Transgender is an umbrella term used to refer to a diverse group of individuals who challenge socially and culturally constructed gender norms. Historically the term was used to refer to cross-dressers or transvestites (those who desire to wear clothing associated with another sex). In contemporary context the term has broadened to include a number of gender variant groups: male-to-female transsexuals (MTF); female-to-male transsexuals (FTM); transgenderists (those who live in the gender role associated with another sex without sex reassignment surgery); bigender persons (those who identify as both man and woman); drag queens and kings (typically gay men and lesbian women, respectively, who dress in women's and men's clothing); and intersexed persons (those born with ambiguous genitalia). Though commonalities among these groups exist, there are several characteristics that make them distinct gender identities.
Transgender refers to an identity that does not adhere to the strict binary categories of man and woman. The term transsexual refers to persons whose physical body is considered to be incongruent with their self-perception as man or woman, and who desire or have undergone hormonal and/or surgical interventions to alter their physical presentation (specifically secondary sex characteristics) to better align their internal (gender) with their external appearance, male or female (sex). In contrast, individuals who identify or associate as transgender often do not seek such interventions; however, they may make suggestive changes in presentation to express their internal perception of self.
Transgender identity differs from biological conditions that produce ambiguous physical characteristics often associated with gender. The terms hermaphrodite and pseudohermaphrodite were first introduced in the nineteenth century to describe individuals with ambiguous genitalia or secondary sex characteristics. In the early twenty-first century the term intersexed is used to describe people born with congenital conditions (e.g., chromosomal, gonadal) that result in ambiguous genitalia. Through genetic and chromosomal testing (karyotyping), typically an individual's biological sex is determined to be either female or male. A differentiation between sex and gender must be understood to grasp the complexity of these variations.
Though the term transgender as defined in the contemporary context is a predominately European and North American concept, the idea of a liminal category that lies outside of the binary of male/man and female/woman has existed since ancient times. However, descriptions and interpretations differ by culture and historical period. Some of the earliest references to a third gender category derive from Native American culture and are set in a spiritual framework that is not bound to the physical body. For example, in Navajo culture the term nádleeh is used to describe persons thought to have a masculine and feminine spirit living in the same body. Winkte, a Lakota word, is a name given to an individual who is thought to have two-spirits or two-souls, one man and one woman. Often the term is used to describe homosexual men, but it also is used to describe a person who is transgender. Within the Native American culture, two-spirited people are valued members of society and are considered to fill social roles that others cannot.
References to a third gender can also be found in Asian and Middle Eastern cultures. In Thai culture, the word kathoey has a similar definition to the word trans-gender; however, it is applied in a broader context that can include effeminate gay men. In some Southeast Asian cultures, the term hijra, or the traditional term kinnar, is used to describe intersexed individuals or those who have been assigned a male sex at birth but later choose to live a religious life dedicated to Bahuchara Mata (the Hindu mother goddess), singing and dancing at birth ceremonies and weddings. Though these traditional roles have had great cultural significance, the influence of European and North American ideologies has greatly decreased cultural reverence.
Since the early twentieth century a number of theories have been proposed in an effort to understand and explain gender variant identities. Early theories proposed by John Money, Harry Benjamin, and Richard Green tended to view gender identity as resulting from pathology deeply rooted in the psyche. However, the introduction of feminist and queer theories, which challenged the traditional gender binary, created an interest in understanding alternative gender identities, including transgender.
The term transgender derives from relatively new concepts surrounding gender identity theory. Though there is no specific author cited for the original use of the term, Virginia Prince was one of the first researchers to use the term in an academic context in the early 1960s. Later, transgender gained use among the gay, lesbian, bisexual, and transsexual community as a distinct identity category independent of sex/gender role and sexual orientation. This identity category served as a contrast to transsexual, differentiating between individuals who sought surgical and hormonal interventions and those who did not.
Conventionally, gender identity theories view gender development as a process that begins at conception and ends at death. Though each theory differentiates between the influence of biological maturation, psychological development, the progression through socially defined stages (e.g., childhood, adolescence, and adulthood), and the individual's interactions with others, researchers agree that these forces collectively shape an individual's gender identity.
ETIOLOGY AND TREATMENT
A number of biological and psychological theories have been proposed in an attempt to explain the cause of transgender identity and behavior; however, none of these has been widely agreed upon. Although medical and psychological efforts to treat and cure transgendered feelings and behaviors date back to the mid-nineteenth century, there is no evidence that treatments or cures are ethical or efficacious. The Diagnostic and Statistical Manual of Mental Disorders: DSM-IV (1994), published by the American Psychiatric Association (APA), is the most widely used set of diagnostic criteria for mental disorders in the United States. The DSM-IV has two diagnostic categories relating to gender: Gender Identity Disorder and Gender Identity Disorder Not Otherwise Specified (NOS). A diagnosis of Gender Identity Disorder is applied to a person when they meet the following five criteria: (1) evidence of strong and persistent cross-gender identification; (2) this cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex; (3) evidence of persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex; (4) the individual must not have a concurrent physical intersex; and (5) evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning. Gender Identity NOS can be applied to inter-sex conditions, transient cross-dressing behavior that results from stress, or a persistent preoccupation with castration or penectomy (removal of the penis) that is not accompanied by the desire to change one's secondary sex characteristics.
There is a great deal of controversy surrounding the notion of transgender as a psychological disorder. Many people argue that the DSM-IV classification system is merely an attempt to pathologize and marginalize individuals who do not adhere to the stereotypical gender norms dictated by society and reject the idea that any form of psychological treatment is necessary. Indeed, some psychological interventions are potentially harmful and are not supported by the majority of mainstream medical and psychological organizations. A controversial but well-known psychological approach to treating gender nonconformists, including gay men and lesbian women, is conversion therapy. Conversion therapy includes a number of techniques aimed at altering gender identity or sexual orientation. Other types of psychological treatment include individual and group therapy aimed at diminishing distress that may be associated with living as a transgendered person.
With the availability of information via the Internet, a number of Web sites for people identifying as transgender have emerged. The function of such sites ranges from providing broad educational information about the meaning of transgender to very specific and targeted information, such as techniques for vocal feminization. There are also a number of chat rooms and online support groups that provide peer education and encouragement.
Since the mid-1980s there has been a noticeable rise in activism by transgender communities both at the social and political level. In 2006 the State of New Jersey passed a bill that extended civil rights protection to transgender individuals and nondiscrimination laws protecting gender identity and expression have been enacted in several states. The increased visibility and activism of transgender communities has challenged traditional constructions of gender and created a space for alternative gender identities within society.
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Brandon J. Hill
Kimberly R. McBride