Gender identity disorder

Definition

Gender identity disorder is a condition characterized by a persistent feeling of discomfort or inappropriateness concerning one's anatomic sex. The disorder typically begins in childhood with gender identity problems and is manifested in adolescence or adulthood by a person dressing in clothing appropriate for the desired gender, as opposed to one's birth gender. In extreme cases, persons with gender identity disorder may seek gender reassignment surgery, also known as a sex-change operation.

Description

Gender identity disorder is distressing to those who have it. It is especially difficult to cope with because it remains unresolved until gender reassignment surgery has been performed. Most people with this disorder grow up feeling rejected and out of place. Suicide attempts and substance abuse are common. Most adolescents and adults with the disorder eventually attempt to pass or live as members of the opposite sex.

Gender identity disorder may be as old as humanity. Cultural anthropologists and other scientists have observed a number of cross-gender behaviors in classical and Hindu mythology, Western and Asian classical history, and in many late nineteenth- and early twentieth-century pre-literate cultures. This consistent record across cultures and time lends support to the notion that the disorder may be, at least in part, biological in origin. Not all behavioral scientists share this conclusion, however.

Gender identity and gender-appropriate behaviors are generally learned. This learning first occurs at home and later outside the home. Behavioral experimentation, particularly when a child is young, is considered normal. As they grow, children will often experiment with a variety of gender role behaviors as they learn to make the fine distinctions between masculine and feminine role expectations of the society in which they live. Some young boys occasionally exhibit behaviors that Western culture has traditionally labeled "feminine." Examples of these behaviors include wearing a dress, using cosmetics, or playing with dolls.

In a similar manner, some young girls will occasionally assume masculine roles during play. An example of this behavior includes pretending to be the father when playing house. Some girls temporarily adopt a cluster of masculine behaviors. These youngsters are often designated as tomboys. Most experts agree that such temporary or episodic adopting of behaviors opposite to one's gender is normal and usually constitute learning experiences in the acquisition of normal sex role socialization.

In pathological cases, however, children deviate from the normal model of exploring masculine and feminine behaviors. Such children develop inflexible, compulsive, persistent, and rigidly stereotyped patterns. On one extreme are boys who become excessively masculine. The opposite extreme is seen in effeminate boys who reject their masculinity and rigidly insist that they are really girls or that they want to become mothers and bear children.

Such males frequently avoid playing with other boys, dress in girls' clothing, play predominantly with girls, try out cosmetics and wigs, and display stereotypically feminine gait, arm movements, and body gestures. Although much less common, some girls may similarly reject traditionally feminine roles and mannerisms in favor of masculine characteristics. Professional intervention is required for both extremes of gender behavior.

This disorder is different from transvestitism or transvestic fetishism , in which cross-dressing occurs for sexual pleasure. Furthermore, the transvestite does not identify with the other sex.

Adults with gender identity disorder sometimes live their lives as members of the opposite sex. They often cross-dress and prefer to be seen in public as a member of the other sex. Some people with the disorder request sex-change or sex reassignment surgery.

Persons with gender identity disorder frequently complain that they were born the wrong sex. They may describe their sexual organs as being ugly and may refrain from touching their genitalia. People with gender identity disorder may try to hide their secondary sex characteristics. For instance, males may try to shave off or pluck their body hair. Many elect to take female hormones in an effort to enlarge their breasts. Females may try to hide their breasts by binding them.

Causes and symptoms

Causes

There is no clearly understood or universally agreed-upon cause for gender identity disorder. However, most experts agree that there may be a strong biological basis for the disorder.

The sex of a human baby is determined by chromosomes. Males have a Y chromosome, in addition to a X chromosome, while females have two X chromosomes. The Y chromosome contains a gene known as the testes determining factor. This gene causes cells in an embryo to differentiate and develop male genitals. Embryos without the testes determining factor continue to develop undifferentiated as females.

The newly formed male testes release significant quantities of male hormones during the third month of pregnancy, further enhancing male differentiation. This sudden surge of hormones occurs again in males sometime between the second and twelfth week after birth. It is important to note that there is no corresponding feminizing hormonal surge sequence observed in females at this age.

These facts provide the biological basis for gender identity disorder. Male hormonal surges must occur not only in sufficient amounts, but also during a short window of time to cause masculinization of the developing infant. If there is insufficient androgen, the hormone primarily responsible for masculinization, or the surge comes too early or too late, the developing infant may be incompletely masculinized.

Disruptions of hormonal surges may come from a variety of sources. A partial list includes a disorder in the mother's endocrine system, common maternal stress , or maternal medications or some other toxic substances yet to be identified.

Recent post-mortem studies conducted on male-to-female transsexuals, non-transsexual men, and non-transsexual women show a significant difference in the volume of a portion of the hypothalamus that is essential for sexual behavior. While further investigations are needed, these initial studies seem to confirm that one's sense of gender resides in the brain and that it may be chemically determined.

In addition to biological factors, environmental conditions, such as socialization, seem to contribute to gender identity disorder. Social learning theory, for example, proposes that a combination of observational learning and different levels and forms of reinforcement by parents, family, and friends determine a child's sense of gender, which, in turn, leads to what society considers sex-appropriate or inappropriate behavior.

Symptoms

The onset of puberty increases the difficulties for people with gender identity disorder. The subsequent development of unwanted secondary sex characteristics, especially in males, increases a person's anxiety and frustrations. In an effort to cope with their feelings, some men with gender identity disorder may engage in stereo-typical, or even super-masculine, activities. For example, a man struggling with the disorder may engage in such "macho" sports as wrestling and football in order to feel more "male." Unfortunately, the result is usually an increase in anxiety.

This anxious state is characterized by feelings of confusion, shame, guilt, and fear. These individuals are confused over their inability to handle their problem. They feel shame over their inability to control what society considers "perverse" activities. Even though cross-dressing and cross-gender fantasies provide relief, the respite is temporary. These activities often leave individuals with a profound shame over their thoughts and activities.

Closely associated with shame is guilt, particularly about being dishonest with family and friends. Sometimes people with gender identity disorder get married and have children without telling their spouse about their disorder. Typically, it is kept secret because they have the mistaken conviction that participation in marriage and parenting will eliminate or cure their gender identity problems. The fear of being discovered further raises their anxiety. With some justification, people with gender identity disorder fear being labeled "sick," and being rejected and abandoned by people they love.

If an individual's gender identity disorder is profound, a lifestyle change such as occasional cross-dressing may be insufficient. In such a case, gender expression may move from a lifestyle problem to a life-threatening imperative. The result can be extreme depression that requires medical treatment. If sufficiently severe, the imperative may result in gender reassignment surgery. If an individual lacks the psychological commitment to undertake surgery, the result may be suicide.

Demographics

Gender identity disorder is more prevalent in males than in females. Accurate estimates of prevalence for either males or females are not available.

Diagnosis

A mental health professional makes a diagnosis of gender identity disorder by taking a careful personal history. He or she obtains the age of the patient and determines whether the patient's sexual attraction is to males, females, both, or neither. Laboratory tests are neither available nor required to make a diagnosis of gender identity disorder. However, it is very important not to overlook a physical illness such as a tumor that might mimic or contribute to a psychological disorder. If there is any question that a physical problem might be the underlying cause of an apparent gender identity disorder, a mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as components of the physical evaluation.

According to the clinician's handbook for diagnosing mental disorders, the Diagnostic and Statistical Manual of Mental Disorders , fourth edition text revised (DSM-IV-TR), the following criteria must be met to establish a diagnosis of gender identity disorder. More specific descriptions and examples of the first two criteria follow the list.

• A strong and persistent cross-gender identification.
• Persistent discomfort with his or her sex or having a sense of inappropriateness in the gender role of one's birth sex.
• The disturbance is not concurrent with a physical intersex condition, such as hermaphroditism in which a person is born with the genitalia of both male and female.
• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

A strong and persistent cross-gender identification

In children, the disturbance is manifested by four (or more) of the following:

• Repeatedly stating a desire to be, or insistence that he or she is, a member of the other sex.
• Strong preference for wearing clothes of the opposite gender. In boys, displaying a preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing.
• Displaying strong and persistent preferences for cross-sex roles in make-believe play or experiencing persistent fantasies of being a member of the other sex.
• Having an intense desire to participate in the games and pastimes that are stereotypical of the other sex.
• Exhibiting a strong preference for playmates of the other sex.

Among adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to become a member of the other sex, frequent passing as a person of the other sex, a desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex. These characteristics cannot be merely from a desire for any perceived cultural advantages of being the other sex.

Persistent discomfort with his or her sex or having a sense of inappropriateness in the gender role of one's birth sex

Among children, the disturbance is manifested by any of the following:

• Among boys, asserting that his penis or testes are disgusting or will disappear, asserting that it would be better not to have a penis, or having an aversion toward rough-and-tumble play and rejecting male stereotypical toys, games, and activities.
• Among girls, rejecting the gender-typical practice of urinating in a sitting position, asserting that she has or will grow a penis, or stating that she does not want to grow breasts or menstruate, or having a marked aversion toward normative feminine clothing.

Among adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (request for hormones, surgery, or other procedures to alter sexual characteristics to simulate the other sex, for example) or a belief that he or she was born the wrong sex.

Treatments

One common form of treatment for gender identity disorder is psychotherapy . The earlier the intervention, the greater likelihood of success. Early intervention can lead to reduced levels of transsexual behavior later in life. The initial aim of treatment is to help individuals function in their biologic sex roles to the greatest degree possible.

Adults who have had severe gender identity disorder for many years sometimes request reassignment of their sex, or sex-change surgery. Before undertaking such surgery, they usually undergo hormone therapy to suppress same-sex characteristics and to accentuate other-sex characteristics. For instance, the female hormone estrogen is given to males to make breasts grow, reduce facial hair, and widen hips. The male hormone testosterone is administered to females to suppress menstruation, deepen the voice, and increase body hair. Following the hormone treatments, pre-operative candidates are usually required to live in the cross-gender role for approximately a year before surgery is performed.

Prognosis

If gender identity disorder persists into adolescence, it tends to be chronic in nature. There may be periods of remission. However, adoption of characteristics and activities appropriate for one's birth sex is unlikely to occur.

Prevention

Providing gender-appropriate clothing and toys in infancy and early childhood is helpful in preventing or mitigating gender identity disorder. Avoiding derogatory comments about a child's toy, clothing, or activity preference reduces the potential for inadvertent psychic harm.

Most individuals with gender identity disorder require and appreciate support from several sources. Families, as well as the person with the disorder, need and appreciate both information and support. Local and national support groups and informational services exist, and health care providers and mental health professionals can provide referrals.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual. Fourth edition, text revised. Washington, D.C.: American Psychiatric Association, 2000.

Gelder, Michael, Richard Mayou, and Philip Cowen. Shorter Oxford Textbook of Psychiatry. 4th ed. New York: Oxford University Press, 2001.

Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.

PERIODICALS

Green, R. "Family concurrence of 'gender dysphoria': ten sibling or parent-child pairs." Archives of Sexual Behavior 29, no. 5 (2000): 499-507.

Marks, I., R. Green, and D. Mataix-Cols. "Adult gender identity disorder can remit." Comprehensive Psychiatry 41, no. 4 (2000): 273-275.

Zucker, K. J., N. Beaulieu, S. J. Bradley, G. M. Grimshaw, and A. Wilcox. "Handedness in boys with gender identity disorder." Journal of Child Psychology and Psychiatry 42, no. 6 (2001): 767-776.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Telephone: (913) 906-6000. Web site: <http://www.aafp.org>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. Telephone: (847) 434-4000. FAX: (847) 434-8000. Web site: <http://www.aap.org/default.htm>.

American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. FAX: (202) 682-6850.

American Psychological Association. 750 First Street NW, Washington, DC, 20002-4242. Phone: (800) 374-2721 or (202) 336-5500. Web site: <http://www.apa.org>.

L. Fleming Fallon, Jr., M.D., Dr.P.H.

Transgender

BIBLIOGRAPHY

Transgender is an umbrella term that describes different ways in which people transgress the gender boundaries that are constituted within a society. Groups encompassed by this term include people who have an atypical gender expression, sex, sexual identity, or gender identity. An understanding of transgender requires an awareness of the difference between the terms sex and gender —terms that often are conflated.

Sex is a biological construct. It refers to a person’s physical anatomy, usually determined by their genetics and exposure to hormones. While sex often is considered dichotomous, so that individuals are classified as male if they have a penis and as female if they have a vagina, intersexed persons are an exception to this dichotomy because they have features of both sexes (Fausto-Sterling 2000). The debate about the treatment of intersexed infants whose sex organs do not appear traditionally male or female has been heated. On one side, people feel that genital surgery should be performed early so that the infant has the genitalia of one sex and can be raised without confusion about their sexual identity —that is, without confusion about how they understand and label their own sex. On the other side, organizations of intersexed people, such as the Intersex Society of North America, have protested this practice on the grounds that the sex assigned to the child in surgery may not correspond with their sexual identity as they mature. Instead, they argue that intersexed children should be raised with their geni-talia unaltered until they are old enough to determine if they would like genital surgery and, if so, to select which sex is a better fit for them.

Unlike sex, gender is a social construct. Within social groups, sets of traits are linked together come to form genders, such as masculinity and femininity, through repeated performance and symbolism. The set of traits may depend upon the culture and time, such that enacting femininity in one country may appear different from doing so within another country or within another era. While many cultures recognize two genders attributed to male or female physical sexes, other cultures have formed genders that are based upon a combination of the sexes and personalities of individuals. For instance, some Native American tribes recognized “two-spirit” people as having distinct genders with valued social roles—so “masculine women” might become warriors and “feminine men” healers (Feinberg 1996).

In most cultures, however, gender is thought to be dictated by one’s physical sex, without any recognition of the cultural assignment of gender traits to one sex or another. When people fall outside the norms of gender transgression—that is, enacting traits that are attributed to the other sex—they may fall into one of the categories of transgender identity. People who adopt gender expressions (i.e., appearances that reflect gendered traits) that are not consistent with their sex by wearing clothing that is associated with the other sex may identify as cross-dressers or as transvestites. Because women are permitted a broader range of apparel in the West, male cross-dressers are more common and noticeable than female cross-dressers. Cross-dressing does not indicate a person’s sexual orientation; in fact, most male cross-dressers identify as heterosexual (Docter and Prince 1997).

Transsexual people have a sexual identity that does not match their physical sex. While some desire sex-reassignment surgery so that their anatomy can match their sense of self, not all transsexuals want to change their bodies. Surgery is costly, and can have mixed results. Hormone therapy may be used as well, as a complement to surgery or independently, and is less costly. To receive services, many clinics require that transsexual people first meet the Harry Benjamin Standards of Care (Meyer et al. 2001), which detail a list of steps that people complete to show that they are ready for surgery—such as living for a year as the other sex. Transmen or FTM (female-to-male) and transwomen or MTF (male-to-female) are common labels to describe the sex of those who transition from one sex to the other.

Sexual orientation refers to one’s emotional, physical, and sexual attraction to another person. Individuals who are attracted to the other sex are heterosexual, to the same sex are homosexual, and to both sexes are bisexual. While having a sexual orientation other than heterosexual does not necessitate a transgender sexual identity or gender expression, there are forms of gender or gender expression within some nonheterosexual communities that fall under a transgender rubric. For instance, being in drag is slang that connotes appearing and acting, for entertainment purposes, in a way that is typical for the other sex—with drag queens being men emulating women and drag kings being women emulating men (Volcano and Halberstam 1999). Within lesbian communities, terms like butch and femme describe the gender identities of women who display different sets of gendered traits. Although they often are misunderstood as mimicking heterosexual genders, these genders are composed of traits that do not fall neatly into masculine or feminine genders but have unique meanings within those communities (Levitt and Hiestand 2004).

People who are transgender tend to experience more discrimination and harassment than those who are not, even when compared to gay or lesbian people who are not transgender (Herek 1995; Levitt and Horne 2002). There is debate within the psychological community on how to understand transgender. A diagnosis for gender identity disorder remains listed in the 2000 edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Many mental health professionals believe that this diagnosis should be abolished because it is based upon a false understanding of gender and that treatment should focus on creating supportive environments for transgender youth rather than pathologizing them (Hiestand and Levitt 2005). At the same time, others believe that the diagnosis is necessary so people can obtain insurance coverage for treatments (Brown and Rounsley 1996), and still others persist in conceptualizing transgen-der as a mental disorder inherent to the individual.

Groups of transgender people have organized to fight for supportive legislation and medical and mental health treatments that meet their needs and respect diversity within gender experiences. Such organizations as the International Foundation for Gender Education and the National Center for Transgender Equality also work to educate the public about transgender issues and concerns.

SEE ALSO Discrimination; Gender; Gender, Alternatives to Binary; Harassment; Sexual Orientation, Determinants of;Sexual Orientation, Social and Economic Consequences; Sexuality

BIBLIOGRAPHY

American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders ( DSM -IV-TR). 4th ed., text rev. Washington, DC: Author.

Brown, Mildred L., and Chloe Ann Rounsley. 1996. True Selves: Understanding Transsexualism—For Families, Friends, Coworkers, and Helping Professionals. San Francisco: Jossey-Bass.

Docter, Richard F., and Virginia Prince. 1997. Transvestism: A Survey of 1032 Cross-dressers. Archives of Sexual Behavior 26 (6): 589–605.

Fausto-Sterling, Anne. 2000. Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books.

Feinberg, Leslie. 1996. Transgender Warriors: Making History from Joan of Arc to Dennis Rodman. Boston: Beacon Press.

Herek, Gregory M. 1995. Psychological Heterosexism in the United States. In Lesbian, Gay, and Bisexual Identities Over the Lifespan: Psychological Perspectives, eds. Anthony R. D’Augelli and Charlotte J. Patterson, 321–346. New York: Oxford University Press.

Hiestand, Katherine, and Heidi M. Levitt. 2005. Butch Identity Development: The Formation of an Authentic Gender. Feminism and Psychology 15 (1): 61–85.

International Foundation for Gender Education. http://www.ifge.org.

Intersex Society of North America. http://www.isna.org.

Levitt, Heidi M., and Katherine Hiestand. 2004. A Quest for Authenticity: Contemporary Butch Gender. Sex Roles: A Journal of Research 50 (9–10): 605–621.

Levitt, Heidi M., and Sharon G. Horne. 2002. Explorations of Lesbian-Queer Genders. Journal of Lesbian Studies 6 (2):25–39.

Meyer, Walter, III (Chairperson), Walter O. Bockting, Peggy Cohen-Kettenis, et al. February 2001. The Standards of Care for Gender Identity Disorders–Sixth Version. The International Journal of Transgenderism 5 (1). http://www.symposion.com/ijt/soc_2001/index.htm.

National Center for Transgender Equality. http://www.nctequality.org.

Volcano, Del LaGrace, and Judith “Jack” Halberstam. 1999. The Drag King Book. New York: Serpent’s Tail.

Brandy L. Smith

Heidi M. Levitt

Gender Identity Disorder

Definition

The psychological diagnosis gender identity disorder (GID) is used to describe a male or female that feels a strong identification with the opposite sex and experiences considerable distress because of their actual sex.

Description

Gender identity disorder can affect children, adolescents, and adults. Individuals with gender identity disorder have strong cross-gender identification. They believe that they are, or should be, the opposite sex. They are uncomfortable with their sexual role and organs and may express a desire to alter their bodies. While not all persons with GID are labeled as transsexuals, there are those who are determined to undergo sex change procedures or have done so, and, therefore, are classified as transsexual. They often attempt to pass socially as the opposite sex. Transsexuals alter their physical appearance cosmetically and hormonally, and may eventually undergo a sex-change operation.

Children with gender identity disorder refuse to dress and act in sex-stereotypical ways. It is important to remember that many emotionally healthy children experience fantasies about being a member of the opposite sex. The distinction between these children and gender identity disordered children is that the latter experience significant interference in functioning because of their cross-gender identification. They may become severely depressed, anxious, or socially withdrawn.

Causes and symptoms

The cause of gender identity disorder is not known. It has been theorized that a prenatal hormonal imbalance may predispose individuals to the disorder. Problems in the individual's family interactions or family dynamics have also been postulated as having some causal impact.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV ), the diagnostic reference standard for United States mental health professionals, describes the criteria for gender identity disorder as an individual's strong and lasting cross-gender identification and their persistent discomfort with their biological gender role. This discomfort must cause a significant amount of distress or impairment in the functioning of the individual.

DSM-IV specifies that children must display at least four of the following symptoms of cross-gender identification for a diagnosis of gender identity disorder:

• a repeatedly stated desire to be, or insistence that he or she is, the opposite sex
• a preference for cross-dressing
• a strong and lasting preference to play make-believe and role-playing games as a member of the opposite sex or persistent fantasies that he or she is the opposite sex
• a strong desire to participate in the stereotypical games of the opposite sex
• a strong preference for friends and playmates of the opposite sex

Diagnosis

Gender identity disorder is typically diagnosed by a psychiatrist or psychologist, who conducts an interview with the patient and takes a detailed social history. Family members may also be interviewed during the assessment process. This evaluation usually takes place in an outpatient setting.

Treatment

Treatment for children with gender identity disorder focuses on treating secondary problems such as depression and anxiety, and improving self-esteem. Treatment may also work on instilling positive identifications with the child's biological gender. Children typically undergo psychosocial therapy sessions; their parents may also be referred for family or individual therapy.

Transsexual adults often request hormone and surgical treatments to suppress their biological sex characteristics and acquire those of the opposite sex. A team of health professionals, including the treating psychologist or psychiatrist, medical doctors, and several surgical specialists, oversee this transitioning process. Because of the irreversible nature of the surgery, candidates for sex-change surgery are evaluated extensively and are often required to spend a period of time integrating themselves into the cross-gender role before the procedure begins. Counseling and peer support are also invaluable to transsexual individuals.

Prognosis

Long-term follow up studies have shown positive results for many transsexuals who have undergone sex-change surgery. However, significant social, personal, and occupational issues may result from surgical sex changes, and the patient may require psychotherapy or counseling.

Resources

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry (AACAP). 3615 Wisconsin Ave. NW, Washington, DC 20016. (202) 966-7300. 〈http://www.aacap.org〉.

OTHER

The National Transgender Guide. 〈http://www.tgguide.com〉.

KEY TERMS

Cross-dressing— Dressing in clothing that is stereotypical of the opposite sex.

Gender identity disorder (GID)— A strong and lasting cross-gender identification and persistent discomfort with one's biological gender (sex) role. This discomfort must cause a significant amount of distress or impairment in the functioning of the individual.

Transsexual— A person with gender identity disorder who has an overwhelming desire to change anatomic sex; one who seeks hormonal or surgical treatment to change sex.

Gender identity disorder

A condition, sometimes called transsexualism, in which an individual develops a gender identity inconsistent with their anatomical and genetic sex.

Researchers have suggested that both early socialization and prenatal hormones may play an important role in the development of transsexuality. It is estimated that about 1 in 20,000 males and 1 in 50,000 females are transsexuals. Gender identity disorder generally begin to manifest between the ages of two and four, in which a child displays a preference for the clothing and typical activities of the opposite sex and also prefer playmates of the opposite sex. Young boys like to play house (assuming a female role), draw pictures of girls, and play with dolls. Girls with gender identity disorder prefer short hairstyles and boys' clothing, have negative feelings about maturing physically as they approach adolescence , and show little interest in typically female pastimes, preferring the traditionally rougher male modes of play, including contact sports. Cross-gender behavior carries a greater social stigma for boys than girls; girls with gender identity disorder experience less overall social rejection, at least until adolescence. Approximately five times more boys than girls are referred to therapists for the disorder.

Most children outgrow gender identity disorder with time and the influence of their parents and peers. Adolescents with gender identity disorder are prone to low self-esteem , social isolation, and distress, and are especially vulnerable to depression and suicide . Preoccupied with cross-gender wishes, they fail to develop both romantic relationships with the opposite sex and peer relationships with members of their own sex, and their relationships with their parents may suffer as well. Approximately 75 percent of boys with gender identity disorder display a homosexual or bisexual orientation by late adolescence or early adulthood, although without a continuation of the disorder. Most of the remaining 25 percent become heterosexual, also without a continuation of the disorder, and those individuals in whom gender identity disorder persists into adulthood may develop either a homosexual or heterosexual orientation.

The major symptom of gender identity disorder in adults is the desire to live as a member of the opposite sex by adopting its social role, behavior, and physical appearance. Some transsexuals become obsessed with activities that reduce gender-related stress , including cross-dressing (dressing as a member of the opposite sex), which may be practiced either privately or in public. (Transvestism is a condition in which individuals cross-dress primarily for sexual arousal.) Both male and female transsexuals may elect to alter their primary and secondary sexual characteristics by undergoing surgery to make their genitals as much like those of the opposite sex as possible. Sex-change surgery was pioneered in Europe in the early 1930s and had gained international notoriety after the procedure was performed on a former American soldier named George (Christine) Jorgenson in Denmark in 1952.

Public awareness of transsexualism has increased through the publicity surrounding such prominent figures as British travel writer Jan Morris (who wrote about her experiences in her book Conundrum ) and American tennis star Renee Richards. As of the mid-1970s, it was estimated that more than 2,500 Americans had undergone sex-change operations, and in Europe 1 in 30,000 males and 1 in 100,000 females sought sex-change surgery. The operation itself is accompanied by hormone treatments that aid in acquiring the secondary sex characteristics of the desired sex. While a number of individuals have gone on to lead happy, productive lives following sex-change operations, others fail to make the transition and continue to suffer from gender identity disorder.

See also Gender identity; Sex roles; Transgender

Further Reading

Morrison, James. DSM-IV Made Easy: The Clinician's Guide to Diagnosis. New York: The Guilford Press, 1995

Transgender

Condition in which an individual wishes to live as if he or she were of the opposite gender, sometimes seeking surgical procedures to change from one sex to the other.

Transgender, or transsexualism, a condition in which the individual defines him or herself as male or female in opposition to their physical gender, or feels strongly that he or she wants to live as a member of the other gender, is rare. By some estimates, no more than 1 person in 350,000 believes he or she was born the wrong gender.

As they progress through childhood , their inability to relate to their own gender identity increases. Some seek the advice of a physician, and by the time they reach early adulthood, begin to take medical action to alter their gender. Since more males than females are diagnosed as transsexuals, it is more common for males to receive hormone treatment to develop secondary sex characteristics, such as breasts. In some cases, a surgical procedure is performed to alter the male sex organs to physically complete the transformation from one gender to the other.

At the Netherlands Institute for Brain Research in Amsterdam, scientists studied six male-to-female transsexuals and found evidence that a section of the hypothalamus that controls sexual function appeared to be more like the type found in women than that found in men. Because human embryos destined to become males differentiate early in the development process, the Netherlands study raises the question of whether the developing embryo could receive mixed hormonal signals to portions of the brain and the developing genitalia. Thus, as of the late 1990s, research seems to indicate that there may be physical reasons for transsexualism.

Further Reading

Glausiusz, Josie. "Transsexual Brains." Discover 17, January 1996, p. 83.

Gorman, Christine. "Trapped in the Body of a Man?" Time 146, November 13, 1995, pp. 94+.

Gender Identity Disorder

What Is Gender Identity Disorder?

What Is Cross-Gender Identification?

Resource

Gender identity disorder (GID) is identified by strong and long-lasting gender identification that is opposite to one’s biological sex. A person with this condition insists that he or she is of the other sex or desires to be the opposite sex. People with this condition are often referred to as transsexuals.

Keywords

for searching the Internet and other reference sources

Cross-gender

Transgender

Transsexual

What Is Gender Identity Disorder?

To understand this disorder, a few terms must be defined:

• Gender: is the category (male or female) a person is assigned to on the basis of sex. The term is used in discussing the different roles, identities, and expectations that our society associates with males and females.
• Gender identity: This term refers to a person’s own perception of their maleness or femaleness.
• Feminine and masculine: These terms often are used to describe behaviors generally associated with females or males. For example, contact sports have long been considered primarily masculine activities, and taking care of babies has been considered a feminine activity.
• Sex: This term usually refers to the biological (physical) differences between females and males. Specifically, these characteristics are the sex chromosomes* and certain anatomical features, for example, the penis or the vulva*.

* chromosomes

(KRO-mo-some) are threadlike chemical structures inside cells on which the genes are located. There are 46 chromosomes (23 pairs) in normal human cells. Genes on the X and Y chromosomes (known as the sex chromosomes) determine whether a person is male or female. Females have two X chromosomes; males have one X and one Y chromosome.

* vulva

genitals is the name for the external sex organs of the female.

Stigma

Boys with GID seem to suffer more than girls, probably because of culturally influenced rejection by their peers. In some studies, five times as many boys as girls saw a doctor for GID. Among adults, two or three times as many men as women sought help for GID. This difference probably is due to the greater social difficulties experienced by males who show cross-gender behavior.

Some people identify with, or conform to, traditional roles and expectations the culture sets for males and females. Others do not. For example, someone who is biologically female may like to play football, and someone who is biologically male may like to ballet dance. Still, under most circumstances, this does not interfere with people’s sense that that they are female or male, and does not mean that they have gender identity disorder.

What Is Cross-Gender Identification?

GID goes beyond a failure or reluctance to identify with traditional roles or expectations about being female or male. A person with GID who is biologically female has the sense of being male. Likewise, a person with GID who is biologically male has a strong inner sense of being a female. When cross-gender identification causes much distress or impairs a person’s functioning in life, that person is said to have GID.

Distress

GID distress may result in a person’s refusal to attend school or social events where feminine or masculine clothing or behavior is expected, because they fear teasing or rejection by their peers. This may result in isolation from other children because of the person’s insistence on behaving and acting like a member of the opposite sex. Children with this disorder often express wishes to be the other sex or beliefs that they will “grow up to be” the opposite sex. Young children with this condition may be unhappy about their assigned sex. Older children may fail to develop age-appropriate same-sex relationships with their peers. For adolescents, GID can be very difficult, because the person may struggle with feelings of uncertainty about the cross-gender identification or be concerned about being unacceptable to his or her own family or peers.

Intersex conditions

GID is not the same as physical intersex conditions. Intersex conditions may be marked, for example, by genitals* that are not completely male or female. Or the person with this condition may be genetically* male but physically female (or the reverse). For

* genitals

(JE-ni-tals) are all the organs of the human reproductive system.

* genetically

(je-NE-ti-klee) means due to heredity and stemming from genes, the material on the chromosome in cells of the human body that helps determine physical and mental characteristics, such as hair and eye color. The X and Y chromosomes contain genetic information that determines sex.

example, a male with an intersex condition would have the XY sex chromosomes of males, even though his genitals might appear female. GID should not be confused with nonconformity to traditional or typical gender roles, as may be seen in the case of “tomboyism” or “stay-at-home dads.” People who do not conform with all aspects of traditional gender roles seldom have any desire to be the opposite sex.

Cross-dressing

There also is a difference between GID and transvestitism. A person who is a transvestite becomes sexually excited by dressing in the clothes of the opposite sex, that is, cross-dressing. This behavior, engaged in for the sole purpose of sexual excitement, most often occurs among heterosexual* or bisexual* men. Transsexuals (people with GID) cross-dress to gain a sense of physical and emotional completeness rather than sexual excitement.

* heterosexual

(he-te-ro-SEKshoo-al) refers to a tendency to be sexually attracted to the opposite sex.

* bisexual

(bi-SEK-shoo-al) means being sexually attracted to both sexes.

The causes of GID are uncertain. Some researchers think that biological factors play a role, and others think that environmental factors, such as social learning, are involved. No one can really say why GID occurs. The more important question may be how to resolve the problems that GID may create.

The distress GID causes is real, and, for some adults with this condition, the only effective relief for this distress is a sex-reassignment procedure, which usually involves sex-change operations. These procedures are the subject of a great deal of controversy, and the scientific community continues to debate the possible benefits of sex-change surgery. These procedures can take several years to complete.

Screening

These sex-change procedures begin with lengthy and detailed screening interviews. These interviews determine the existence and severity of GID. The person then is instructed about adopting a lifestyle that agrees with his or her gender identity. If people successfully adjust to this lifestyle change over a period of several months to a year, they begin hormone therapy to develop more of the physical traits of the desired sex. This step also can last one year or longer.

Surgery and other treatment

If the person continues to adjust successfully to these activities, the final stage is hormone* therapy and sex-change surgery. For males wishing to become females, hormone treatments may produce enough breast development, although some people choose later to have breast enlargement surgeries. In male to female reassignment, body and facial hair growth is reduced by the hormone treatments and hair may also be removed by electrolysis*. People who undergo sex-change surgery to become females are able to have sexual intercourse.

* hormones

are chemicals that are produced by different glands in the body. A hormone is like the body’s ambassador. It is created in one place but is sent through the body to have specific effects in different places.

* electrolysis

(ee-lek-TRAW-li-sis) is a method of destroying hair roots by passing an electric current through them.

Females wishing to become males have surgeries to remove the breasts, the uterus*, and the ovaries* and to seal off the vagina*. The operation to construct a penis is extremely complicated, and the resulting penis is not capable of a natural erection. There are, however, artificial devices available that can help the person successfully engage in sexual intercourse.

* uterus

(YOO-te-rus) is the organ in females for containing and nourishing the fetus during pregnancy. It is also called the womb.

* ovaries

(O-va-reez) are the sexual glands in females from which eggs are released.

* vagina

(va-JY-na) is the canal in females that leads from the uterus to the outside of the body.

Follow-up

There have been several worldwide studies conducted to assess the outcomes of sex-change surgery. These studies have shown that 9 of 10 transsexuals who undergo hormonal and surgical sex-reassignment procedures experience a satisfactory result. One of the studies found that 94 percent of the people who underwent the surgery and answered questionnaires stated that if they had it to do over again, they would make the same choice.

See also

Body Image

Gender Identity

Sexual Development

Resource

Book

Boenke, Mary. Trans Forming Families: Real Stories About Transgendered Loved Ones. Imperial Beach, CA: Walter Trook Publishing, 1999. Includes 31 stories of parents of gender variant children. For older readers.

trans·sex·u·al / tran(s)ˈsekshoōəl/ • n. a person born with the physical characteristics of one sex who emotionally and psychologically feels that they belong to the opposite sex. ∎  a person who has undergone surgery and hormone treatment in order to acquire the physical characteristics of the opposite sex. • adj. of or relating to such a person. DERIVATIVES: trans·sex·u·al·ism / -ˌlizəm/ n. trans·sex·u·al·i·ty / -ˌsekshoōˈalitē/ n.

transsexual A person born into one sex who crosses over into the other, requiring sex surgery to change the sex organs, and being fully trained into the gender role of that sex. The ideal for many transsexuals is to pass completely and imperceptibly into the other sex and gender. Transsexualism was invented as a clinical phenomenon during the mid-twentieth century, but it is of great sociological interest in the study of gender and deviance. See also TRANSVESTISM.

transsexual Person who permanently changes gender, or who desires to do so. It may be achieved partly through hormone treatment or through surgery, and in some countries the change can be accompanied by a legal change of status.

gender identity disorder (GID) (jen-der) n. a condition in which an individual belongs to one gender on the basis of physical appearance and genetics but identifies psychologically with the other gender. See also transsexualism.

transsexual •denial, dial, espial, Lyall, mistrial, myall, Niall, phial, trial, vial, viol •sundial •knawel, withdrawal •avowal, Baden-Powell, bowel, disembowel, dowel, Howell, Powell, rowel, towel, trowel, vowel •semivowel •bestowal, koel, Lowell, Noel •loyal, royal, viceroyal •accrual, construal, crewel, cruel, dual, duel, fuel, gruel, jewel, newel, renewal, reviewal •eschewal •artefactual (US artifactual), contractual, factual, tactual •perpetual •aspectual, effectual, intellectual •conceptual, perceptual •contextual, textual •habitual, ritual •conflictual • instinctual • spiritual •mutual • punctual • virtual • casual •audio-visual, televisual, visual •usual • gradual • individual •menstrual • actual •asexual, bisexual, heterosexual, homosexual, psychosexual, sexual, transsexual, unisexual •accentual, conventual, eventual •Samuel •annual, biannual, Emanuel, Emmanuel, manual •Lemuel •consensual, sensual •continual