untreated transsexual people.

Prevalence is the proportion of a population found to be affected by a condition.

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    Transsexual people experience a gender identity that is inconsistent with, or not culturally associated with, their assigned sex , and desire to permanently transition to the gender with which they identify, usually seeking medical assistance including hormone replacement therapy and other sex reassignment therapies to help them align their body with their identified sex or gender. Transsexual is a subset of transgender , [1] [2] [3] but some transsexual people reject the label of transgender.

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